ACT for Depression: How It Works, Examples, & Effectiveness

What Is Acceptance & Commitment Therapy?

Acceptance and commitment therapy (ACT) is a therapeutic approach developed to cultivate psychological flexibility. Created by Steven C. Hayes, ACT helps individuals accept their thoughts and feelings while committing to actions aligned with their values. Initially designed for various psychological issues, ACT has shown remarkable efficacy in treating depression.¹

How Does ACT Help With Depression?

ACT empowers individuals to navigate the challenges of depression by encouraging individuals to accept their emotions without judgment while committing to actions aligned with their values as opposed to their symptoms of depression. This acceptance and commitment to values can reduce the overwhelming impact of depressive thoughts and feelings. ACT enables individuals to manage their depression and enhance overall well-being.

ACT can help with the following symptoms of depression:

• Persistent sadness or empty mood: ACT teaches individuals acceptance of their sadness and feelings of emptiness without judgment, reducing their intensity and duration over time.
• Feelings of worthlessness: ACT combats feelings of worthlessness through mindfulness and self-compassion exercises. It emphasizes that a person’s worth is not defined by their experiences or emotions.
• Loss of interest in pleasurable activities: ACT helps individuals re-engage in activities they no longer find enjoyable by encouraging them to act on their values rather than their depressive symptoms.
• Difficulty concentrating or poor memory: ACT mindfulness practices improve a person’s awareness of the present moment, which can increase a person’s ability to focus and help with short-term memory loss when depressed.
• Negative self-talk: ACT teaches techniques to help people separate themselves from their negative self-talk. According to ACT, thoughts are like clouds in the sky that come and go and are not depictive of a formal truth.

Does ACT Effectively Treat Depression?

Research and statistics consistently support ACT’s effectiveness in treating depression. A review of 25 studies found that ACT was effective in maintaining treatment gains over time. This is important because depression is a chronic disorder that often relapses.³ Notably, a study in the Journal of Consulting and Clinical Psychology found ACT to be significantly more effective than the control condition in reducing depression symptoms.²

ACT Vs. CBT for Depression

Comparing ACT to cognitive behavioral therapy (CBT) reveals nuanced differences in their therapeutic approaches. While both are effective treatments for depression, ACT emphasizes acceptance and mindfulness, encouraging individuals to embrace their emotions rather than challenging or changing them, setting it apart from the more cognitive-focused CBT.

ACT Vs. Interpersonal Therapy for Depression

Contrasting ACT with interpersonal therapy (IPT) reveals distinct approaches to addressing depression. ACT concentrates on fostering psychological flexibility, while IPT centers around improving interpersonal relationships. Understanding these differences assists individuals and therapists in choosing the most suitable treatment.

ACT Therapy Techniques Applied to Depression

ACT therapy techniques include metaphors, experiential techniques, and skills like acceptance, mindfulness, and defusion. When applied to depression, these techniques offer transformative insights and strategies for managing and overcoming depressive symptoms.

Here is how some ACT therapy techniques are applied to depression:

Acceptance, Mindfulness, & Defusion Skills

Acceptance, mindfulness, and defusion Skills (AMD) are core components of ACT. These skills are essential for developing psychological flexibility, which is the ability to accept difficult thoughts and emotions and engage in valued behaviors even in the presence of discomfort.

Acceptance, mindfulness, and defusion skills that are taught in ACT for depression include:

• Acceptance skills: Instead of fighting thoughts and emotions, let them come and go without getting caught up in them. It’s like observing the weather – one can’t control the rain or the sunshine, but they can accept that they’ll pass.
• Mindfulness skills: With mindfulness skills, people focus on the present moment without getting caught up in their thoughts and emotions. This can be done through practices like meditation for depression, yoga, or simply paying attention to your breath. When you’re mindful, you’re not dwelling on the past or worrying about the future. You’re just aware of what’s happening right now.
• Defusion skills: Defusion skills help people distance themselves from their unhelpful thoughts. This means not taking thoughts too seriously or believing in them as absolute truths. Instead, view them as just thoughts, like passing clouds in the sky. This can help you take some of the power out of the thoughts themselves, making it easier to let them go.

Identifying Values & Committing to Action

When individuals connect their actions with their values, they create a sense of purpose, a driving force that propels them forward. This connection empowers individuals to make choices that align with what truly matters to them, even in the face of depressive challenges. Rather than focusing solely on symptom relief, this ACT technique encourages a holistic pursuit of meaningful goals, fostering resilience and empowerment within individuals.

Imagine waking up each morning with a sense of direction, knowing that actions align with one’s core values. This is the power of ACT’s values-driven approach. It’s about reclaiming one’s life, one step at a time, guided by the compass of one’s values.

Metaphors to Teach ACT Theory

Using metaphors to clarify intricate psychological concepts makes the therapy technique more relatable to those battling depression. The metaphors create powerful illustrations that help people learn and apply the therapy’s principles to their own experiences of depression.

