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Research from AccEPT

Our research aims to develop or improve psychological therapies for people who experience depression or related conditions. At any one time we have several research projects running within the AccEPT Service.

Current Projects: recruiting now or in the near future

Augmented Depression Therapy for first onset depression (ADepT-FO): 2020 - Recruiting now
 
The ADepT-FO project is adapting the ADepT wellbeing protocol already used in previous work to focus specifically on the treatment of young adults experiencing their first episode of depression. A multiple randomised baseline case series aims to recruit 15 students from the University wellbeing service who are experiencing depression. This case series is currently recruiting. The AccEPT clinic will host the project and all treatment will be delivered by AccEPT therapists.
 
Mindfulness Based Cognitive Therapy Non-Responders project: 2020 – Opening for recruitment in Jan 2021

A subgroup of individuals treated with current best practice individual psychological therapies are still symptomatic at the end of treatment and require further support. This multi-centre trial will evaluate if Mindfulness Based Cognitive Therapy (MBCT) can help individual reach recovery who have not previously responded to individual CBT delivered in NHS Improving Access to Psychological Therapy Services. 234 patients will be randomised to receive treatment as usual or treatment as usual + MBCT and both clinical- and cost- effectiveness will be evaluated. The AccEPT clinic is one of three sites in the trial (which is being led from University of Surrey by Thorsten Barnhofer). This project was funded by an NIHR Research for Patient Benefit Grant 

Past Projects:

Below are the Research projects that have been supported by the AccEPT Clinic in the past.  These projects are no longer recruiting.

Imagery Based Emotion Regulation for Bipolar Disorder (IBER): 2019  

The IBER project, funded by NIHR, is a pilot randomised controlled trial evaluating whether an imagery based therapy can help individuals with bipolar disorder manage anxiety symptoms. Participants were recruited at three sites (Devon, Berkshire and Oxford), and half received one-to-one imagery-based therapy on top of their usual care. The therapy consists of up to 12 sessions over four months. This project has now finished recruiting, treatment has been completed and the results are expected in early 2021. The AccEPT clinic hosted the project at the Devon site and one of our therapists delivered the therapy to local participants.

Publications:

  • Steel, C., Wright, K., Goodwin, G., Simon, J., Morant, N., Taylor, R., ... & Holmes, E. (2020). The IBER study: study protocol for a feasibility randomised controlled trial of Imagery Based Emotion Regulation for the treatment of anxiety in bipolar disorder. Pilot and feasibility studies, 6(1), 1-9.

Behavioural Activation for Bipolar Depression (BA-BD): 2019 

The BA-BD project is evaluating whether Behavioural Activation is an effective treatment for depression in the context of bipolar disorder. Behavioural Activation has been found to be effective in people with unipolar depression; in this study we adapted it for people who have a Bipolar diagnosis. BA-BD is an individual therapy consisting of up to 20 one-to-one sessions. Twelve patients have been offered the treatment, which is being evaluated with a randomised multiple baseline case series design. This project has now finished recruiting and treatment is being completed. The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.  

Therapy for Inter-episode Mood Variability in Bipolar (ThrIVe-B): 2017 to 2020  

A substantial number of people with a Bipolar spectrum diagnosis report experiencing frequent mood swings outside of major episodes of depression or mania. The ThrIVe-B project, funded by NIHR, was a randomised controlled feasibility trial of an adapted version of an existing therapy (Dialectical Behaviour Therapy: DBT) which is designed to help with emotion regulation. The study was conducted at two sites (Devon and Cumbria). Once the results have been published in an academic journal they will be reported here. This study built on the findings of a previous case series study of the ThrIVe-B approach which was conducted within AccEPT.

Publications:

  • Wright, K., Palmer, G., Javaid, M., Mostazir, M., & Lynch, T. (2020). Psychological therapy for mood instability within bipolar spectrum disorder: a single-arm feasibility study of a dialectical behaviour therapy-informed approach. Pilot and Feasibility Studies, 6, 1-12.
  • Wright, K., Dodd, A., Warren, F. C., Medina-Lara, A., Taylor, R., Jones, S., ... & Newbold, A. (2018). The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study. Trials, 19(1), 560.

