Choosing ACT or CBT: A preliminary test of incorporating client preferences for depression treatment with college students

• Published in: Journal of affective disorders Vol. 325; pp. 413 - 420
• Main Authors: Davis, Carter H., Twohig, Michael P., Levin, Michael E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.03.2023
• Subjects: Acceptance and Commitment Therapy; Anxiety - therapy; Client preferences; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Depression; Depression - therapy; Humans; Self-help; Students; Treatment Outcome; Depression; Self-help; Client preferences; Acceptance and commitment therapy; Cognitive behavioral therapy
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.12.097

Depression is a significant concern among college students, who suffer at higher rates and with greater severity than the general population. Online self-help could reduce the burden currently placed on college counseling centers, and programs based in cognitive behavioral therapies (CBTs) have a strong evidence base. However, online CBTs for depression often suffer from low adherence rates. An understudied method for improving adherence in this population is offering students a choice between various CBTs. We conducted a randomized trial with 142 students with high levels of depression, with a subset of participants randomly receiving either traditional cognitive behavioral therapy (tCBT) or acceptance and commitment therapy (ACT) and an additional arm who could choose between the two. Both treatments effectively reduced depression over 10 weeks, with ACT showing a slight advantage over tCBT. Surprisingly, students who were randomized to their treatment saw greater reductions in anxiety, and higher adherence to the program, than those who chose between the two. Our study suffered from a notable amount of dropout and our results should be considered preliminary. Our sample size was relatively small at posttreatment, limiting our ability to make strong conclusions about group differences. Additionally, further steps could have been taken to minimize the risk of bias when presenting treatment options to the choice group. Our preliminary results suggest that simply providing students with an evidence-based resource may be more important than providing options and raise additional questions about the function of client preference in self-help dissemination. •College students with depression were either randomly given or chose a treatment.•Two self-help cognitive behavioral therapies both effectively reduced depression.•Unexpectedly, randomized students had better adherence than those choosing.•Anxiety improved more for randomized students.