ACT metaphors that are used in depression treatment include:

• Drivers vs. passengers: Just as a driver controls a car, individuals can learn to manage their thoughts and emotions in depression treatment. This metaphor emphasizes personal agency in navigating mental health challenges surrounding depression.
• Beach ball underwater: Imagine holding a beach ball underwater – the deeper it goes, the stronger it pushes back. Applied to depression, it shows that accepting emotions, rather than resisting them, allows for a lighter mental state.
• Quicksand: Quicksand symbolizes the effort to control emotions. Many individuals with depression struggle with emotional numbness because feeling their sadness feels terrifying. Embracing emotions, rather than resisting them, leads to greater freedom.
• Tug of war: The tug-of-war metaphor highlights the internal struggle between values, such as being productive, and negative behaviors, such as struggling to get out of bed due to depression. It encourages alignment with values and moving towards a fulfilling life rather than being pulled back by negative thoughts.
• Rain Clouds: Like passing rain clouds, depressive thoughts are temporary. Therapy helps individuals observe these thoughts without being overwhelmed, acknowledging their impermanence.

Evaluating Control & Avoidance Strategies

In ACT, evaluating control and avoidance strategies is a technique that encourages individuals to examine their automatic responses to difficult thoughts and feelings closely. This process involves recognizing the limitations of old coping strategies, which often involve trying to control or avoid uncomfortable emotional experiences. By identifying these patterns, individuals can work towards enhancing their psychological flexibility. This means they become more open to experiencing a range of emotions without excessive control or avoidance, leading to the development of more effective coping mechanisms. As a result, individuals can cultivate a healthier relationship with their emotions, facilitating emotional resilience and well-being.

Control and avoidance strategies that are evaluated in ACT for depression include:

• Suppression: Instead of trying to push away your emotions, accept them as a part of your experience. This doesn’t mean you must like them, but it can help you better manage them.
• Isolation: Depression encourages isolation. Instead, reach out to friends, family, or support groups. Connecting with others can help you feel less alone and give you a different perspective on your struggles.
• Perfectionism: Many individuals experience depression when they fall short of perfection. Be kind to yourself and accept that everyone makes mistakes. Focus on your progress, not on being perfect.
• Substance use: Instead of relying on substances such as alcohol to cope with depression, find healthier ways to cope with difficult emotions, like exercise, relaxation techniques, or talking to a therapist.

Promoting Self-Compassion

Self-compassion, treating oneself with kindness and understanding, can help individuals cope with the difficult emotions and self-criticism that are inherent to depression. This can be cultivated by observing thoughts and feelings without judgment and adopting an internal dialogue akin to how one would converse with a friend. Would the things said to oneself about their depression be uttered to a friend with depression? If not, it’s time to cultivate greater self-kindness.

What to Expect During ACT Treatment

ACT treatment for depression typically unfolds in a collaborative process that spans several weeks to a few months. During these sessions, individuals embark on a journey that includes committing to specific actions aligned with their values, practicing mindfulness techniques to enhance present-moment awareness, and exploring and clarifying personal values.

Additionally, individuals engage in experiential exercises to deepen their understanding and application of ACT principles. They also learn defusion techniques to reduce the impact of depressive thoughts and develop problem-solving strategies to navigate the challenges of depression. This multifaceted approach aims to empower individuals to transform their relationship with depression and live more values-driven and fulfilling lives.

ACT sessions will involve:

• Commit to specific actions that align with their values, fostering a sense of purpose and direction.
• Engage in mindfulness practices for depression to enhance present-moment awareness and accept their thoughts and emotions without judgment.
• Explore and clarify their personal values to form a foundation for guiding purposeful actions..
• Learn defusion techniques to distance themselves from distressing thoughts and reduce their impact.
• Develop effective problem-solving strategies to navigate challenges and setbacks.

How to Find an ACT Therapist for Depression

An online therapist directory is a great way to find an ACT for depression therapists in your area. Alternatively, recommendations from your doctor can be very helpful, and many mental health organizations can also provide referrals. If you prefer to meet with a therapist virtually, an online therapy for depression platform may be the ideal option for you.

Finding the right therapist who specializes in ACT for depression requires careful consideration of their qualifications, as well as ensuring there is a sense of comfort with the therapist. Asking questions, reading reviews, interviewing multiple therapists, and being open to switching if necessary are essential tips in this process.

Other Treatment Options for Depression

There are many diverse approaches to treating depression. From psychodynamic therapy, which delves into unconscious patterns, to the use of antidepressants and cognitive-behavioral therapy, each option contributes uniquely to comprehensive treatment. Mindfulness-based stress reduction, exercise therapy, and nutritional psychiatry further enrich the landscape, providing individuals with an array of ways to address the complexities of depression.