Acceptance and commitment therapy for depression after psychosis: a pilot trial

A parallel group randomised open blinded evaluation of acceptance and commitment therapy for depression after psychosis: a pilot trial (ADAPT)

Status

Active, not recruiting

Phases

Unknown

Study type

Interventional

Source

ISRCTN

Registry ID

ISRCTN33306437

Enrollment

Registered

2013-03-19

Start date

2013-04-01

Completion date

Unknown

Last updated

2016-12-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Schizophrenia Mental and Behavioural Disorders Schizophrenia, unspecified

Interventions

Participants will be consecutively recruited, assessed and randomised to ACTdp plus ST or ST alone. Acceptance and Commitment Therapy for depression after psychosis (ACTdp): Individuals will receive

highlight how attempts to avoid these appraisals can paradoxically increase their frequency

develop individuals? ability to let go of appraisals rather than get caught up reacting to them

facilitate understanding about how distress can inform values

explore valued life domains

and help individuals to commit to behaviours consistent with these valued life domains. Standard Treatment (ST): We will examine treatment received by all participants in the trial in order to establ

Eligibility

Sex/Gender

All

Inclusion criteria

Inclusion criteria: 1. Outpatients, aged 16 or over, receiving secondary mental health care from community based services in NHS Greater Glasgow and Clyde (NHSGG&C) 2. Meet DSM-IV-TR criteria for schizophrenia and criteria for major depression (confirmed by Structured Clinical Interview for DSM / SCID-I & Calgary Depression Scale / CDSS for Schizophrenia; score >721). Individuals with substance use problems will not be excluded.

Exclusion criteria

Exclusion criteria: 1. Those with significant learning disability 2. Who are unable to speak English

Design outcomes

Primary

Measure	Time frame
1. The EQ-5D is a generic, preference-based quality of life instrument that has been successfully used in schizophrenia patients, and which facilitated the calculation of Quality Adjusted Life Years for health economic analyses. 2. The Calgary Depression Scale for Schizophrenia (CDSS); The potential for phenomenological overlap between depression, negative symptoms, and extrapyramidal symptoms is addressed by including the CDSS. This clinician administered interview measure is based on items selected from the Hamilton Rating Scale for Depression (HAM-D) and the Present State Exam (PSE) and was developed in order to reliably distinguish co-morbid depression from symptoms that are diagnostic features of schizophrenia-spectrum disorders. When compared to the ?gold standard? SCID assessment of depressive symptoms the CDSS outperforms the BDI, PANSS ? Depression subscale, and HAM-D for both sensitivity (94%) and specificity (89%) 3. The Positive and Negative Syndrome Scale (PANSS); will be used to measure psychiatric symptoms including negative symptoms. We will utilise the improved 5-factor model based on 5769 participants which incorporates positive, negative, disorganisation, excitement and emotional distress symptoms. 4. The Beck Depression Scale (BDI-II) is a well established measure of depression with excellent reliability and validity. 5. The Client Service Receipt Inventory (CSRI) is an instrument developed specifically for capturing service use among psychiatric patients. In addition to the standard health service resource use (e.g. G.P., specialist, hospital visits) the CSRI also includes specific psychiatric resource use (both hospital and community based) plus contacts with the judicial system.	—

Measure

Time frame

1. The EQ-5D is a generic, preference-based quality of life instrument that has been successfully used in schizophrenia patients, and which facilitated the calculation of Quality Adjusted Life Years for health economic analyses. 2. The Calgary Depression Scale for Schizophrenia (CDSS); The potential for phenomenological overlap between depression, negative symptoms, and extrapyramidal symptoms is addressed by including the CDSS. This clinician administered interview measure is based on items selected from the Hamilton Rating Scale for Depression (HAM-D) and the Present State Exam (PSE) and was developed in order to reliably distinguish co-morbid depression from symptoms that are diagnostic features of schizophrenia-spectrum disorders. When compared to the ?gold standard? SCID assessment of depressive symptoms the CDSS outperforms the BDI, PANSS ? Depression subscale, and HAM-D for both sensitivity (94%) and specificity (89%) 3. The Positive and Negative Syndrome Scale (PANSS); will be used to measure psychiatric symptoms including negative symptoms. We will utilise the improved 5-factor model based on 5769 participants which incorporates positive, negative, disorganisation, excitement and emotional distress symptoms. 4. The Beck Depression Scale (BDI-II) is a well established measure of depression with excellent reliability and validity. 5. The Client Service Receipt Inventory (CSRI) is an instrument developed specifically for capturing service use among psychiatric patients. In addition to the standard health service resource use (e.g. G.P., specialist, hospital visits) the CSRI also includes specific psychiatric resource use (both hospital and community based) plus contacts with the judicial system.

