This study aimed to determine whether adverse childhood experiences (ACEs) predict treatment outcome for clients with major depressive disorder in a Norwegian public mental health program.

One hundred adults diagnosed with major depression who completed 9 to 18 sessions of either Cognitive Behavioral Therapy (CBT; n=48) or Emotion-focused Therapy (EFT; n=52).

ACE exposure before the age of 18 was assessed using the Adverse Childhood Experiences Scale (ACE). Participants were categorized into three groups: Low ACE (0-1 ACEs), Moderate ACE (2-3 ACEs), and High ACE (≥4 ACEs). The relationship between ACE score, treatment type, and treatment outcome—measured by changes in the Beck Depression Inventory-II—was analyzed using Generalized Additive Modeling.

High ACE exposure was associated with more severe baseline symptoms. By session nine and at the 12-month follow-up, there was no significant difference in symptom severity between the groups.

Greater exposure to ACEs was associated with more severe symptoms at the start of therapy. Both CBT and EFT, in a short-term format, appeared effective regardless of the number of adverse childhood experiences, with no significant differences between treatment conditions.