Acceptance, Mindfulness & Valued Action in the Treatment of Depression

1. Acceptance, Mindfulness & Valued Action in the Treatment of Depression Kirk Strosahl Ph.D. Patricia Robinson Ph.D. Mountainview Consulting Group Inc. mountainconsult@msn.com

2. What we don’t mean by depression • It is not a biological illness • It is not a syndrome • It is not genetically transmitted • It is not the result of brain chemistry alteration • It is not abnormal (25% lifetime prevalence in men, 30% in women)

3. What we do mean by depression • It is the “common cold” of contemporary living • It is an exquisitely accurate signal that life is out of balance in some important way • It is a state of emotional numbness, detachment and directionless behavior

4. An ACT Perspective on Depression • Numbness, detachment, withdrawal, displaced emotional expressions all signal that depression itself is a form of emotional avoidance • Depression provides a convenient “solution” to life problems by immobilizing the self • Fusion with unworkable rules about how to achieve a “happy life” and the toxic nature of painful feelings drives emotional avoidance

5. The Three Pillars of Psychological Flexibility • Acceptance—Fusion polarity contains defusion, willingness, acceptance—we will call this pillar “OPEN” • This undermines emotional avoidance • Choose mindfully---automatic pilot polarity contains self experience, evaluation/reason giving and valuing—we will call this pillar “AWARE” • This undermines fusion with rules, hidden evaluations, reason giving and attachment to the self story • Take action-avoidance of action polarity contains willingness, value based goal setting to create exposure to vitality producing life moments—we will call this pillar “ENGAGED” • This undermines behavioral avoidance

6. Even More Simply, Think Of Pillars As Core Response Styles • OPEN: Accepting Versus Rejecting Stance Toward Unwanted Experience • Willingness to stand with all forms of personal experience • Defused, non-judgmental witnessing stance • AWARE: Chosen Versus Automatic Behavior Style • Balance between present moment experience & absorption in self process • Ability to take perspective, identify values and pick responses • ENGAGED: Taking Action Versus Avoiding Action • Willingness to put self in harms way based upon values • Ability to persist with value based commitments and change strategies based upon results

7. A Self Assessment Exercise • Complete the Depressive Behaviors Inventory • Score it and profile yourself on the three pillars • Discuss your findings with your partner

8. The Role of the Open Pillar in Depression • Fusion is a major problem in depression • Ruminative processing • Fusion with self evaluations • Fusion with self story • Fusion with provocative evaluations (right-wrong, good-bad, fair-unfair, responsibility versus blame)

9. The Role of the Open Pillar in Depression • Depressed patients tend to take a rejecting stance toward unpleasant experience • Actively avoid potentially painful emotional triggers • Numbness and apathy as defenses against “caring” • Day dreaming and self distractions

10. The Role of the Aware Pillar in Depression • Depressed patients have trouble getting in the present moment • Meaningless routines such as over cleaning, napping, watching TV • Rumination as a form of distraction • Out of contact with personal values

11. The Role of the Aware Pillar in Depression • Depressed patients set their sights low and live from day to day without contacting their bigger self • Very limited spiritual behavior—often self developing behaviors have been stopped (i.e., church, meditation, yoga) • Self story promotes a self defeating world view

12. The Role of the Engaged Pillar in Depression • Most depressed patients are living in ways that contradict their values • They are often exceedingly pliant, lack assertiveness and will not state their needs to others • Numbness and apathy pull them further out of touch with what they believe in

13. The Role of the Engaged Pillar in Depression • There is not only emotional avoidance in depression but behavioral avoidance • Constructive problem solving behaviors are lacking, especially if they require confronting some painful reality • There is also a problem with behavioral excesses (drinking, drugging, sleeping) that defeat effective action

14. Video Demonstration • Young man recovering from drug addiction, presenting with depression • Two Groups • Group 1: Catalog depressive behaviors described by the patient • Group 2: Profile the patient on the three pillars • All: What ACT intervention(s) would you use?

15. Acceptance-Willingness Interventions with Depression • Goal is to establish a stance of standing with difficult material • Willingness is a commitment to enter a painful situation with the intent of staying there • Acceptance is what you do when you get there—see private experience for what it is • Defusion interventions help promote a stable platform of acceptance

16. Exercise: Railroad Crossing • We will take you through a very simple defusion/acceptance exercise • Complete the exercise • Discuss your reactions with your partner

17. Present Moment Interventions in Depression • We are pitting two forms of mental activity against each other • Reactive mind—the problem solving, rule generating, evaluative mind • Wise mind—What is left when you remove all of the contents of reactive mind • Mindfulness interventions try to pull for wise mind awareness

18. Exercise: Moonrise Mountain • We will now take you through one of our favorite mindfulness exercises • Complete the exercise • Discuss your reactions with your partner

19. Valued Actions in the Treatment of Depression • Behaving according to ones values makes the pain of a situation “healthy” • Committed actions flow naturally out of contact with values • We are trying to give the patient a sense of mission • It’s OK to start small just to learn what valued actions feel like in contrast to avoidance based behavior

20. Exercise: Vision Plateau • This is our favorite exercise for getting the patient to look up to the horizon in their life • Complete the exercise with us • After completing it, write down one thing you are committing to do to increase the vitality of your life!

21. Pulling It All Together: Role Play Demonstration • We need some brave volunteer from the audience to play a depressed patient • Not required, but it would be even better if you have actually struggled with depression and still have some “issues” that are bugging you