An open trial of a new acceptance-based behavioral treatment for major depression with psychotic features.
ADAPT, a mix of behavioral activation and ACT, shows early promise for adults with psychotic depression yet needs a controlled trial.
01Research in Context
What this study did
Fahmie et al. (2013) tested a new therapy called ADAPT. It mixes behavioral activation with ACT skills.
Fourteen adults with both major depression and psychosis got up to six months of ADAPT plus their usual pills.
What they found
Depression scores, psychotic symptoms, and daily living skills all got much better.
Gains stayed strong at follow-up. No control group was used, so we cannot be sure ADAPT caused the change.
How this fits with other research
Clarke et al. (2003) showed that plain behavioral activation beats supportive care for depressed inpatients. ADAPT adds ACT tools for people who also hear voices or hold delusions.
Lappalainen et al. (2015) later gave ACT online to depressed adults and saw large mood gains. Both studies line up: ACT parts can help when paired with action-based work.
Ellingsen et al. (2014) used ACT for teens with PTSD and also saw big symptom drops without a control. The pattern matches: ACT looks helpful, but firmer trials are still needed.
Why it matters
If you serve adults with both mood and psychotic symptoms, ADAPT offers a ready-made manual that blends values work with simple activity scheduling. Track mood and hallucination ratings weekly; if you see clear drops, consider joining the promised RCT to strengthen the evidence.
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02At a glance
03Original abstract
Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial.
Behavior modification, 2013 · doi:10.1177/0145445512465173