Acceptance and Commitment Therapy for the treatment of adolescent depression: a pilot study in a psychiatric outpatient setting

Based on promising results with adults, Acceptance and Commitment Therapy (ACT) presents as a treatment opportunity for depressed adolescents. We present a pilot study that compares ACT with treatment as usual (TAU), using random allocation of
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  Hayes, L., Boyd, C. P., & Sewell, J. (2011). Acceptance and Commitment Therapy for theTreatment of Adolescent Depression: A Pilot Study in a Psychiatric OutpatientSetting.  Mindfulness. doi: 10.1007/s12671-011-0046-5The final publication is available at   ORIGINAL PAPERAcceptance and Commitment Therapy for the Treatment of Adolescent Depression: A Pilot Study in a Psychiatric OutpatientSettingLouise Hayes • Candice P. Boyd • Jessica Sewell  ___________________________ L. Hayes    •    J. SewellPsychology Department, University of Ballarat, P.O. Box 663, MountHelen, Victoria, Australia, 3353e-mail:  C. P. BoydCentre for Youth Mental Health, Orygen Youth Health Research Centre,University of Melbourne, Australiae-mail: 2  Abstract Based on promising results with adults, Acceptance and Commitment Therapy(ACT) presents as a treatment opportunity for depressed adolescents. We present a pilotstudy that compares ACT with treatment as usual (TAU), using random allocation of  participants who were clinically referred to a psychiatric outpatient service. Participantswere 30 adolescents, aged  M = 14.9 ( SD = 2.55), with 73.6% in the clinical range for depression. At posttreatment on measures of depression participants in the ACT conditionshowed significantly greater improvement statistically ( d  =0.38), and 58% showed clinicallyreliable change with a response ratio of 1.59 in favor of ACT. Outcomes from 3-monthfollow-up data are tentative due to small numbers but suggest that improvement increasedin magnitude. Measures of global functioning showed statistically significant improvementfor both conditions, although clinical change measures favored only the ACT condition. Theresults support conducting a larger trial of ACT for the treatment of adolescent depression.Keywords: Acceptance and Commitment Therapy, Adolescent psychopathology,Adolescent Depression,3  Introduction Acceptance and mindfulness treatments have revealed positive outcomes for thetreatment of psychopathology in adults. Adult treatment studies demonstrate thatAcceptance and Commitment Therapy (ACT) can achieve positive long-term outcomes for depression, anxiety, psychosis, chronic pain, work stress, stigma and burnout (S. C. Hayes,Luoma, Bond, Masuda, & Lillis, 2006; S. C. Hayes, Masuda, Bissett, Luoma, & Guerrero,2004). In a review of 21 treatment studies the weighted mean effect size for ACT was d= 0.66 at posttreatment (  N= 704) and this was maintained at follow-up (S. C. Hayes, et al.,2006). For depression, the ACT literature has shown positive outcomes in treatingdepressed adults individually and in group settings (Lappalainen et al., 2007; Zettle &Hayes, 1986; Zettle & Rains, 1989). ACT is now listed with modest research support as anempirically supported treatment for depression and chronic pain (Division 12 of theAmerican Psychological Association, with adolescents is a new treatment frontier with empirical literature beginningto emerge. Wicksell and colleagues tested ACT for adolescents with chronic pain and foundsignificant improvements in functional ability, pain intensity, and pain related discomfort(Wicksell, Melin, Lekander, & Olsson, 2009; Wicksell, Melin, & Olsson, 2007). They alsofound adolescents treated with ACT reported less catastrophizing and lowered perceived pain (Wicksell, et al., 2009). Other adolescent studies have been undertaken in school4  settings, with one randomized controlled trial comparing ACT to a no treatment controlgroup finding improved outcomes up to two years later on measures of stress and psychological flexibility (Livheim, 2004). Thus, previous studies suggest ACT for adolescents should be evaluated further.A recent review of treatments for adolescent depression treatment argued that theACT model could be suitably adapted (Hayes, L. L., Bach, & Boyd, 2010). We present a pilot study of ACT with adolescent depression. The aim was to examine ACT whencompared to treatment as usual (TAU) provided in a psychiatric outpatient setting. The primary outcome variable was depressive symptoms and the secondary outcome variableglobal functioning (a measure that includes emotional symptoms, prosocial behavior, and peer interactions). Given that empirical literature on adolescent depression has shown thattreatment as usual can perform similarly to an experimental treatment (Watanabe, Hunot,Omori, Churchill, & Furukawa, 2007) and that adolescents attending a psychiatric serviceare rarely discharged without improvement (they drop out instead), it was hypothesized thatadolescents in both ACT and TAU groups would show significant improvements. However,given the empirical findings on ACT studies with adults, it was expected that adolescentsreceiving ACT would show larger gains than those receiving TAU. It was also hypothesizedthat at follow-up, participants who received ACT would continue to show significantlymore improvement than those receiving TAU.5
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