ACT

ACT for Mental Health

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“ACT work is based more on the psychology of the normal. I think we have every reason to believe that most of the things that people struggle with are based on the failure to bring out normal psychological processes.” – Stephen Hayes

 

Acceptance and Commitment Therapy (ACT) is a psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT). It 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. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Mindfulness practices have in general been shown to be effective in treating depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/) and anxiety disorders (see http://contemplative-studies.org/wp/index.php/category/research-news/anxiety/) Since Acceptance and Commitment Therapy (ACT) employs mindfulness training it is not surprising that it is also effective for a variety of mental health issues including depression (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/act/).

 

ACT contains a number of modules that allow the client to work on particular thoughts and actions that are relevant to the individual’s problems. This allows for component analysis research, where certain ACT modules are used or dropped out and the change in ACT effectiveness measured, thus allowing the assessment of the effectiveness of each component module. In today’s Research News article “Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes”

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Villatte and colleagues examined “two ACT component modules; one targeting openness to thoughts, feelings, and sensations and the other emphasizing engagement in meaningful actions.” Participants who were suffering from depression and/or anxiety disorders were randomly assigned to receive ACT therapy emphasizing one of the two modules.  In the ACT OPEN module, the client explores the thoughts and ideas about the depression or anxiety and are then encouraged to let go of these thoughts, to let them diffuse, “(e.g. thoughts are observed as if they are leaves floating on a stream).” In the ACT ENGAGED module the client’s own values are explored as guides to orient actions and as sources of satisfaction. They then explore their experiences with an eye toward allowing their values to guide them through the obstacles that occur in everyday life.

 

Villatte and colleagues found that both modules produced significant improvements in acting with awareness and nonreactivity to thoughts, feelings, sensations. They both also produced significant reductions in anxiety and depression symptom severity, but the ACT OPEN module was significantly more effective than the ACT ENGAGED module. The ACT OPEN module only produced significant improvements in cognitive diffusion and experiential acceptance. Both modules also produced clinically significant improvements in quality of life and values based action, but the ACT ENGAGED module was significantly more effective than the ACT OPEN module.

 

Hence they found that the module emphasizing letting go of thoughts and ideas about their problems, ACT OPEN, was more effective in reducing the symptoms of anxiety and depression than the module emphasizing applications of the individual’s own values to guide actions, ACT ENGAGED. This finding reinforces the importance of the emphasis of mindfulness practice on letting go of thoughts and focusing on present experience. It suggests that this may be a critical component in mindfulness applications to mental health issues. The fact that the module emphasizing applications of the individual’s own values to guide actions, ACT ENGAGED produced greater improvements in quality of life suggests that the emphasis in mindfulness practice on acting with awareness may be crucial to satisfying engagement in life.

 

It is possible that letting go is needed as a prerequisite before values based actions are effective. So, values based actions may not be as effective when practiced before practicing letting go. Future research should investigate presenting these modules in different orders. Regardless it is clear that Acceptance and Commitment Therapy (ACT) modules are effective in the treatment of anxiety and depression.

 

So, ACT for mental health.

 

“People don’t go into therapy when life is moving forward at a reasonable clip; they go in when life is stuck or going backwards. And it’s not that they get cured or fixed, because humans are not broken, they don’t need to be fixed. They need to be supported in a way that allows them to grow and do a better job over time with the things that they really care about—their kids, their work, their intimate relationships, their sense of participation and connection with the world around them.” – Stephen Hayes
CMCS – Center for Mindfulness and Contemplative Studies

Log-on for Less Anxiety with Mindfulness

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“Needless anxiety and stress cannot burden us if the thoughts don’t enter our mind. And fortunately, we are only capable of focusing on one thing at a time. When you’re aware of only what you’re working on and the sensations of your body, conscious worry is not possible.” – Jordan Bates

 

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. (Source: National Institute of Mental Health). Generalized Anxiety Disorder (GAD) affects about 3.1% of the U.S. population. GAD involves excessive worry about everyday problems. People with GAD may excessively worry about and anticipate problems with their finances, health, employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their anxiety is more intense than the situation warrants. Physically, GAD sufferers will often show excessive fatigue, irritability, muscle tension or muscle aches, trembling, feeling twitchy, being easily startled, trouble sleeping, sweating, nausea, diarrhea or irritable bowel syndrome, and headaches.

