Relieve Generalized Anxiety and Depression with a 2-Session Acceptance and Commitment Therapy (ACT)
By John M. de Castro, Ph.D.
“ACT is about acceptance and it is about change at the same time. Applied to anxiety disorders, patients learn to end the struggle with their anxiety-related discomfort and take charge by engaging in actions that move them related to their chosen life aims.” – Mohsen Hasheminasab
Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused.
Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.
There are a number of psychological therapies for anxiety and depression. But, les than half the patients treated respond to the therapy and do not relapse. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders. A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and has also been shown to relieve anxiety. ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.
In prior research Ruiz and associates have demonstrated that a 3 session Acceptance and Commitment Therapy (ACT) is effective Generalized Anxiety Disorder (GAD) and for depression. In today’s Research News article “Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial.” (See summary below or at: https://pubmed.ncbi.nlm.nih.gov/31944806/), Ruiz and colleagues examine the efficacy of a 2-session ACT for Generalized Anxiety Disorder (GAD) and for depression.
They recruited via social media patients diagnosed with either Generalized Anxiety Disorder (GAD) or depression and randomly assigned them to either a wait-list control condition or to receive 2 60-minute individual sessions of Acceptance and Commitment Therapy (ACT). They were measured before and after treatment and 1- and 3-months month later for anxiety, depression, perceived stress, perseverative thinking, experiential avoidance, cognitive fusion, valued living, and generalized pliance (rule governed behavior).
They found that in comparison to baseline and the wait-list control group, the patients who received Acceptance and Commitment Therapy (ACT) had significantly improved levels of all outcome measures including anxiety, depression, perceived stress, perseverative thinking, experiential avoidance, cognitive fusion, valued living, and generalized pliance that persisted at the 1- and 3-month follow-ups. Fully 91% of the patients receiving ACT had clinically significant changes in their Generalized Anxiety Disorder (GAD) or depression compared to 9% of the wait-list controls.
The findings are remarkable in that 2 1-hour sessions of Acceptance and Commitment Therapy (ACT) produced such large, significant and lasting improvements in patients with Generalized Anxiety Disorder (GAD) or depression. These disorders are widespread affecting a large number of people and are frequently debilitating or at least interfere with their ability to conduct their lives. It is exciting that a brief treatment that can be implemented cost-effectively is capable of relieving their suffering.
The study, however, lacked an active control condition, e.g. exercise, and so is open to a variety of confounding variables. Future research should include such an active control. The effects of confounding variables, however, generally fade fairly quickly over time. So, the fact that the current results were still large and significant 3-months later argues that the benefits were produced by ACT.
So, relieve generalized anxiety and depression with a 2-session Acceptance and Commitment Therapy (ACT).
“ACT has been used effectively to help treat workplace stress, test anxiety, social anxiety disorder, depression, obsessive-compulsive disorder, and psychosis.” – Psychology Today
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Ruiz FJ, Peña-Vargas A, Ramírez ES, et al. Efficacy of a two-session repetitive negative thinking-focused acceptance and commitment therapy (ACT) protocol for depression and generalized anxiety disorder: A randomized waitlist control trial [published online ahead of print, 2020 Jan 16]. Psychotherapy (Chic). 2020;10.1037/pst0000273. doi:10.1037/pst0000273
Abstract
This parallel randomized controlled trial aimed to evaluate the effect of acceptance and commitment therapy (ACT) focused on disrupting repetitive negative thinking (RNT) versus a waitlist control (WLC) in the treatment of depression and generalized anxiety disorder (GAD). Forty-eight participants with a main diagnosis of depression and/or GAD were allocated by means of simple randomization to a 2-session RNT-focused ACT intervention or to the WLC. The primary outcomes were emotional symptoms as measured by the Depression, Anxiety, and Stress Scales-21. Process outcomes included ACT- and RNT-related measures: general RNT, experiential avoidance, cognitive fusion, values, and generalized pliance. At the 1-month follow-up, linear mixed effects models showed that the intervention was efficacious in reducing emotional symptoms (d = 2.42, 95% confidence interval [1.64, 3.19]), with 94.12% of participants in the RNT-focused ACT condition showing clinically significant change in the Depression, Anxiety, and Stress Scales-21 total scores versus 9.09% in the WLC condition (70% vs. 8% in intention-to-treat analysis). The intervention effects were maintained at the 3-month follow-up. No adverse events were found. A very brief RNT-focused ACT intervention was highly effective in the treatment of depression and GAD.
Clinical Impact Statement Question: What is the applied clinical practice question this paper is hoping to address?
To analyze whether a 2-session acceptance and commitment therapy (ACT) intervention focused on disrupting repetitive negative thinking (RNT) is effective in treating depression and GAD. Findings: How would clinicians meaningfully use the primary findings of this paper in their applied practice? Clinicians might use the RNT-focused ACT protocol to treat depression and GAD. Meaning: What are the key conclusions and implications for future clinical practice and research? The RNT-focused ACT protocol was highly effective in treating depression and GAD. Next Steps: Based on the primary findings and limitations of this paper, what are future directions to be explored in clinical practice and research? To analyze the long-term effects of the RNT-focused ACT protocol.
https://pubmed.ncbi.nlm.nih.gov/31944806/