"ACT for Depression - a Method Comparison” A talk given by Gerhard Andersson at the Nordic ACBS Forum 2012.

1. ACT for depression
Gerhard Andersson, professor
Linköpings Universitet and Karolinska Institutet
www.gerhardandersson.se

2. 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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3. 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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4. In spite of all our efforts
• All serious psychological treatments appear to work as well
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5. 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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6. 6

7. 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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8. Early on
• Zettle and Hayes work on depression and ”distancing” set the
stage for ACT
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9. Act for depression
• Behavioral analysis? Control is the problem – not the solution
• Creative hopelessness
• Metaphors
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10. 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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11. Accept your reactions and be present, Choose
a valued direction, and Take action.
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12. 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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13. 30 Pretreatment
25
Posttreatment
20
Follow-up
15
10
5
0
Treatment Control
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14. 25 Pretreatment
20 Posttreatment
15 Follow-up
10
5
0
Treatment ext Treatment mini Control
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15. Therapy form Rationale Therapy Active Home Technique Emotions
relation therapist work
Psychodynamic Yes Yes Nej No Yes Yes
Humanistic Yes Yes Yes No Yes Yes
Interpersonal Yes Yes Yes No Yes Yes
Behavioural Yes Yes Yes Yes Yes Yes
activation
Cognitive Yes Yes Yes Yes Yes Yes
therapy
ACT Yes Yes Yes Yes Yes Yes
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16. 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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17. Be sceptical about generic treatments!
• Mindfulness classes might not be the solution
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18. 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