Symptoms of Depression
Depression, referred to as Major Depressive Disorder in the DSM-V, is characterized by episodes of depression that last for at least two weeks. Symptoms of these depressive episodes are marked by a depressed mood, decreased pleasure or interest in activities that an individual once enjoyed, weight loss or weight gain, insomnia or hypersomnia, fatigue, feelings of worthlessness and/or guilt and difficulty focusing.
Individuals with depression also often experience suicidal thoughts. For some individuals, depression is episodic and for others it is more constant (DSM). Over 8% of adults in the United States reported experiencing depression in 2020 (National Institute of Mental Health, 2022). Individuals suffering from depression are also at increased risk of suicide (Brådvik, 2018).
Can Depression be cured or treated?
While there is no cure, depression has been shown to respond incredibly well to a variety of treatments. Both psychotherapy and medication have been proven effective at treating depression. Many individuals find antidepressants such as SSRIs effective at reducing their depressive symptoms and improving their quality of life.
However, research has suggested that combining psychotherapy with medication is more effective than taking medication alone (Cuijpers et al., 2020). Research has also suggested that psychotherapy, specifically cognitive behaviorally based psychotherapy, can be just as effective as medication alone (DeRubeis et al., 2008).
What is ACT?
ACT, pronounced as one word “act,” stands for Acceptance and Commitment Therapy. ACT is a type of evidence-based psychotherapy aimed at helping clients increase their psychological flexibility. Psychological flexibility refers to an individual’s ability to be mindful of one’s present experiences while simultaneously behaving in accordance with one’s values.
ACT utilizes six core processes designed to help individuals increase their psychological flexibility: acceptance, cognitive defusion, contact with the present moment, self as context, values and committed action. The acceptance aspect of ACT is designed to target client’s avoidance of thoughts and feelings. Instead, clients are taught to recognize their thoughts non-judgmentally, without trying to change them.
The purpose of acceptance is to help clients become more mindful of their thoughts and feelings, rather than avoid them. Cognitive defusion is another key part of ACT. Cognitive defusion techniques in ACT are designed to help change the way in which clients relate to their thoughts and feelings. For example, clients are taught to label their thoughts as just thoughts, rather than assigning them a label such as good or bad.
ACT also aims to help clients increase their connectedness to the present moment. When clients are able to connect to their internal and external experiences more directly, they are then able to start to alter their behavior to be more in line with their core values. Another aspect of ACT is helping clients understand the “self as context.”
This is the idea that the mind, along with thinking and feeling, simply notices. ACT techniques help clients see their mind in this detached way, something Russ Harris, a leader in ACT, calls the “noticing self” (Harris, 2019). Another goal of ACT is helping clients identify the values that are most important to them.
ACT therapists help clients identify and label these values, so that they are able to make committed action (the final process of ACT) that is in line with these values (Hayes, 2013). These six processes are not chronological steps, but rather six techniques that are utilized throughout ACT treatment (Harris, 2019).
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Is ACT one of the most effective treatments for Depression?
While many experts in the mental health field consider Cognitive Behavioral Therapy (CBT) to be the gold-standard treatment of depression, many scientific studies have found that ACT is also incredibly effective at treating depression. In 1989, researchers determined that group ACT was just as effective as group CBT at treating depression (Zettle and Rains, 1989).
A study in 2007 confirmed this finding, showing that individual ACT to be just as effective as individual CBT at treating individuals with depression (Forman et al., 2007). ACT operates based upon the belief that depression serves a function of avoidance. That is, individuals with depression are (unsuccessfully) trying to escape the negative thoughts and feelings they are experiencing.
The goal of ACT for depression is to help clients become more open to acknowledging their thoughts and feelings, so that they no longer feel the need to avoid or escape these negative emotions. ACT also aims to help individuals with depression by helping them engage in the world more actively in a way which aligns with their values (Batten, 2011).
How many sessions are necessary for ACT to be effective for Depression?
The appropriate length of treatment for depression varies case by case. Many scientific studies have proven ACT to be effective at treating depression in as few as twelve sessions. However, studies have found that a large percentage of individuals diagnosed with Major Depressive Disorder also meet the criteria for another psychological disorder (Thaipisuttikul et al., 2014).
