acceptance, mindfulness & valued action in the treatment of depression kirk strosahl ph.d....
TRANSCRIPT
Acceptance, Mindfulness & Valued Action in the
Treatment of Depression
Kirk Strosahl Ph.D.Patricia Robinson Ph.D.
Mountainview Consulting Group Inc.
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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)
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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
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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
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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
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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
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A Self Assessment Exercise
Complete the Depressive Behaviors Inventory
Score it and profile yourself on the three pillars
Discuss your findings with your partner
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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)
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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
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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
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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
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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
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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
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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?
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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
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Exercise: Railroad Crossing
We will take you through a very simple defusion/acceptance exercise
Complete the exercise Discuss your reactions with your
partner
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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
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Exercise: Moonrise Mountain
We will now take you through one of our favorite mindfulness exercises
Complete the exercise Discuss your reactions with your
partner
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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
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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!
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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
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