Augmented Depression Therapy (ADepT): 2015 - 2020

The ADepT project developed and then evaluated in a case series and pilot trial a novel wellbeing oriented treatment for depression. ADepT is an individual therapy consisting of up to 15 acute sessions and 5 booster sessions.  A multiple randomised baseline case series (11 patients)  evaluation showed promising evidence of acceptability, feasibility and clinical efficacy and is now published (Dunn et al., 2019a). The pilot trial randomised 80 depressed participants to receive either ADepT or CBT (trial protocol paper; Dunn et al., 2019b). The trial follow up period finished in March 2020 and the results of the pilot trial are currently being written up.  The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.  This project was funded by an NIHR Career Development Fellowship awarded to Barney Dunn.

 Publications:

  • Dunn, B. D., Widnall E, Reed, N., Owens, C., Campbell, J., Kuyken, W.  (2019) Bringing light into darkness: A randomised multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT). Behaviour Research & Therapy, 120, 103418.
  • Dunn, B. D., Widnall, E., Reed, N., Taylor, R., Owens, C. et al (2019) Evaluating Augmented Depression Therapy (ADepT): Study protocol for a pilot randomised controlled trial. Pilot and Feasibility Studies, 5: 63

The Morita Trial: 2015 – 2017

The Morita Trial developed and tested the feasibility and acceptability of Morita Therapy for depression. Morita Therapy is a Japanese psychological therapy previously untested in the UK, which contrasts with established Western approaches in teaching that symptoms are part of the natural ecology of human experience. The Morita Trial consisted of a pilot randomised controlled trial, post-treatment qualitative interviews and integrative mixed methods analysis, which showed promising evidence of acceptability, feasibility and treatment benefits (Sugg et al., 2018; Sugg et al., 2019; Sugg et al., 2020a). The pilot trial randomised 68 depressed participants to receive either 8-12 individual sessions of Morita Therapy according to the UK Morita Therapy protocol (Sugg et al., 2017) or treatment as usual. 94% of participants were retained at four month follow-up; 70.6% of Morita Therapy participants adhered to the minimum treatment dose, and 66.7% achieved remission in depressive symptoms (compared to 30.0% in TAU). Qualitative and mixed methods findings indicated that Morita Therapy was broadly acceptable to therapists and participants, and highlighted potential moderators of acceptability, treatment adherence and outcomes.  The AccEPT clinic hosted the project and all treatment was delivered by AccEPT therapists.  This project was funded by a University of Exeter Medical School PhD awarded to Holly Sugg.

 Publications:

  • Sugg HVR, Richards DA, Frost J. 2020. What is Morita Therapy? The nature, origins and cross-cultural application of a unique Japanese psychotherapy. Journal of Contemporary Psychotherapy, pp.1-10, doi: 10.1007/s10879-020-09464-6.
  • Sugg HVR, Frost J, Richards DA. 2020. Personalising psychotherapies for depression using a novel mixed methods approach: an example from Morita therapy. Trials, 21(41), pp.1-12.
  • Sugg HVR, Frost J, Richards DA. 2019. Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability. BMJ Open, 9, e023873.
  • Sugg HVR, Richards DA, Frost J. 2018. Morita Therapy for depression (Morita Trial): a pilot randomised controlled trial. BMJ Open, 8(8), e021605.
  • Sugg HVR, Richards DA, Frost J. 2017. Optimising the acceptability and feasibility of novel complex interventions: an iterative, person-based approach to developing the UK Morita therapy outpatient protocol. Pilot and Feasibility Studies, 3(1), 37.
  • Sugg HVR, Richards DA, Frost J. 2016. Morita therapy for depression and anxiety (Morita Trial): study protocol for a pilot randomised controlled trial. Trials, 17(1), 161. 

HeLM: 2014 - 2016 

The HeLM project developed an adapted version of MBCT for supporting patients with depression and cardiovascular disease and compared it in a three arm pilot trial to Mindfulness Based Stress Reduction (MBSR) or treatment as usual (TAU). The project is now completed, with the main results having been published (Alsubaie et al., 2020). The project was funded through a Saudi Arabian government PhD award to Modi Alsubaie and some additional support from PenCLARHC.

