Psychological Treatment for Depressive Disorder

The Efficacy of Group Acceptance and Commitment Therapy for Preventing Post-Stroke Depression: A Randomized Controlled Trial

BACKGROUND AND PURPOSE

Post-stroke depression (PSD) is a common psychiatric complication of stroke and is associated with the subsequent prognosis, yet still lacking of enough attention. PSD is preventable, and psychotherapy is an alternative prophylactic treatment which needs more solid evidences to confirm its efficacy. In this study, group Acceptance and Commitment Therapy (G-ACT) was performed in acute stroke patients to see if it can effectively relieve depressive symptoms and improve neurological function. The efficacy was also evaluated in stroke patients of different severity.

METHODS

One hundred and four hospitalized patients with acute ischemic stroke were enrolled according to the inclusion criteria and exclusion criteria. After baseline evaluation, they were randomly allocated to the intervention (G-ACT) group and the control (usual care) group. Patients in the control group received routine stroke treatment, while those in the intervention group were given additional G-ACT treatment (5 sessions, 45-55 min/session). Both of the two groups were assessed with 24-item Hamilton Depression Scale (HAMD-24), National Institutes of Health Stroke Scale (NIHSS), and Barthel Index (BI) at baseline, 2 weeks, 1 month, and 3 months follow-up. Patients were further divided into the mild stroke group (NIHSS 0-3) and the moderate stroke group (NIHSS 4-9), HAMD scores at different time points were also assessed.

RESULTS

The HAMD score of G-ACT group was significantly lower than that of control group at 1 month (p = 0.018) and 3 months follow-up (p = 0.001). As to the NIHSS score, there was no significant difference between the two groups within the follow-up period (p > 0.05). The BI score of the two groups was statistically different at 2 weeks (p = 0.033) and 1 month (p = 0.019), while no difference was shown at 3 months (p = 0.191). In acute phase, the HAMD score of moderate stroke patients was significantly higher than that of mild ones (p < 0.001). After G-ACT treatment, both mild and moderate stroke patients showed lower HAMD score at 3 months follow-up (p = 0.004; p = 0.033).

CONCLUSIONS

G-ACT seems to be a viable and effective treatment for preventing PSD in the acute phase of stroke, while the efficacy of which on improving neurological deficits needs to be further evaluated.

Internet Cognitive Behavioral Therapy With or Without Face-to-Face Psychotherapy: A 12-Weeks Clinical Trial of Patients With Depression

Depressive disorders are a curable, global health problem. However, most patients remain untreated, and more and more patients use internet-based interventions, but it is unclear whether it is beneficial for ongoing face-to-face psychotherapy. Thus, we compared the outcome of internet cognitive behavioral therapy (ICBT) with (ICBT+) or without (ICBT) additional face-to-face outpatient psychotherapy in adult patients with moderate to severe depressive disorder. For this longitudinal interventional clinical trial (NCT02112266), 168 of 252 online recruited adults with depressive symptoms received ICBT+ (n = 96) or ICBT (n = 72). Demographics (sex, age, age at first depressive episode, years of education, duration of depressive symptoms) were assessed and compared between groups. All patients underwent ICBT for 12 weeks. Quality of life (QoL) and severity of depressive symptoms were assessed within each group at three time points [baseline (T0), postinterventional after ICBT at 12 weeks (T1), and for follow-up at 6 months (T2)] using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) global score to assess QoL as primary and the Beck Depression Inventory (BDI-II) to assess self-rated depressive symptoms as secondary outcome variables, respectively. Differences were assessed between groups using t test and over time using repeated-measures analysis of variance. Data of intention-to-treat analysis are given as mean ± SD. Group differences were assumed at p < 0.05. Partial η² is given as effect size. Demographic data, QoL, and depressive symptoms did not differ between groups (ICBT+/ICBT) at baseline (T0). Patients of both groups suffered from moderate to severe depressive disorders and gained improved QoL scores (WHOQOL-BREF-global: p < 0.001, η² = 0.16), as well as experienced decreased depressive symptoms (BDI-II: p < 0.001, η² = 0.2) after 12 weeks of ICBT compared to baseline. Patients without additional face-to-face outpatient psychotherapy lost QoL-albeit not significant-and had increased depressive symptoms (BDI: p = 0.02, η² = 0.04) at 6 months' follow-up. Thus, ICBT is suitable for psychiatric treatment, although additional face-to-face outpatient psychotherapy helps stabilizing long-term outcome.