Psychological Medicine

Original Articles

Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial

M. Fledderusa1 c1, E. T. Bohlmeijera1, M. E. Pietersea1 and K. M. G. Schreursa1a2

a1 University of Twente, Faculty of Behavioural Sciences, Department of Psychology, Health and Technology, Enschede, The Netherlands

a2 Roessingh Rehabilitation Centre, Enschede, The Netherlands


Background In order to reduce the high prevalence of depression, early interventions for people at risk of depression are warranted. This study evaluated the effectiveness of an early guided self-help programme based on acceptance and commitment therapy (ACT) for reducing depressive symptomatology.

Method Participants with mild to moderate depressive symptomatology were recruited from the general population and randomized to the self-help programme with extensive email support (n=125), the self-help programme with minimal email support (n=125) or to a waiting list control group (n=126). Participants completed measures before and after the intervention to assess depression, anxiety, fatigue, experiential avoidance, positive mental health and mindfulness. Participants in the experimental conditions also completed these measures at a 3-month follow-up.

Results In the experimental conditions significant reductions in depression, anxiety, fatigue, experiential avoidance and improvements in positive mental health and mindfulness were found, compared with the waiting list condition (effect sizes Cohen's d=0.51–1.00). These effects were sustained at the 3-month follow-up. There were no significant differences between the experimental conditions on the outcome measures.

Conclusions The ACT-based self-help programme with minimal email support is effective for people with mild to moderate depressive symptomatology.

(Received February 14 2011)

(Revised May 16 2011)

(Accepted June 10 2011)

(Online publication July 11 2011)