Publications:

  • Alsubaie M., Dickens C., Dunn B. D., Gibson A., Ukoummunne O., Evans A, et al. (2020). Feasibility and Acceptability of Mindfulness-Based Cognitive Therapy Compared with Mindfulness-Based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a three-arm Randomised Controlled Trial. Mindfulness, 11, 30-50. 
  • Alsubaie, M., Abbot, R., Dunn, B. D., Dickens, C., Keil, T.F. et al. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74-91.

PREVENT trial - Mindfulness Based Cognitive Therapy (MBCT) for recurrent Depression: 2012 – 2015 

PREVENT was a large scale multicentre definitive trial comparing MBCT to maintenance anti-depressant medication (ADM) in preventing relapse in those vulnerable to depression. The main trial paper was published in 2015, showing that MBCT (with an invitation to stop making meds) was equivalently effective to continuing with meds. This is one part of the evidence that has led to MBCT now starting to be rolled out nationally as part of the Improving Access to Psychological Therapies Programme. The trial was led from the Mood Disorders Centre and AccEPT clinic staff contributed to delivery of the mindfulness groups run at the Exeter site. The trial was funded by an NIHR HTA grant.

Publications

  • Kuyken, W., Hayes, R., Barrett, B., Byng, R, Dalgleish, T., Kessler, D. et al (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT). The Lancet, 386, 63-73.

Group treatment for survivors of interpersonal trauma with complex PTSD: 2012 

The treatment combines elements of trauma-focussed therapy with interpersonal therapy and a compassion-informed emotion regulation component. It is run over 18 weeks. The AccEPT clinic supported this treatment development project. Altogether, 28 clients successfully completed the group. At three months after the treatment, we found overall large reductions in PTSD and medium size reductions in depression and dysfunctional self-organisation a key feature of complex PTSD. A manuscript is currently finalised for publication (Karl et al., 2020) and funding is sought for the evaluation of its effectiveness and cost-effectiveness (an NIHR grant application been submitted recently).

Related to research around self-compassion as one hypothesised key mechanism of addressing negative self bias as it is key vulnerability factor for both PTSD and depression, PhD student Hans Kirschner conducted a psychophysiological study in individuals with recurrent depression who engaged in the clinic’s MBCT program (Kirschner et al., 2020).

Publications

  • Kirschner, H., Kuyken, W, & Karl, A. (2020). A biobehavioural approach to understand how mindfulness-based cognitive therapy reduces dispositional negative self-bias. Manuscript under review.
  • Karl, A., Shepstone, L., Gilmore, L., Gerdes, S., Drake, A., Handley, V., Haslam, A., Haslam, C. & O'Mahen, H. (2020). Boosting trauma-focused therapy for individuals with PTSD subsequent to interpersonal trauma – development of a new group therapy for more resilient self, emotion regulation and interpersonal learning. Manuscript in preparation.

Other Publications:

  • O’Mahen, H. A., Moberly, N. J., & Wright, K. A. (2019). Trajectories of change in a group behavioral activation treatment for severe, recurrent depression. Behavior therapy, 50(3), 504-514.
  • Mars B, Gibson J, Dunn B. D., Gordon, C., Heron, J., Kessler, D., Wiles, N., Moran, P. (2020). Personality difficulties and response to community-based psychological treatment for anxiety and depression. Journal of Affective Disorders. Unedited accepted version
  • Kuyken, W. & Dunn, B. D. (in press). Case conceptualisation in Mindfulness Based Cognitive Therapy. Handbook of Psychotherapy Case Formulation (3rd edition), Guilford Press.
  • Dunn, B. D. (2019) Augmenting Cognitive Behavioural Therapy to Build Positive Mood in Depression in Gruber, J (eds) The Oxford Handbook of Positive Emotion and Psychopathology.
  • Widnall, E., Price, A., Trompetter, H., & Dunn, B.D (2019). Routine Cognitive Behavioural Therapy for anxiety and depression is more effective at repairing symptoms of psychopathology than enhancing wellbeing. Cognitive Therapy & Research, 44, 28-39.