Depression Treatment: Acceptance and Commitment Therapy

Acceptance and Commitment Therapy or ACT, is generally pronounced as the word rather than the acronym, and is an effective psychotherapy for the treatment of depression.  ACT is based on the belief that depression, and all human suffering, is caused by repeated attempts to avoid uncomfortable emotions and experiences.  According to ACT, when people attempt to avoid or escape distressing feelings or experiences , they may begin to engage in behaviors that are unhealthy and increase risk for more depressive symptoms (e.g., isolation, drinking, using drugs, TV watching, internet surfing). Ultimately, these behaviors, which ACT therapists call “experiential avoidance,” become normal and life gets really small as people spend a good chunk of their days focused on escaping from or reducing distressing private experiences.  Treatment for depression with ACT focuses on teaching people how to accept distressing emotions and experiences and commit to engaging in behaviors that are based on their personal values.  
 
How does ACT work? The basic idea in ACT is that depression is caused and maintained by people’s natural desire to avoid suffering.  Based on a theory called Relational Frame Theory (Hayes, Barnes, & Roche, 2001), ACT suggests that human language and the ways we learn language early in life, create an idea that “psychological health” means the absence of unwanted or distressing private experiences such as sadness, angry thoughts, and worries. Efforts to obtain relief from these experiences results in “psychological inflexibility,” which can lead to difficulty in adjusting to life’s challenges .  As inflexibility increases, people can get stuck in using ineffective behaviors, especially when life gets difficult.

ACT helps people become aware of the ways in which they are “stuck” in psychological inflexibility and identify what activities are most consistent with their values. A number of core strategies are used in ACT, including increasing activities that provide a sense of accomplishment or pleasure, decreasing avoidance behaviors, identifying and working towards important life goals even in the face of negative moods, and solving problems. 

What does ACT look like in action?  After learning how ACT therapists think about depression, clients begin the process of becoming more OPEN, AWARE, and ENGAGED to increase psychological flexibility and improve depression.   
    OPEN: Being open means being able to accept thoughts and emotions as they are without going to great lengths to try to control these private experiences.  Being OPEN is the opposite of experiential avoidance.
    AWARE: Being aware means being able to stay in the present moment during individual and social activities.  Being AWARE is the opposite of being checked out.
    ENGAGED: Being engaged means being able to identify personal values and pursue activities that are consistent with those values.  Being engaged is the opposite of being withdrawn.
    Although there is not a formal sequence for ACT, treatment does follow a predictable pattern in most cases.  ACT therapists begin by helping clients understand that trying to control private experiences (experiential avoidance) generally creates more problems than solutions. Logically, the next the step is to identify problematic behaviors that clients use to avoid or control their symptoms of depression and start brainstorming ways to use more effective behaviors.  One strategy ACT therapists often use here is mindfulness, which means being able to pay attention on purpose in a non-judgmental way.  Mindfulness strategies are used to help clients develop an alternative to avoidance behaviors such as over-thinking problems or numbing activities (e.g., drugs, alcohol, TV watching).  Finally, ACT therapists help clients identify what’s really important to them and why.  This process called “values identification” helps ACT therapists and clients pinpoint which types of activities are most likely to improve mood and help build meaning into life.

Sources


•    Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commit- ment therapy: An experiential approach to behavior change. New York, NY: Guilford.
•    Hayes, SC.. (2004). Acceptance and Commitment Therapy, Relational FrameTheory, and the Third Wave of Behavioral and Cognitive Therapies. Behavior Therapy 35, 639-665.