A clinical effectiveness trial comparing ACT and CBT for inpatients with depressive and mixed mental disorders

Figures & data

Figure 1. Participant flow through the study. ACT = Acceptance and Commitment Therapy; CBT = Cognitive Behavioral Therapy.

Table I. Sociodemographic and clinical characteristics for the Acceptance and Commitment Therapy (ACT) group and Cognitive Behavioral Therapy (CBT) group at baseline.

Characteristics	ACT (n = 83)	CBT (n = 94)	Statistic
Sociodemographics
Sex
male	32	37
female	51	56
other	0	1	χ^2 (2) = 0.92, p = 0.94
Age	37.96 (12.57)	40.98 (13.41)	t(175) = 1.54, p = 0.13
Education^a
no	2	5
low	15	13
medium	33	42
high	20	15
academic	13	18	χ^2 (4) = 3.60, p = 0.47
Employment status
paid job	35	47
apprenticeship	6	3
college student	6	2
student	2	4
retired	7	11
no work or education	27	27	χ^2 (5) = 5.70, p = 0.35
Verbal IQ (WST)	98.73 (11.24)	99.35 (9.75)	t(175) = 0.39, p = 0.70
Clinical
Diagnoses
MDD and comorbid disorders	62	70
Any disorder other than MDD	21	24	χ^2 (1) = 0.01, p = 0.97
Previous medication
AD	32	48	χ^2 (1) = 2.79, p = 0.06
AP	6	14	χ^2 (1) = 2.58, p = 0.08
Benz	26	26	χ^2 (1) = 0.29, p = 0.62
MS	1	2	χ^2 (1) = 0.23, p = 0.55
Psychiatric treatments in the past
none	41	47
inpatient ward	22	24
day clinic	8	4
both	12	19	χ^2 (3) = 2.74, p = 0.44
Current psychotherapy
yes	25	24
no	58	70	χ^2 (1) = .46, p = 0.51
Psychotherapy in the past
yes	45	44
no	38	50	χ^2 (1) = .97, p = 0.37
ADS score	28.20 (8.93)	30.39 (8.57)	t(175) = 1.66, p = 0.10
MADRS score	26.66 (9.21)	28.34 (9.38)	t(175) = −1.23, p = 0.22
ISR overall score	1.51 (0.59)	1.67 (0.62)	t(175) = −1.73, p = 0.09
SWLS score	14.94 (7.45)	14.22 (7.12)	t(175) = 0.65, p = 0.51

Note. Standard deviations shown in parentheses, WST = Wortschatztest, MDD = Major Depressive Disorder, AD = antidepressant, AP = antipsychotic, Benz = benzodiazepine, MS = mood stabilizer, ADS = Allgemeine Depressionsskala, MADRS = Montgomery Asperg Depression Scale, ISR = ICD-10 Symptom Rating, SWLS = Satisfaction with life scale, ^alow = graduation after 9th grade, medium = graduation after 10th grade, high = Abitur (A-Level or Highschool equivalent), academic = university degree.

Table II. Treatment characteristics of the ITT sample divided by group.

Characteristics	ACT (n = 83)	CBT (n = 94)	Statistics
Duration of stay	43.87 (14.45)	40.17 (11.73)	t(175) = 1.88, p = 0.06
Number of group therapy sessions	10.69 (4.10)	9.89 (2.86)	t(144.05) = 1.46, p = 0.14
Stability of medication
altered during study course	42	42
not altered during study course	52	41	χ^2(1) = 0.62, p = 0.45

Note. Standard deviations shown in parentheses, ACT = Acceptance and Commitment Therapy, CBT = Cognitive Behavioral Therapy.

Table III. Primary and secondary outcome scores of study-completers and dropouts at baseline.

Scales	Study-Completer (n = 116)	Dropouts (n = 61)	Statistics
ADS score	29.34 (9.00)	29.43 (8.43)	t(175) = 0.07, p = 0.95
MADRS score	27.31 (9.56)	27.97 (8.73)	t(175) = 0.45, p = 0.66
ISR overall score	1.60 (0.58)	1.59 (0.67)	t(107.26) = 0.11, p = 0.91
SWLS score	14.70 (7.50)	14.30 (6.86)	t(175) = 0.35, p = 0.73

Note. Standard deviations shown in parentheses, study-completer = patients who were assessed at all three time points, dropouts = patients who dropped out of the study at any time of the study course, ADS = Allgemeine Depressionsskala, MADRS = Montgomery Asperg Depression Scale, ISR = ICD-10 Symptom Rating, SWLS = Satisfaction with life scale.

Table IV. ITT pre-treatment, post-treatment and 6-months follow-up scores on primary and secondary outcome measures and within- and between-group effect sizes (Cohen’s d).

