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Depression and Acceptance and Commitment Therapy

Written by sshowalter, cmite12, ritasharma.

Acceptance and Commitment Therapy (ACT) is a form of behavioral therapy that includes practices of acceptance and mindfulness along with behavior-change strategies that can help in the treatment of depression. Unlike behavioral therapy which emphasizes controlling thoughts and feelings, ACT teaching strategies to observe, accept and embrace these thoughts and feelings.1 Some have found the therapy hard to categorize as it challenges the current western psychological paradigm, preferring instead to describe it as an "existential humanistic cognitive behavioral therapy." 2

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Effect of Acceptance and Commitment Therapy on Depression

ACT does not seek to reduce the symptoms (i.e. symptoms of depression) associated with any chronic mental illnes, believing resistance of symptoms to be futile, though symptom reduction is often achieved. 2 Rather, through therapy, clients seek to open to their emotions and thoughts and invest their energies in taking effective action to change their lives.2 ACT therapy, then, is centered around two main focuses: 1) accept experiences outside of the individual's control and 2) take actionable steps towards living a valued and balance life.2

The six core principles of ACT are:2

1) Cognitive diffusion- allows the individual to "step back" from whatever they are experiencing and objectively observe their emotion or thought as merely words and ideas. These words and ideas are not (necessarily) the threatening situations the individual perceives them to be and are indeed separate from the individual themselves.

2) Acceptance- urges the client to openly embrace whatever unpleasant feelings, emotions or thoughts come up.

3) Contact with the present moment- brings the client's awareness to the here-and-now.

4) The observing self- helps the individual to see they they are an objective observer to their emotions and thoughts and the situations the individual perceives are actually separate from the individual themselves.

5) Values- help identify what values are central to the individual.

6) Committed action- helps the individual set goals based on their established meaningful values.

ACT treatment can be additionally aided by a regular meditation practice which would reinforce many similar principles.

Read more details about Acceptance and Commitment Therapy.

Research Evidence on Acceptance and Commitment Therapy

Results from a formidable study conducted in the 1986 found that acceptance and commitment therapy (ACT), when coupled with cognitive therapy, produced a significant decrease in depression in the study participants.4 (Reduction of depression was determined via the Hamilton Rating Scale for Depression or HAM-D; a reputable means for rating depression.)

In another study, ACT was found to both decrease depression and increase concrete stress-reduction actions taken in by 90 individuals in the workplace.5 Additionally, stress and psychological health were beneficially affected as a result of exposure to ACT.5

One study conducted on mental health workers in Sweden found that those exposed to four 1-hour sessions per week of acceptance and commitment therapy utilized fewer sick days and fewer medical treatment resources (including physician, specialist and physical therapy visits) than those who were not exposed to ACT.3

Yet another study found that the majority of participants self-reported lower rates of depression and anxiety and 37% of those participants improved so dramatically the change was considered clinically significant (meaning the client no longer meets the criteria for a clinical diagnosis.)6

Other Uses

ACT has been used in and tested for the effective treatment of a variety of mental health conditions. It may be used in conjunction with other forms of therapy or other treatment and has no known side effects.

References

  1. Acceptance and commitment Therapy for Depression. Society of Clinical Psychology: American Psychological Association, Division 12. Retrieved from http://www.div12.org/PsychologicalTreatments/index.html
  1. Harris, R. (2006). Embracing your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4).
  1. Dahl, J., Wilson, K.G. & Nilsson, A. (2004). Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting from Stress and Pain Symptoms: A Preliminary Randomized Trial. Behavior Therapy 35, 785-801.
  1. Zettle, R.D. & Hayes, S.C. (1986). Dysfunctional Control by Client Verbal Behavior: The Context of Reason-Giving. The Analysis of Verbal Behavior 4, 30-38.
  1. Bond, F.W. & Bruce, D. (2000). Mediators of Change in Emotion-Focused and Problem-Focused Worksite Stress Management Interventions. Journal of Occupational Health Psychology 5, 156-163.
  1. Dalrymple, K.L (2005). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study (Doctoral Dissertation). Drexel University, Philadelphia, PA. Retrieved from http://144.118.25.24/bitstream/1860/612/7/Dalrymple_Kristy.pdfAcceptance and Commitment Therapy (ACT) is a form of behavioral therapy that includes practices of acceptance and mindfulness along with behavior-change strategies that can help in the treatment of depression. Unlike behavioral therapy which emphasizes controlling thoughts and feelings, ACT teaching strategies to observe, accept and embrace these thoughts and feelings.1 Some have found the therapy hard to categorize as it challenges the current western psychological paradigm, preferring instead to describe it as an "existential humanistic cognitive behavioral therapy." 2

How it Works?

