Pilot randomized controlled trial of a video self-help intervention for depression based on acceptance and commitment therapy: Feasibility and acceptability

Abstract

A common setting where depression is identified and treated is in primary care, where there is a need for low-intensity and cost-effective interventions to be used as part of a stepped-care model. The current study involved a pilot, parallel-group, randomized controlled trial of a video self-help intervention for primary care patients based on acceptance and commitment therapy (ACT). The intervention, called LifeStories, consisted of storytelling vignettes of patients describing their use of ACT-consistent coping skills for depression. Primary care patients were recruited to determine feasibility, acceptability, and potential clinical effects of the intervention. Twenty-one participants were assigned to use LifeStories over a period of 4 weeks, and 19 participants were assigned to an attention-matched comparison group. Qualitative feedback indicated that participants using LifeStories found the intervention to be engaging and useful in transmitting key ACT principles. Furthermore, those receiving LifeStories rated their level of "transportation" or immersion in the videos higher than the control group. Both conditions showed large improvements in levels of depression at a 12-week follow-up. There were no significant differences in symptom outcomes between groups; however, because this was a pilot study, it was not powered to detect differences between interventions. Both conditions additionally showed smaller effect size changes in psychological flexibility, a key ACT mechanism. The results suggest LifeStories to be a feasible and acceptable psychological intervention that may improve depression, and further research is warranted to determine its effectiveness as part of a stepped-care approach to treating depression in primary care.

Keywords: acceptance and commitment therapy; depression; mHealth; primary care; self-help; stepped-care.

Conflict of interest statement

Conflicts of Interest Statement: Dr. Gaudiano receives grant funding from the National Institutes of Health and Brown Mindfulness Center related to Acceptance and Commitment Therapy. He also receives book royalties from Oxford University Press and Routledge/Taylor & Francis, and consults for McKesson/Change Healthcare. Dr. Uebelacker’s spouse is employed by Abbvie pharmaceuticals.

© 2020 John Wiley & Sons, Ltd.

Figures

Figure 1.

Diagram of participant flow