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Cited by 37Mindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

Acceptance-based Behavior Therapy for Depression With Psychosis

Open access
GAUDIANO, BRANDON A., BUSCH, ANDREW M., WENZE, SUSAN J., NOWLAN, KATHRYN, EPSTEIN-LUBOW, GARY, MILLER, IVAN W.·2015·Journal of Psychiatric Practice
DOI 10.1097/pra.0000000000000092PMC PMC4704101
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Abstract

Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N=13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT posttreatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared with medications alone and requires testing in a fully powered randomized trial. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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Registry

Crossref · 10.1097/pra.0000000000000092

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

11 of 66 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The American Psychological Association recognizes acceptance and commitment therapy as having modest empirical support for depression and psychosis.

    “Acceptance and commitment therapy is recognized by the American Psychological Association as having a modest level of empirical support for the treatment of depression and psychosis.16,17”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [16] source

      The Discussion (page not available in our copy) says that, according to the Society of Clinical Psychology, there is a modest amount of research on ACT’s efficacy for depression and psychosis. It does not say that the American Psychological Association formally recognizes ACT as having a modest level of empirical support for those treatments. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [17]

      The Results section discusses small ACT trials for depression, but does not state how the American Psychological Association rates ACT. Searches for APA recognition, modest empirical support, and psychosis found no passage establishing the claimed rating for depression and psychosis. Page numbers were not available in our copy. (LLM, conf=0.72)

      Experimental — accuracy not yet measured
  • Premisecitation

    Depression and psychosis often occur together.

    “Depression and psychosis frequently co-occur,1–3, and this pattern of comorbidity is associated with increased illness severity, functional impairment, and treatment resistance compared with either disorder alone.2,4,5”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [1] source
    • cites [2] source
    • cites [3] source
  • Premisecitation

    For severe depression and psychotic disorders, adding evidence-based psychotherapy to medication yields clinically significant improvement beyond medication alone.

    “Combining medication with evidence-based psychotherapy produces clinically significant improvement over medications alone for severe depression and psychotic disorders.9,10”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] source
    • cites [10] source

      The Results report that CBT for psychosis improved positive symptoms, and the Methods compare it with treatment as usual or an inactive adjunct. But the Discussion calls the benefit modest, and the paper does not establish clinically significant improvement over medication alone. Its evidence concerns schizophrenia, not severe depression. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Experiential avoidance is positively associated with delusional experiences such as paranoia.

    “Recent work has also shown that experiential avoidance is positively associated with delusional experiences such as paranoia,29,30 and that it may contribute to cognitive impairments in schizophrenia.31”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [29] source
    • cites [30] source

      The Introduction section “Experiential Avoidance in Depression and Psychosis” says avoidance-based coping has been implicated in psychosis, and the References list a study of experiential avoidance and paranoia. Our copy does not report a positive association specifically with paranoia or other delusional experiences; its Results report changes in delusion proneness and psychological inflexibility, not their correlation. No page numbers are available in our copy. (LLM, conf=0.80)

      Experimental — accuracy not yet measured
  • Premisecitation

    A recent meta-analysis of mindfulness/acceptance interventions for psychosis showed these treatments are most effective for distress related to psychosis and negative or affective symptoms.

    “A recent meta-analysis of mindfulness/acceptance interventions for psychosis showed that these treatments are most effective for distress related to psychosis and negative or affective symptoms.60,61”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [60] source

      The Abstract identifies this as a meta-analysis of family intervention and cognitive behavioural therapy, reporting effects on relapse, readmission and mental state. Searches for mindfulness/acceptance interventions and for distress, negative symptoms and affective symptoms found no passage assessing the claimed treatments or comparing which outcomes they treat most effectively. No page numbers were available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [61]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims. 40
  • Classified as probably not a substantial claim. 42

  • May combine two claims.

    Premisecitation

    Comorbid depression and psychosis is linked to greater illness severity, functional impairment, and treatment resistance than either condition alone.

    “Depression and psychosis frequently co-occur,1–3, and this pattern of comorbidity is associated with increased illness severity, functional impairment, and treatment resistance compared with either disorder alone.2,4,5”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [2] source

      The Results section reports greater depression severity and social and work impairment in patients with psychotic major depression than in those with nonpsychotic major depression. The Introduction reports higher treatment resistance in the same comparison. The paper does not compare this group with patients who have psychosis alone, so it does not support the claim’s full ‘either disorder alone’ comparison. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [4] source
    • cites [5] source

      The Conclusions report greater illness severity and impairment in psychotic major depression than in nonpsychotic major depression, as well as poorer response to standard depression treatments. The comparison is with depression without psychotic features; the paper does not establish the claimed comparison with psychosis alone. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Systematic assessment and feedback to clinicians can improve treatment outcomes.

