ACT for depression

Gerhard Andersson, professorLinköpings Universitet and Karolinska Institutet

www.gerhardandersson.se

Aims

• The scope of depression

• The fact that most treatments seem to work (or not?)

• The ACT contribution

• Future challenges for a CBS of depression

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Depression

• Widely prevalent

• Higly costly

• Projected by the WHO to be one of the most costly medical problems for society

• More than one condition – can be chronic

• Tend to relapse

• Numerous theories: Biological, psychological and social.

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In spite of all our efforts

• All serious psychological treatments appear to work as well

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Regardless of brand

• CT as good as BT (perhaps not for more severe depression)

• Format also makes little difference: Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38, 196-205.

• Cuijpers, P., van Straten, A., & Warmerdam, L. (2008). Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. European Journal of Psychiatry, 22, 38-51.

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ACT and depression

• Not much of a theory specific for depression

• However the concept of experiential avoidance makes sense and so does cognitive fusion

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Early on

• Zettle and Hayes work on depression and ”distancing” set the stage for ACT

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Act for depression

• Behavioral analysis? Control is the problem – not the solution

• Creative hopelessness

• Metaphors

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More to it

• Experiential

• Monitor thoughts and beliefs

• Defusion

• Acceptance

• Reason giving

• Mindfulness

• Committed action

• Willingness

• Ok to use BA and other CBT techniques

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Accept your reactions and be present, Choose a valued direction, and Take action.

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Evidence in favour of ACT

• Zettle, R. D., & Hayes, S. C. (1987). Component and process analysis of cognitive therapy. Psychological Reports, 61, 939-953.

• Zettle, R. D., & Rains, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 436-445.

• Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Behavior Modification, 35, 265-283.

• Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772-799.

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Treatment Control0

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30Pretreatment

Posttreatment

Follow-up

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Treatment ext Treatment mini Control0

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25Pretreatment

Posttreatment

Follow-up

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Therapy form Rationale Therapy

relation

Active

therapist

Home

work

Technique Emotions

Psychodynamic Yes Yes Nej No Yes Yes

Humanistic Yes Yes Yes No Yes Yes

Interpersonal Yes Yes Yes No Yes Yes

Behavioural

activation

Yes Yes Yes Yes Yes Yes

Cognitive

therapy

Yes Yes Yes Yes Yes Yes

ACT Yes Yes Yes Yes Yes Yes

What more is there to do?

• Theory for depression

• Choose target group where acceptance is key! Chronic depression, somatic comorbidity etc

• Could RFT be useful as a framework?

• Comparative RCTs are boring but RCTs per se

are needed!

• Integrate with behaviourism?

• Basic science? At least some experiments

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Be sceptical about generic treatments!

• Mindfulness classes might not be the solution

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Conclusions

ACT is not evidence-based enough for depression

But probably as good as the rest

Theory and basic research needed!

Do not feel tempted to apply the same approach to all

act