ADepT
A research study of Augmented Depression Therapy – A new treatment for depression
Clinical depression is a common and debilitating psychiatric disorder. It makes the biggest contribution to the burden of disease of all mental health problems and is predicted to become the second-highest of all general health problems by 2020.
We already have good psychological treatments for depression, but these do not work for everyone and there is room to improve. Current psychological treatments are effective at reducing negativity (thinking and feeling sad and anxious) but are less successful at building positivity (thinking and feeling happy; experiencing wellbeing). We know that reduced positivity predicts that individuals will stay depressed for longer and are more likely to become depressed again in the future. This project aimed to develop and evaluate an enhanced psychological therapy for depression that simultaneously reduces negativity and builds positivity in an effort to keep people well in the long term.
Phase 1 of the project developed alongside service-users and NHS clinicians a novel talking therapy for depression targeting positivity and negativity in a way that is acceptable to service-users and can be implemented in the NHS. We have called this novel intervention Augmented Depression Therapy (ADEPT). Whether ADEPT was effective at reducing depression and building wellbeing has been evaluated in a case series design.
Phase 2 of the project ran a pilot clinical trial, evaluating if the novel talking therapy for depression is better than current best practice in the NHS (cognitive behaviour therapy) in reducing depression and in building wellbeing.
Who was involved?
Participants were aged over 18 who had a primary diagnosis of ‘Major Depressive Disorder’, assessed through a standard clinical interview by the research team.
Participants were recruited via selected GP surgeries and local Improving Access to Psychological Therapies Services.
Where did the study take place?
The study took place in Devon, led by the Mood Disorders Centre at the University of Exeter. Both treatments are being delivered by the AccEPT clinic hosted in the Mood Disorders Centre.
When did the project ran?
The project began in January 2015 and ended in January 2020. The case studies evaluating the novel intervention began in February 2016 and completed in March 2017. The pilot clinical trial contrasting the novel intervention to CBT began recruitment in April 2017 and recruited its last patient in July 2018, and completed its last follow-up in 2019.
Who funded the project?
The project was funded by a Career Development Fellowship awarded to Barney Dunn by the UK National Institute for Health Research (NIHR)
What did the project find?
In a range of secondary analyses we showed that current treatments like CBT do not adequately repair positive mood/wellbeing (Widnall et al., 2019; Dunn et al., 2020; AlSayedNasser et al., 2021). We developed ADepT and were able to show that it was feasible and acceptable to clients and therapists. In a case series evaluation, we demonstrated ADepT led to large improvements during treatment in depression and wellbeing that were sustained at one year follow-up (Dunn et al., 2019a). In a pilot trial, we showed that ADepT was not inferior to and has the potential to be superior to CBT in the treatment of depressionand also was cost effective relative to CBT (Dunn et al., 2019b; Dunn et al., 2023).Results of the trial were covered by the BBC and other media outlets.
What are we doing next?
We are now developing and evaluating a clinician training pipeline for ADepT, writing the ADepT treatment manual for publication, adapting and further evaluating ADepT to work with young adults and those with more complex depression, and seeking funding for a large scale definitive trial evaluating ADepT.
Publications linked to the ADepT project
Alsayednasser B, Widnall E, O'Mahen H, Wright K, Warren F, Ladwa A, Khazanov GK, Byford S, Kuyken W, Watkins E, et al (2022). How well do Cognitive Behavioural Therapy and Behavioural Activation for depression repair anhedonia? a secondary analysis of the COBRA randomised controlled trial. Behaviour Research and Therap
Dunn BD, German RE, Khazanov G, Xu C, Hollon SD, DeRubeis RJ (2020). Changes in Positive and Negative Affect During Pharmacological Treatment and Cognitive Therapy for Major Depressive Disorder: a Secondary Analysis of Two Randomized Controlled Trials. Clinical Psychological Science, 8(1), 36-51.
Widnall E, Price A, Trompetter H, Dunn BD (2020). Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing. Cognitive Therapy and Research, 44(1), 28-39.
Dunn BD, Widnall E, Reed N, Owens C, Campbell J, Kuyken W (2019). Bringing light into darkness: a multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behaviour Research and Therapy, 120, 103418-103418
Dunn BD, Widnall E, Reed N, Taylor R, Owens C, Spencer A, Kraag G, Kok G, Geschwind N, Wright K, et al (2019). Evaluating Augmented Depression Therapy (ADepT): Study protocol for a pilot randomised controlled trial. Pilot and Feasibility Studies, 27, 63-63.
Dunn, B. D. et al (2023). A comparison of Augmented Depression Therapy (ADepT) versus Cognitive Behavioural Therapy (CBT) for the treatment of anhedonic depression: Results of a pilot randomized controlled trial. Lancet eClinicalMedicine.
Contact details
The chief investigator for the project was Barney Dunn, Mood Disorders Centre, University of Exeter. E-mail: b.d.dunn@exeter.ac.uk