    “Research suggests that systematic assessment and feedback to clinicians can improve treatment outcomes.41”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [41] source

      The Introduction (page not provided) discusses the WHODAS 2.0 as a measure for assessing patients and its responsiveness to change. Our copy does not address whether systematic assessment combined with feedback to clinicians improves treatment outcomes; searches for that claim and for clinician feedback and treatment outcomes found no supporting passage. (LLM, conf=0.75)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Behavioral activation has recently shown promise for treating negative symptoms of schizophrenia.

    “Behavioral activation has also recently shown promise for treating the negative symptoms of schizophrenia.14”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] source

      The Other studies section (p. 19) describes ACT for positive psychotic symptoms, and Mediational studies (p. 18) describes ACT for hallucinations and delusions. Searches for behavioral activation and negative symptoms found no passage reporting its promise for treating negative symptoms of schizophrenia. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Patients found both the EAM and ADAPT conditions acceptable.

    “Both conditions were deemed acceptable by patients.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Post-treatment between-group effect sizes favored ADAPT and were medium to large for depression, psychosocial functioning, and experiential avoidance.

    “Differences in between-subjects effect sizes favored ADAPT post-treatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Participants had a mean age of 50 years (SD=17) and 14 years (SD=2.5) of education.

    “Participants had a mean age of 50 years (SD = 17.0) and 14 years (SD = 2.5) of education.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The 13 eligible patients were randomized to EAM (n=7) or ADAPT (n=6).

    “The 13 eligible patients were randomized to EAM (n = 7) or ADAPT (n = 6).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Eighty-five percent had major depressive disorder with psychotic features and 15% had schizoaffective disorder, depressive type.

    “A total of 85% (n = 11) had a diagnosis of major depressive disorder with psychotic features and 15% (n = 2) were diagnosed with schizoaffective disorder, depressive type.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All 13 patients were prescribed antidepressant medication and 92% antipsychotic medication at baseline.

    “Although we did not collect detailed information on dosages, all patients (n = 13) were prescribed an antidepressant medication and 92% (n = 12) were prescribed antipsychotic medication at baseline.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At baseline, the EAM group had a mean CES score of 34.0 (SD=11.1) and the ADAPT group had a mean of 44.0 (SD=4.4), a large effect size difference (d=1.18), z=-1.81, P=0.069.

    “Results from the CES at baseline indicated that the EAM group had a mean of 34.0 (SD = 11.1) and the ADAPT group had a mean of 44.0 (SD = 4.4), representing a large effect size difference (d = 1.18), z = −1.81, P = 0.069.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The severity of psychosis at baseline was similar in the two trials, but the severity of depression at baseline was somewhat higher in the previous open trial (QIDS-C mean = 21.1, SD = 3.3).

    “Although the severity of psychosis at baseline was similar in the two trials, it should be noted that the severity of depression at baseline was somewhat higher in the sample treated in the previous open trial (eg, QIDS-C mean score = 21.1, SD = 3.3).36”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    At baseline, 85% of participants had hallucinations and 69% had delusions.

    “Regarding psychotic symptoms, 85% (n = 11) had hallucinations and 69% (n = 9) had delusions at baseline.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Differences in experiential avoidance (AAQ-II) were medium to large and changes in behavioral activation (BADS) were small at posttreatment.

    “Differences in experiential avoidance (AAQ-II) were in the medium to large range and changes in behavioral activation (BADS) were in the small range at posttreatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Ratings of treatment expectations and treatment satisfaction in this study were similar to those in the previous open trial of ADAPT.

    “In addition, ratings of treatment expectations and treatment satisfaction in this study were similar to those in the previous open trial of ADAPT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Between-subjects effect sizes at posttreatment ranged from small to large, and all favored the ADAPT condition.

    “Between-subjects effect sizes at posttreatment ranged from small to large, but all favored the ADAPT condition.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among treatment completers at posttreatment, 100% were prescribed antidepressant medication and 78% antipsychotic medication.

    “Among the treatment completers, at the posttreatment assessment, 100% of patients (n = 9) were prescribed antidepressant medication and 78% (n = 7) were prescribed antipsychotic medication.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    Recruitment was most successful from the psychiatric hospital compared with outpatient settings.

