Narrative intervention to disseminate ACT for depression in primary care

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DESCRIPTION (provided by applicant): The public health impact of existing treatments for depression is limited by our ability to disseminate those treatments. There is a particular need to find innovative ways to disseminate key principles of empirically supported psychotherapy in primary care settings. Over half of U.S. residents who receive mental health care receive it in primary care, and primary care can reach many who might not access psychiatric care due to perceived stigma or other barriers. Narrative communication is an alternative way to disseminate key principles of psychotherapy that catalyze behavior change. Narrative communication refers to "storytelling" -real people telling stories about their struggles and successful ways of coping. Narrative interventions can result in behavior change for other problems, such as hypertension. An advantage of narrative communication is that it can be easily distributed (by video), can be very engaging, and may reach people who do not have access to other technologies or who experience barriers to traditional psychotherapy. We propose that key principles of a type of cognitive-behavioral therapy (Acceptance and Commitment Therapy, or ACT) can be disseminated through a video storytelling intervention. ACT is an empirically-supported therapy for depression and related problems. Key principles for catalyzing behavior change and alleviating depression include: 1) striving for consistency between personal values and daily actions; 2) being more willing to experience negative thoughts/ feelings in the service of personal values; 3) viewing negative thoughts/feelings as transient; and 4) being more fully present (or mindful) in everyday life. There are two primary aims of this treatment development project. First, together with a video production firm, we will produce a storytelling video intervention (sTVi), with real primary care patients discussing their own (ACT-consistent) successful coping strategies. Using an iterative process, we will create 4 30-minute "episodes" intended to be viewed over the course of a month; we will also create an accompanying workbook. Second, we will conduct a) a small open trial (n = 10) of sTVi and b) pilot randomized controlled trial (n = 40) with depressed primary care patients receiving antidepressant medication treatment as usual (TAU) + sTVi vs. TAU + attention control videos. Assessments will occur at baseline and 4 and 12 weeks. We will examine feasibility and acceptability of sTVi (by examining uptake and completion of sTVi, whether the videos are considered engaging, and whether viewers understand key ACT principles and see them as relevant to their lives) and of the RCT research design. We will examine treatment differences (within relevant confidence intervals) on outcomes (e.g., depression). We will examine change in hypothesized mechanisms, i.e., ACT-consistent coping strategies. The next step in this line of research is to test, in a large- scale randomized controlled trial, the efficacy of sTVi as an adjunct to antidepressant medication in depressed primary care patients, and to examine ACT-consistent coping strategies as mechanisms of action.