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Secondary

Measure	Time frame
Therapy Mechanisms: 1. Kentucky Inventory of Mindfulness Skills (KIMS) is a self-report inventory for the assessment of four mindfulness skills: observing, describing, acting with awareness, and accepting without judgement. Analyses have shown that the KIMS has good internal consistency, test retest reliability and construct validity. 2. The Acceptance and Action Questionnaire (AAQ-II) is a 7-item scale that measures experiential avoidance. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. 3. The Ruminative Response Scale (RRS) includes 22 items describing responses to depressed mood that are self-focused, symptom-focused, and focused on the possible causes and consequences of dysphoric mood. Psychometric evaluations have demonstrated good 5-month test?retest reliability (r=0.80) and good internal consistency (a=.89; a=.89). 4. The Autobiographical Memory Test (AMT) is a widely used recall task based on Crovitz?s classic single word cueing paradigm. Low autobiographical memory (AM) recall specificity is a known predictor of poor clinical outcome for people with unipolar depression34 and it has been argued that these problems with retrieval specificity are related to attempts to avoid unwanted mental experiences35. Reducing experiential avoidance is a central aim of the ACT approach36 but previous studies have not determined whether post-ACT improvements are associated with changes in autobiographical memory functioning. Greater AM retrieval specificity following treatment would indicate a possible mechanism of therapeutic change, namely, less avoidance of unwanted memories and related thoughts. The other main advantage of including the AMT in the current research is that it extends the assessment beyond purely questionnaire methods. Data from the ADAPT trial will provide a more nuanced understanding of the way that various change processes operate in ACT for depression after psychos	—

Measure

Time frame

Therapy Mechanisms: 1. Kentucky Inventory of Mindfulness Skills (KIMS) is a self-report inventory for the assessment of four mindfulness skills: observing, describing, acting with awareness, and accepting without judgement. Analyses have shown that the KIMS has good internal consistency, test retest reliability and construct validity. 2. The Acceptance and Action Questionnaire (AAQ-II) is a 7-item scale that measures experiential avoidance. Results from 2,816 participants across six samples indicate the satisfactory structure, reliability, and validity of this measure. 3. The Ruminative Response Scale (RRS) includes 22 items describing responses to depressed mood that are self-focused, symptom-focused, and focused on the possible causes and consequences of dysphoric mood. Psychometric evaluations have demonstrated good 5-month test?retest reliability (r=0.80) and good internal consistency (a=.89; a=.89). 4. The Autobiographical Memory Test (AMT) is a widely used recall task based on Crovitz?s classic single word cueing paradigm. Low autobiographical memory (AM) recall specificity is a known predictor of poor clinical outcome for people with unipolar depression34 and it has been argued that these problems with retrieval specificity are related to attempts to avoid unwanted mental experiences35. Reducing experiential avoidance is a central aim of the ACT approach36 but previous studies have not determined whether post-ACT improvements are associated with changes in autobiographical memory functioning. Greater AM retrieval specificity following treatment would indicate a possible mechanism of therapeutic change, namely, less avoidance of unwanted memories and related thoughts. The other main advantage of including the AMT in the current research is that it extends the assessment beyond purely questionnaire methods. Data from the ADAPT trial will provide a more nuanced understanding of the way that various change processes operate in ACT for depression after psychos

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Countries

United Kingdom

Outcome results

None listed

Source: ISRCTN (via WHO ICTRP) · Data processed: Feb 4, 2026