    “Compared with outpatient settings, we had the greatest success recruiting patients from psychiatric hospital where more acutely ill individuals with active psychotic and depressive symptoms are likely to be found.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At posttreatment, all patients self-reported good adherence to their primary psychiatric medications.

    “At the posttreatment assessment, all patients (100%) self-reported good adherence to their primary psychiatric medications (ie, missing no more than 1–2 doses in the previous month).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Age was similar across the samples in the two studies, but a greater percentage of women were included in the open trial than in this pilot RCT (86% vs 54%).

    “Age was similar across the samples in the two studies, but a greater percentage of women were included in the open trial than in this pilot randomized controlled trial (86% vs 54%, respectively).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At post-assessment, mean CSQ-8 satisfaction was 25.5 (SD=3) for EAM and 29.5 (SD=2.4) for ADAPT out of 32, a large effect (d=1.47), z=-1.75, P=0.080.

    “The average total score on the CSQ-8 at post-assessment was 25.5 (SD = 3) for the EAM group versus 29.5 (SD = 2.4) for the ADAPT group, out of a possible total score of 32, which represents a large effect (d = 1.47), z = −1.75, P =0.080.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Patients assigned to ADAPT completed an average of 11.3 sessions (SD=5.1).

    “Patients assigned to the ADAPT condition completed an average of 11.3 (SD = 5.1) sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Between-group differences at posttreatment were large for depressive symptoms (QIDS-C) and psychosocial functioning (WHODAS-II), and small for psychotic symptoms (BPRS-Psychosis).

    “Between group differences were large for depressive symptoms (QIDS-C) and psychosocial functioning (WHODAS-II) and small for psychotic symptoms (BPRS-Psychosis).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    A number of patients initially screened were not eligible based on the specified selection criteria.

    “A number of patients we initially screened for the study were not eligible based on our specified selection criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Eighteen patients completed baseline assessments; 13 met eligibility criteria and 5 did not, mainly due to incorrect diagnosis or insufficient depression severity.

    “Eighteen patients completed baseline assessments to determine eligibility, 13 of whom met eligibility criteria and 5 of whom did not (mainly due to incorrect diagnosis or insufficient depression severity at the time of assessment).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Recent recommendations argue that Stage 1b studies should focus less on formal hypothesis testing because effects in small samples are unreliable, and should instead assess feasibility and acceptability and verify randomization procedures.

    “Recent recommendations also have argued for a reduced focus on formal hypothesis testing (due to unreliability of effects in small samples) in Stage 1b studies, and instead have emphasized the goal of further assessing the feasibility and acceptability of treatments and verifying the appropriateness of the randomization procedures being used.35”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] source

  • May combine two claims.

    Premisecitation

    Meta-analyses have shown acceptance and commitment therapy to be efficacious across several conditions and to have possible advantages over other psychological treatments.

    “Several meta-analyses have demonstrated the efficacy of acceptance and commitment therapy for a number of different conditions and its potential advantages compared with other psychological treatments.19–23”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [19] source
    • cites [20] source
    • cites [21] source
    • cites [22] source
    • cites [23] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Acceptance and commitment therapy is listed as an evidence-based practice by the Substance Abuse and Mental Health Services Administration.

    “It is also listed as an evidence-based practice by the Substance Abuse and Mental Health Services Administration.18”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The authors have found the strategies of behavioral activation and acceptance and commitment therapy to be complementary.

    “We have found that the strategies in behavioral activation and acceptance and commitment therapy are complementary.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In White et al's trial, acceptance and commitment therapy led to greater improvements in depression, negative symptoms, and mindfulness and fewer crisis contacts than treatment as usual.

    “Compared with treatment as usual, acceptance and commitment therapy produced greater improvements in depression, negative symptoms, and mindfulness, and resulted in fewer crisis contacts.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The QIDS-C is a reliable and valid 16-item interviewer-rated measure of depression severity.

    “The Quick Inventory of Depressive Symptomatology-Clinician (QIDS-C) is a 16-item interviewer-rated scale that is reliable and valid for assessing severity of depression.43”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Experiential avoidance may contribute to cognitive impairments in schizophrenia.

    “Recent work has also shown that experiential avoidance is positively associated with delusional experiences such as paranoia,29,30 and that it may contribute to cognitive impairments in schizophrenia.31”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The WHODAS-II is a 12-item self-report measure with evidence of reliability and validity for assessing psychosocial and physical disability.