Scales	Condition	Pre-treatment	Post-treatment	Within-group d pre to post	Between-group d pre to post	6-months follow-up	Within-group d pre to follow-up	Between-group d pre to follow-up
ADS score	ACT	28.20 (0.98)	14.83 (1.03)	1.46***		17.43 (1.11)	1.13***
	CBT	30.39 (0.88)	13.30 (0.88)	2.01***	0.17	15.85 (0.96)	1.61***	0.17
MADRS score	ACT	26.63 (1.01)	11.85 (0.90)	1.70***		14.00 (0.87)	1.42***
	CBT	28.34 (0.96)	11.26 (0.78)	2.01***	0.08	14.38 (0.83)	1.56***	0.05
ISR overall score	ACT	1.51 (0.06)	1.03 (0.06)	0.83***		1.11 (0.07)	0.68***
	CBT	1.67 (0.06)	1.03 (0.06)	1.03***	0	1.08 (0.06)	0.93***	0.05
SWLS score^a	ACT	14.94 (0.82)	17.49 (0.76)	−0.35***		17.23 (0.77)	−0.31**
	CBT	14.22 (0.73)	17.29 (0.74)	−0.43***	0.03	17.37 (0.65)	−0.46***	0.02

Note. Standard error shown in parentheses, ACT = Acceptance and Commitment Therapy, CBT = Cognitive Behavioral Therapy, ADS = Allgemeine Depressionsskala, MADRS = Montgomery Asperg Depression Scale, ISR = ICD-10 Symptom Rating, SWLS = Satisfaction with life scale, ^ahigher scores indicate better functioning, **p < 0.01 after Bonferroni correction, ***p < 0.001 after Bonferroni correction.

Table V. ITT percentage of patients who reliably remitted, reliably responded, reliably deteriorated and non-responded from pre- to post-treatment.

Scales	Condition	Remission	Response	Deterioration	Nonresponse
ADS	ACT	57	68	2	30
	CBT	60	79	0	21
MADRS	ACT	52	81	2	17
	CBT	54	90	1	9
ISR	ACT	7	31	1	68
	CBT	16	38	0	62

Note. ACT = Acceptance and Commitment Therapy, CBT = Cognitive Behavioral Therapy, Healthy norms and retestreliability were based on Hautzinger and Bailer (1993) for ADS (Allgemeine Depressionsskala), on Neumann and Schulte (1989) for MADRS (Montgomery Asperg Depression Scale), healthy norms on Tritt et al. (2015) and retest reliability on Fisher et al. (2011) for ISR (ICD-10 Symptom Rating) and ISR subscales.

Table A1. Distribution of diagnoses referring to the SCID-I interview for the Acceptance and Commitment Therapy (ACT) group and Cognitive Behavior Therapy (CBT) group at baseline.

Diagnoses	ACT (n = 83)	CBT (n = 94)	Statistic
Major Depressive Disorders	62	70	χ^2 (1) = 0.01, p = 0.76
Anxiety Disorders	34	31	χ^2 (1) = 1.21, p = 0.27
Somatoform Disorders	12	7	χ^2 (1) = 2.26, p = 0.13
Eating Disorders	4	2	χ^2 (1) = 0.98, p = 0.32
Adjustment Disorders	7	11	χ^2 (1) = 0.52, p = 0.47
Substance-Related Disorders	19	14	χ^2 (1) = 1.86, p = 0.17

Note. Values shown in absolute frequencies. SCID-I = Structured Clinical Interview for DSM-IV Axis I Disorders.

Hautzinger, M., & Bailer, M. (1993). Allgemeine Depressions-Skala: ADS; Manual: Beltz-Test-GmbH.

 Google Scholar

Neumann, N., & Schulte, R. (1989). MADR-Skala zur psychometrischen Beurteilung depressiver Symptome (MADRS) [MADR-Scale for psychometric assessment of depressive symptoms]. Perimed.

 Google Scholar

Tritt, K, Von Heymann, F, Zaudig, M, Probst, T, Loew, T, Klapp, B, Söllner, W, Fydrich, T, & Bühner, M. (2015). ICD-10-Symptom-Rating (ISR) - Das Handbuch zum Fragebogen. Graz: neobooks.

 Google Scholar

Fischer, HF, Schirmer, N, Tritt, K, & Klapp, BF. (2011). Retest-Reliabilität und Änderungssensitivität des ICD-10-Symptom-Rating (ISR) in verschiedenen Stichproben. PPmP-Psychotherapie. Psychosomatik· Medizinische Psychologie, 61(03-04), 162–169.

 PubMedGoogle Scholar

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, MS, upon reasonable request.