 

Anxiety disorders are not only a torment for the victims but they also place tremendous pressure on the health care system. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders. Anxiety disorders are treatable but only about a third of the sufferers get treatment. The most common treatment for GAD is drugs. Anxiolytic drugs are some of the most prescribed drugs in the U.S. Psychotherapy is another common form of treatment with Cognitive Behavioral Therapy particularly effective. Mindfulness practices are known to reduce anxiety (see http://contemplative-studies.org/wp/index.php/2015/11/02/be-open-or-focused-in-meditation-to-reduce-anxiety/,  http://contemplative-studies.org/wp/index.php/2015/07/17/the-mindfulness-cure-for-social-anxiety/, http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/), and appear to do so by altering brain activity (see http://contemplative-studies.org/wp/index.php/2015/08/13/get-the-brain-to-reduce-anxiety-with-meditation/).

 

The problems with these treatments is that drugs can have very troublesome side effects and psychotherapy can be expensive and time consuming. Therapy also demands that there be a qualified professional in the immediate area and the patient has the time and transportation available to attend therapy sessions. So, there is a need for cost-effective, convenient, and safe alternative treatments.

 

One way to lower costs and make therapy available for patients over wide geographical areas is to deliver therapy over the internet. In today’s Research News article “Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial”

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Dahlin and colleagues developed a form of mindfulness based Acceptance and Commitment Therapy (ACT) for delivery by a therapist over the internet. They recruited participants with GAD over the internet and assigned them randomly to either receive therapy for 9-weeks or to a waiting list control condition. They found significant improvement in Generalized Anxiety Disorder (GAD) and depression for the therapy group with large to moderate effect sizes. These improvements were still present 34-weeks later.

 

These are exciting results. Anxiety disorders are so prevalent and so infrequently treated that it’s important to demonstrate that a safe and effective therapy can be inexpensively delivered over the internet. This opens the door to widespread access to safe, convenient, effective, and inexpensive treatment. Future trials should employ a more active control condition and open up treatment to a wider array of GAD sufferers.

 

Mindfulness practices have a number of effects that appear to be helpful with anxiety disorders. They have been shown to improve emotion regulation. This allows the individual to experience the anxiety but react to it in a constructive way and thereby preventing an upward spiraling of anxiety as the patient becomes more anxious of becoming more anxious. Mindfulness practices also appear to blunt physiological and psychological reactions to stress. Since, high levels of anxiety are stressful, mindfulness practices may reduce the reactions to this stress, making the anxiety more bearable. Finally, anxiety involves worries about the future. By focusing the individual on the present, mindfulness practices interrupt worries about the future.

 

Regardless of the explanation, it is clear that mindfulness based Acceptance and Commitment Therapy (ACT) is effective for Generalized Anxiety Disorder (GAD) even when delivered over the internet.

 

So log-on for less anxiety with mindfulness.

 

“I confessed to him that I saw breathing exercises as an attempt to distract. He said, “Yes. It’s a tool. Mindfulness is all in the subtleties.” Then he paused and told me, “Instead, when thoughts and feelings come, you simply say to them ‘Hello. I see you. Welcome.’”” – Lucy Roleff


CMCS – Center for Mindfulness and Contemplative Studies

 

ACT for Depression in Childhood Diabetes

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“Self-acceptance means you refuse to buy into your judgments your mind makes about you, whether they’re good judgments or bad ones. Instead of judging yourself, you recognize your strengths and your weaknesses, and you do what you can to be the person you want to be.” – Russ Harris

 

There is an image, a societal meme, of childhood being a time of great happiness, fancifulness, freedom, creativity, and play. But, the reality is frequently starkly different. It has been estimated that 2% to 4% of children are depressed. This is particularly true with children under intense stress from childhood illness, particularly chronic illness. Indeed, 2.4% of children suffer from childhood diabetes. The day to day struggle with diabetes and the feelings that they are burdens on the family frequently produces depression in these children.

 

Acceptance and Commitment Therapy (ACT) has been shown to be effective for depression in adults (see http://contemplative-studies.org/wp/index.php/2015/09/17/act-for-depression/). ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, ACT helps people strengthen aspects of cognition such as in committing to living according to their values. It is not known, however, if ACT is effective for depression in diabetic children

 

In today’s Research News article “Effectiveness of Acceptance and Commitment Therapy for Depression, Psychological Well-Being and Feeling of Guilt in 7 – 15 Years Old Diabetic Children”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575800/

Moghanloo and colleagues provided ACT modified for children and adolescents in ten weekly sessions to a randomly assigned group of 7-15 year old diabetic children. The change from before to after was compared to a no intervention control group of children. They found that the children treated with ACT reported lower depression and feelings of guilt and had improved psychological well-being. The effects sizes were large and clinically meaningful. Hence, ACT appeared to be effective in children as it’s been shown to be in adults.

