Treatment for Depression and Acceptance and Commitment Therapy (ACT)

Treatment for depression has been shown to be effective for many people who have been in Acceptance and Commitment therapy, also known as ACT. ACT is considered a newer wave of behavioral therapy. In this treatment we are frequently employing the six different domains of this therapy. I will describe each one of them and how it can be applicable in help for depression.

One domain is called defusion. The idea here is that we often buy into our thoughts and when we do we call this fusion. If you have the thought that you are a banana it might be very easy to not buy into that thought so you would then defuse from it. If you are depressed and have the thought that you are stupid you may readily buy into it, that is, become fused with it. When you do your mood would become worse. We have developed a bunch of techniques to use to help you put distance between you and the thought. The idea is to detached yourself from the thought.

Another domain is called acceptance. I prefer not to use that name and rather call it letting in or allowing in. To many people the word acceptance means liking begrudgingly. Here we mean allowing in uncomfortable sensations, thoughts and feelings. I consider it the learning of how to practice this. I believe that human beings are allergic to uncomfortableness, that we are born that way, and when we become uncomfortable we tend to want to get rid of that right away. When something like anxiety or a certain sadness comes over us we tend to try not to feel it. We may distract ourselves through various coping strategies including using drugs, watching TV, eating etc. Through ACT we are able to learn more helpful ways that would enable us not to put so much of our energy into avoiding these negative experiences and therefore providing more time and energy to our lives.

Mindfulness is another area we cover and it is the practice of learning to be present. Our minds are either busy with past or future thinking as compared to be noticing the present. You would learn how to practice being here and now on a regular basis.

The observing self is another domain. It is difficult to explain this in writing but it is like being e in a state where you are noticing your thoughts or noticing that you are thinking.

Values, another domain of ACT, is related to what is truly important to you deep down inside. We work around tuning in to your values. Often we may look at how do you want to act in relationships, how to do want to be as a parent, how you want to act as a community member, etc.

Commitment is about how willing are you to go in the direction of your values even when uncomfortable sensations, like sadness or anxiety, arise.

Let me illustrate this with an example. Let’s say John has been depressed since his girl fried broke up with him a couple of months ago. He continues to work but when he comes home instead of going to the gym as he usually has done he sits in front of his TV. He does not initiate phone calls to friends or relatives he is close to. He is not checking his mail very much and his bills pile up along with his dishes. In treatment we could start at any of the domains and let’s say we start, after his talking about his situation, on defusion. His negative thoughts may include: it is all his fault the relationship ended and he is a loser. After using some techniques to defuse from these thoughts we might explore what he would like to start doing again. Let’s say he wants to get back into all the activities he has withdrawn from. We would set up a program where he could start doing these things even though he may have a good deal of unpleasant sensations that come up with these. This could be especially feelings like he does not want to bother. We might ask him to observe these feelings and thoughts and get a sense of how willing he is to feel unpleasant things and still do the things that have really mattered to him before his depression. He would be taught mindfulness as a tool to learn to be more present in his life (as compared to be stuck in his mind).

The book by Russ Harris, Ph.D.,M.D. called The Happiness Trap is a very good self help book covering ACT.