In these cases, treatment may need to be longer in order to address all of the client’s concerns. Your therapist will determine what length of treatment is appropriate for you after conducting an assessment.
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How to find an ACT therapist in NYC?
Finding a therapist can seem daunting, and often is a process which takes time. However, there are many resources available to help you in your search. One popular and effective tool is psychologytoday.com. This is a website in which you are able to find therapists in your area, and filter based on presenting issue, type of therapy and cost.
If you are looking for an ACT therapist specifically, you can enter your zip code and then apply the ACT filter. A list will then populate of therapists in your area who utilize ACT in their practice. You are then able to filter based on price and insurance plan to help you find a quality ACT therapist within your budget. Another great way to find therapy is via referral.
Many primary care doctors have relationships with local therapists, and can provide referrals to mental healthcare, including ACT treatment. When looking for a therapist, the most important thing is finding someone who is a good fit for you. Many therapists offer free consultation services in which you can discuss what you are looking for, what services they offer and determine whether you may be a good match.
What techniques from ACT are used at New York Behavioral Health?
Many therapists at NYBH utilize ACT techniques when working with clients struggling with depression. These techniques include values clarification, mindfulness exercises, and cognitive defusion techniques. Many individuals struggling with depression think of themselves negatively and have what are called Automatic Negative Thoughts.
Some examples of automatic negative thoughts that someone with depression may have are “I am a failure” or “nobody loves me.” One of the goals of ACT is to help clients defuse, or distance themselves, from these negative thoughts. One way in which your therapist may help you to do this is through what are called revocalization exercises.
Your therapist will ask you to repeat your negative self-evaluations (such as “I am a failure”) aloud, but in atypical ways such as with an odd accent or with a very low voice. Exercises such as revocalization can help take away some of the response associated with these negative thoughts that can amplify feelings of depression.
Another technique from ACT that many therapists at NYBH utilize is value clarification. Many individuals with depression are withdrawn and unengaged with the world around them. When clients are able to identify what is important to them in their life, they are then able to engage with the world in a more meaningful way.
Your therapist may help you identify your values by asking you to describe a person’s life which you admire or asking you to write your own obituary. You and your therapist can then use your responses as a means to identify what exactly your values are, so you are able to live in a way that aligns with these values (Zettle, 2007).
Batten, S. V. (2011). Act for depression. In Essentials of acceptance and commitment therapy (pp. 85-94). SAGE Publications Ltd, https://dx.doi.org/10.4135/9781446251843.n10
Brådvik L. (2018). Suicide Risk and Mental Disorders. International journal of environmental research and public health, 15(9), 2028. https://doi.org/10.3390/ijerph15092028
Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World psychiatry : official journal of the World Psychiatric Association (WPA), 19(1), 92–107. https://doi.org/10.1002/wps.20701
Eifert, George H & Forsyth, John P.. (2005). Acceptance and Commitment Therapy for Anxiety Disorders : A Practitioner’s Treatment Guide to Using Mindfulness, Acceptance, and Values-Based Behavior Change Strategies. New Harbinger Publications
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms. Nature reviews. Neuroscience, 9(10), 788–796. https://doi.org/10.1038/nrn2345
Forman, E.M., Herbert, J.D., Moitra, E., Yeomans, P.D. and Geller, P.A. (2007) A randomized controlled effectiveness trial of Acceptance and Commitment Therapy and Cognitive Therapy for anxiety and depression. Behaviour Modification, 31: 772–99.
Harris, R. (2019). Act Made Simple: An easy-to-read primer on acceptance and commitment therapy . New Harbinger Publications, Inc.
Thaipisuttikul, P., Ittasakul, P., Waleeprakhon, P., Wisajun, P., & Jullagate, S. (2014). Psychiatric comorbidities in patients with major depressive disorder. Neuropsychiatric disease and treatment, 10, 2097–2103. https://doi.org/10.2147/NDT.S72026
U.S. Department of Health and Human Services. (2022, January). Major depression. National Institute of Mental Health. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression
Zettle, R. D. (2007). Act for depression: A clinician’s guide to using acceptance and commitment therapy in treating depression. New Harbinger Publication. Zettle, R.D. and Rains, J.C. (1989) Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45: 436–45.