    “The brief version of the World Health Organization Disability Assessment Schedule (WHODAS-II) 47,48 is a 12-item self-report measure that has evidence of reliability and validity for assessing various aspects of psychosocial and physical disability.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [47] source
    • cites [48] source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The open trial provided initial proof-of-concept and indicated that ADAPT should be further examined in a randomized design.

    “The open trial provided the initial “proof-of-concept” and suggested the utility of examining ADAPT further in a randomized design.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Emerging treatment development models suggest improving the stage approach by clarifying assumptions, linking to basic research, and attending earlier to mechanisms and dissemination/implementation.

    “Emerging treatment development models propose ways of improving this approach, such as increasing clarity of underlying assumptions, links with basic research, and attention to mechanisms of action and dissemination/implementation issues earlier in the process.34”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mueser et al reported a mean BPRS Psychosis Subscale score of 8.4 in 528 individuals with schizophrenia after stabilization following an acute exacerbation.

    “Mueser et al reported a mean total score on the BPRS Psychosis Subscale of 8.4 in a sample of 528 individuals with schizophrenia after stabilization following an acute exacerbation.46”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] source

  • Classified as probably not a substantial claim.

    Premisecitation

    Shawyer et al found that experiential avoidance was related to depression and hallucinations in 43 patients with psychotic disorders.

    “For example, Shawyer et al reported that experiential avoidance was related to depression and hallucinations in a sample of 43 patients with psychotic disorders.27”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The stage approach has been criticized as too linear and rigid.

    “However, the stage approach has been criticized in recent years for being too linear and rigid.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The BPRS is a widely used interview-rated outcome scale that assesses symptom severity.

    “The Brief Psychiatric Rating Scale (BPRS)44 is an interview-rated scale that is a widely used outcome scale that assesses symptom severity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] source

  • May combine two claims.

    Premisecitation

    Medication treatments for depression and psychosis often reduce symptoms to some degree, but they can also produce unintended effects that negatively impact functioning.

    “The medication treatments that patients receive for depression and psychosis often reduce symptoms to some degree, but they can also produce unintended effects that have a negative impact on functioning.66–69”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [66]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [67]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [68]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [69]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Study design and conductown data

    Overall treatment integrity was high: an average of 93.9% of sessions were adherent to specific protocol components, and no sessions contained significant non-ADAPT content.

    “Overall treatment integrity was high, with an average of 93.9% of sessions found to be adherent to the specific components of the protocol and no sessions rated as containing significant amounts of non-ADAPT content.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Interviewers were trained to administer the measures until interrater reliability exceeded 0.80.

    “Interviewers were trained to administer measures until acceptable interrater reliability (> 0.80) was achieved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Two patients who completed posttreatment failed follow-up: 0 in EAM versus 2 of 5 (40%) in ADAPT (P=0.44).

    “Two patients who completed the posttreatment assessment failed to complete the follow-up for unknown reasons as they could not be reached: no patients were lost to follow-up in the EAM group versus 2 of the 5 remaining patients (40%) in the ADAPT group (P = 0.44).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CSQ-8 is an 8-item self-report measure of satisfaction with services.

    “The Client Satisfaction Questionnaire-8 (CSQ-8) is an 8-item self-report measure that reflects respondents’ satisfaction with services.52”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study's strengths included a randomized design, high treatment integrity, and blinded assessments.

    “The strengths of this study included the use of a randomized design, high treatment integrity, and blinded assessments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Although the overall magnitude of changes was similar across studies, effects appeared somewhat attenuated on certain measures (eg, BADS) in this trial, possibly related to changes in study design and sample composition.

    “Although the overall magnitude of changes was similar across studies, effects appeared to be somewhat attenuated on certain measures (eg, BADS) in the trial described here, which may possibly have been related to the changes in the study design and sample composition discussed above.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The posttreatment attrition rate among those randomized to treatment was 31%, which was within expected margins.

    “Overall, we observed a 31% posttreatment attrition rate among those randomized to treatment, which was within expected margins (eg, see Swift and Greenberg 201259).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Swift and Greenberg 201259

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    The EAM comparison condition also appeared acceptable and feasible for most patients, though expectancies for improvement and treatment satisfaction were greater for ADAPT.

    “The comparison condition (EAM) also appeared to be acceptable and feasible for most patients, although ratings of expectancies for improvement and treatment satisfaction appeared to be greater for ADAPT.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Four patients dropped out before posttreatment assessment: 3 (43%) in EAM and 1 (17%) in ADAPT, a non-significant difference (P=0.56).