 

It should be noted that there was no follow-up to determine if the effects persisted after the end of active therapy. Also, since the control group did not receive psychological treatment of any kind, it is impossible to determine if ACT is particularly effective or any form of therapy would have worked as well.

 

Like most mindfulness techniques ACT is targeted to improving awareness and acceptance of experiences in the present moment. These include emotions. This may be particularly important in children. By making the children more aware of how they’re feeling and why, they may become better able to deal with and accept these sometimes overpowering emotions. In addition, ACT supplies tools to look at their own thoughts about their disease and psychological state and recognize, accept, and form a different relationship with them. This allows the individual to be more psychologically flexible and mindful. In this way ACT can assist the children in coping with not only their emotions but also their disease and thoughts about it in a more accepting and productive fashion.

 

So, ACT for depression in childhood diabetes.

 

“We have not passed that subtle line between childhood and adulthood until… we have stopped saying “It got lost,” and say “I lost it.” – Sydney J Harris

 

CMCS – Center for Mindfulness and Contemplative Studies

 

ACT for Depression

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ACT depressed_man

 

“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” – Elizabeth Wurtzel

Depression is challenging and potentially deadly. It permeates the individual’s entire life and being. It is also widespread, affecting millions of people in the U.S. and worldwide. Recently mindfulness based therapies have been developed to treat depression and have been found to be quite effective (see links below). In fact, Mindfulness Based Cognitive Therapy (MBCT) was developed specifically to treat depression. But Mindfulness Based Stress Reduction (MBSR), Mindfulness Meditation, and Loving Kindness Meditation have all been shown to be effective.

 

Acceptance and Commitment Therapy (ACT) is a new form of Cognitive Behavioral Therapy (CBT) that has been shown to be effective for depression. It helps the individual examine how their thoughts, feelings, and behavior 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. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living.

 

As impressive as the effectiveness of many of the therapies for depression are, they require the supervision of a trained therapist working either with a single individual or in small groups. With the magnitude of the problem of depression, these therapies can only touch a small fraction of depression suffers. Recently the internet has been used to provide therapy to a wide audience. It allows for therapies to be made available to a much larger number of patients over a much larger geographical area.

 

In today’s Research News article “Web-Based Acceptance and Commitment Therapy for Depressive Symptoms With Minimal Support: A Randomized Controlled Trial.”

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Lappalainen and colleagues use the internet to deliver Acceptance and Commitment Therapy (iACT) for the treatment of depression and compared its effectiveness to a group of participants on a wait list for treatment. They found large significant and much greater improvements for the iACT group for depression overall and also marked improvements in experienced psychological and physiological symptoms, psychological flexibility, mindfulness, frequency of automatic thoughts, and thought suppression. In addition, the improvements continued and even increased over the year following treatment, demonstrating the long lasting effectiveness of iACT.

 

These are impressive results and indicate that ACT can be delivered effectively over the internet, producing long-lasting improvement in depression. The results suggest that iACT worked the way it was designed to, by producing more mindful, positive, and constructive thought processes. Thinking was more targeted to the present moment reducing rumination about past events, it was more under control and less automatic, and provided much greater flexibility in evaluative thinking. So the depressed individuals’ broke the cycle produced by the ideas and thoughts they have regarding their depression contributing further to their depression, allowing them to understand better the nature of their problems and the sources of their feelings.

 

So, ACT for depression.

 

“Depression isn’t about, ‘Woe is me, my life is this, that and the other’, it’s like having the worst flu all day that you just can’t kick.” – Robbie Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

LINKS

Mindfulness Based Cognitive Therapy (MBCT) is effective for major depression even after drugs fail

http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/

Mindfulness Based Stress Reduction (MBSR) is effective for depression

http://contemplative-studies.org/wp/index.php/2015/07/17/does-spirituality-account-for-mindfulness-anti-depressive-effects/

Loving Kindness Meditation is effective for depression

http://contemplative-studies.org/wp/index.php/2015/08/04/get-out-of-the-dumps-with-loving-kindness-meditation/

Mindfulness Based Cognitive Therapy (MBCT) is effective for depression

http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/

Mindfulness Meditation alters the brain to relieve depression

http://contemplative-studies.org/wp/index.php/2015/08/19/this-is-the-brain-on-meditation-major-depressive-disorder/