• A-TjakJacqueline G LJGLSkils, Dr van Deenweg 98, 8025 BJ, Zwolle, The Netherlands., Nexhmedin Morina, Maurice Topper, and EmmelkampPaul M GPMGDepartment of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129 B, 1018 WS, Amsterdam, The Netherlands..
• Skils, Dr van Deenweg 98, 8025 BJ, Zwolle, The Netherlands.
• Bmc Psychiatry. 2021 Jan 14; 21 (1): 41.

BackgroundExisting therapies for depression are effective, but many patients fail to recover or relapse. To improve care for patients, more research into the effectiveness and working mechanisms of treatments is needed. We examined the long-term efficacy of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for Major Depressive Disorder (MDD), testing the hypothesis that CBT outperforms ACT and that both therapies work through their designated mechanisms of change.MethodsWe conducted a randomized controlled trial with 82 patients suffering from MDD. Data were collected before, during and after treatment, and at 12-month follow-up, assessing symptoms of depression, quality of life, dysfunctional attitudes, decentering, and experiential avoidance.ResultsPatients in both conditions reported significant and large reductions of depressive symptoms (d = - 1.26 to - 1.60) and improvement in quality of life (d = 0.91 to - 1.28) 12 months following treatment. Our findings indicated no significant differences between the two interventions. Dysfunctional attitudes and decentering mediated treatment effects of depressive symptoms in both CBT and ACT, whereas experiential avoidance mediated treatment effects in ACT only.ConclusionsOur results indicate that CBT is not more effective in treating depression than ACT. Both treatments seem to work through changes in dysfunctional attitudes and decentering, even though the treatments differ substantially. Change in experiential avoidance as an underlying mechanism seems to be an ACT-specific process. Further research is needed to investigate whether ACT and CBT may work differently for different groups of patients with depression.Trial Registrationclinicaltrials.gov; NCT01517503 . Registered 25 January 2012 - Retrospectively registered.

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