    “Four patients dropped out prior to the posttreatment assessment: 3 (43%) in the group randomized to EAM and 1 (17%) in the group assigned to ADAPT (P = 0.56).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Reductions in positive psychotic symptoms were similar in both ADAPT and EAM, possibly due to a floor effect on the measure.

    “Similar reductions in the severity of positive psychotic symptoms were seen in both the ADAPT and EAM conditions, which could have resulted from a “floor effect” on this measure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The mean competence rating per session was 5.42 (SD=0.24) on a 0-6 scale, suggesting therapists delivered the protocol reliably and proficiently.

    “Furthermore, the mean competence rating per session was 5.42 (SD = 0.24), on a scale from 0 = poor to 6 = excellent, suggesting that study therapists were able to reliably and proficiently follow the protocol.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    About 10% of session recordings from the other study therapists were randomly selected and rated by the lead author.

    “Approximately 10% of session recordings of the other study therapists were randomly selected and rated by the lead author.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Visual inspection of follow-up data suggests maintenance of treatment gains, though only descriptive statistics are reported due to small sample.

    “Given the smaller sample size for the follow-up assessments, we conservatively report only the descriptive statistics in Table 2; although visual inspection suggests maintenance of treatment gains.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous studies in nonpsychotic depression have shown greater benefits for combined treatment over medication alone.

    “Previous studies in nonpsychotic depression have also shown greater benefits for combined treatment over medication alone.9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The AAQ-II is a validated 7-item self-report measure of experiential avoidance and psychological inflexibility.

    “The Acceptance and Action Questionnaire-II (AAQ-II) is a 7-item, validated self-report measure of experiential avoidance/psychological inflexibility.49”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The BADS is a validated 25-item self-report measure of activation and withdrawal related to depression.

    “The Behavioral Activation for Depression Scale (BADS) is a 25-item validated self-report measure of activation and withdrawal related to depression.50”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Effect sizes varied significantly and percentages were based on a small sample, so the findings should be interpreted cautiously.

    “We recognize that there is significant variability among these effect sizes and that percentages reported are based on a small sample; thus, these findings should be interpreted cautiously.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The treatment phase was 6 months in the previous open trial versus 4 months in this study, which could have affected the overall magnitude of effects.

    “As discussed earlier, the treatment phase in the open trial was 6 months, whereas it was 4 months in this study, which could have affected the overall magnitude of effects.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Baseline demographic characteristics and symptom severity were similar between the two treatment conditions, with no significant differences on nonparametric tests.

    “Visual examination of baseline scores indicated similar demographic characteristics and severity of symptoms between the two treatment conditions, and no significant differences were identified using nonparametric tests (Table 2).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The lead author trained the study therapists in the ADAPT manual, and their sessions were recorded and regularly reviewed for treatment integrity.

    “The remaining participants were treated by 3 study therapists who were initially trained in the treatment manual by the lead author, and whose sessions were recorded and regularly reviewed to ensure treatment integrity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Post-treatment interviewers were blinded to the patient's treatment condition.

    “Posttreatment interviewers were kept blind to the patient’s condition.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Patients were randomized using an urn randomization computer program that balanced the groups on gender and recruitment setting.

    “Patients were randomized to conditions using an urn randomization computer program that balanced for gender and recruitment setting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Treatment expectations and overall satisfaction were relatively high in both groups, but somewhat better in the ADAPT group.

    “These results indicate that treatment expectations and overall satisfaction were relatively high in both groups, but somewhat better in the group randomized to ADAPT.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The CES is a self-report measure of patients' initial expectations for improvement from treatment.

    “The Credibility and Expectancy Scale (CES) is a self-report measure of patients’ initial expectations for improvement from treatment.51”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Medication treatments were unstandardized and could have affected group differences in undetected ways.

    “Finally, medication treatments were unstandardized and could have affected group differences in undetected ways.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    It has increasingly been recognized that an individual's relationship or response to a psychotic symptom is more important than its frequency.

    “It has increasingly been recognized that an individual’s relationship or response to a psychotic symptom is more important than its frequency.62”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

65 of 65

  • The paper relies on this without support.

    There is a scarcity of psychotherapy studies that specifically target both depression and psychosis together.

    “However, few studies have specifically focused on addressing both depression and psychosis in psychotherapy.”

  • The paper relies on this without support.