ACT does not seek to reduce the symptoms associated with any chronic mental illnes, believing resistance of symptoms to be futile, though symptom reduction is often achieved. 2 Rather, through therapy, clients seek to open to their emotions and thoughts and invest their energies in taking effective action to change their lives.2 ACT therapy, then, are centered around two main focuses: 1) accept experiences outside of the individual's control and 2) take actionable steps towards living a valued and balance life.2

The six core principles of ACT are:2

1) Cognitive diffusion- allows the individual to "step back" from whatever they are experiencing and objectively observe their emotion or thought as merely words and ideas. These words and ideas are not (necessarily) the threatening situations the individual perceives them to be and are indeed separate from the individual themselves.

2) Acceptance- urges the client to openly embrace whatever unpleasant feelings, emotions or thoughts come up.

3) Contact with the present moment- brings the client's awareness to the here-and-now.

4) The observing self- helps the individual to see they they are an objective observer to their emotions and thoughts and the situations the individual perceives are actually separate from the individual themselves.

5) Values- help identify what values are central to the individual.

6) Committed action- helps the individual set goals based on their established meaningful values.

Evidence that it Works?

Results from a formidable study conducted in the 1986 found that acceptance and commitment therapy (ACT), when coupled with cognitive therapy, produced a significant decrease in depression in the study participants.4 (Reduction of depression was determined via the Hamilton Rating Scale for Depression or HAM-D; a reputable means for rating depression.)

In another study, ACT was found to both decrease depression and increase concrete stress-reduction actions taken in by 90 individuals in the workplace. 5 Additionally, stress and psychological health were beneficially affected as a result of exposure to ACT.5

One study conducted on mental health workers in Sweden found that those exposed to four 1-hour sessions per week of acceptance and commitment therapy utilized fewer sick days and fewer medical treatment resources (including physician, specialist and physical therapy visits) than those who were not exposed to ACT.3

Yet another study found that the majority of participants self-reported lower rates of depression and anxiety and 37% of those participants improved so dramatically the change was considered clinically significant (meaning the client no longer meets the criteria for a clinical diagnosis.)6

References:

1 Acceptance and commitment Therapy for Depression. Society of Clinical Psychology: American Psychological Association, Division 12. Retrieved from http://www.psychology.sunysb.edu/eklonsky-/division12/treatments/depression_acceptance.html

2 Harris, R. (2006). Embracing your Demons: An Overview of Acceptance and Commitment Therapy. Psychotherapy in Australia, 12(4).

3 Dahl, J., Wilson, K.G. & Nilsson, A. (2004). Acceptance and Commitment Therapy and the Treatment of Persons at Risk for Long-Term Disability Resulting from Stress and Pain Symptoms: A Preliminary Randomized Trial. Behavior Therapy 35, 785-801.

4 Zettle, R.D. & Hayes, S.C. (1986). Dysfunctional Control by Client Verbal Behavior: The Context of Reason-Giving. The Analysis of Verbal Behavior 4, 30-38.

5 Bond, F.W. & Bruce, D. (2000). Mediators of Change in Emotion-Focused and Problem-Focused Worksite Stress Management Interventions. Journal of Occupational Health Psychology 5, 156-163.

6 Dalrymple, K.L (2005). Acceptance and Commitment Therapy for Generalized Social Anxiety Disorder: A Pilot Study (Doctoral Dissertation). Drexel University, Retrieved from http://144.118.25.24/bitstream/1860/612/7/Dalrymple_Kristy.pdf

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