    Behavioral activation is often especially difficult for patients with severe depression and psychosis because rumination and distress intolerance make it hard for them to persist with goal-directed activities.

    “However, behavioral activation in the context of severe depression and psychosis is often particularly challenging for patients due to rumination and intolerance of distress that result in difficulties persisting with goal-directed activities.”

  • The paper relies on this without support.

    Patients with comorbid depression and psychosis often have multiple problems, including suicidality and severe functional impairment.

    “The clinical population with comorbid depression and psychosis is challenging and often exhibits multiple problems, including suicidality and severe functional impairment.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a one-day workshop trial, 71% to 77% of ACT participants recovered from depression at 3-month follow-up.

    “71 and 77% recovered from depression in ACT at 3 month follow up after a one day workshop.68”

    From Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression (2017) · cites this paper as [68]

    The Method section (page unavailable) describes a 16-session treatment over four months, not a one-day workshop. The Results report reliable improvement in depressive symptoms for 50% of ADAPT participants at posttreatment, not 71%–77% recovery at three months; the Discussion says the three-month sample was too small for definitive conclusions. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • ACT has been tested in six randomized controlled trials using a group format, one of which was a single-day workshop.

    “ACT has also been evaluated in 6 RCTs in a group format, one of which used a single day workshop format.68”

    From Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression (2017) · cites this paper as [68]

    The Introduction describes this paper’s pilot randomized trial of ADAPT and mentions another ACT-based pilot trial, but it does not count six group-format RCTs. The Methods describe a 16-session protocol, not a single-day workshop. Searches for group trials and a workshop found no passage supporting the cited claim; page numbers were unavailable in our copy. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

  • Gaudiano et al. (2015) found medium to large effects of ACT on depression and psychosocial functioning in people with affective psychoses.

    “Gaudiano et al. (2015) conducted a randomized controlled trial of an ACT based treatment package for people with affective psychoses (mostly major depression with psychotic features) and found medium to large effects for of ACT on depression and psychosocial functioning.”

    From A parallel group randomised open blinded evaluation of A cceptance and Commitment Therapy for d epression a fter p sychosis: Pilot t rial outcomes (ADAPT) (2017) · cites this paper as Gaudiano et al. (2015)

  • Gaudiano et al. (2015) had a sample size of n=13, randomization was not independent of trial team, and assessment of outcome was unblinded.

    “The study sample size was n=13, randomization was not independent of trial team and assessment of outcome was unblinded.”

    From A parallel group randomised open blinded evaluation of A cceptance and Commitment Therapy for d epression a fter p sychosis: Pilot t rial outcomes (ADAPT) (2017) · cites this paper as Gaudiano et al. (2015)

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Not confirmedz = -1.81reported p = .069 · recomputed p = .070

    “z = −1.81, p = .069”

  • Consistentz = -1.75reported p = .08 · recomputed p = .080

    “z = −1.75, p = .080”

2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Reliable worsening percentage for ADAPT does not match count

    Major

    The paper reports reliable worsening in one ADAPT patient (16%). If the relevant denominator is the 6 ADAPT completers used throughout the results, 1/6 is 16.7%, not 16% exactly. This is within rounding tolerance and not a discrepancy.

    Reported 16 · recomputed 16.666667

1 of 1

Cites

Flagged first, then by citations

6 of the 69 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
GAUDIANO, B. A., BUSCH, A. M., WENZE, S. J., NOWLAN, K., EPSTEIN-LUBOW, G., & MILLER, I. W.
Affiliations
University of North Carolina at Chapel Hill (US)
ORCID
Venue
Journal of Psychiatric Practice
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-09
Volume
21
Issue
5
Pages
320-333
ISSN
  • 1527-4160 (ISSN-L)
  • 1538-1145
DOI
10.1097/pra.0000000000000092
PMC
PMC4704101
OpenAlex
W1474740825
Cited by
37
References
69
Citations by year
2026: 1 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 4 · 2016: 6
FWCI
6.20
Type
journal article
Language
en
Open access
Locations
  • Journal of Psychiatric Practice (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K23MH076937)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
ADAPT, psychosis, comorbid depression, behavioral activation, mindfulness, acceptance and commitment therapy, experiential avoidance, treatment feasibility, psychosocial functioning, outpatient care
MeSH terms
Adult, Major Depressive Disorder, Feasibility Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Psychotic Disorders, Comorbidity, Outcome Assessment, Health Care, Acceptance and Commitment Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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