1. Acceptance, Mindfulness & Valued Action in the Treatment of Depression Kirk Strosahl Ph.D. Patricia Robinson Ph.D. Mountainview Consulting Group Inc. mountainconsult@msn.com 1

2. 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) 2

3. 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 3

4. 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 4

5. The Three Pillars of Psychological Flexibility A cceptance—Fusion polarity contains defusion, willingness, acceptance—we will call this pillar “OPEN” This undermines emotional avoidance C hoose 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 T ake 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 5

6. 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 6

7. A Self Assessment Exercise Complete the Depressive Behaviors Inventory Score it and profile yourself on the three pillars Discuss your findings with your partner 7

8. 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) 8

9. 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 9

10. 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 10

11. 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 11

12. 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 12

13. 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 13

14. 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? 14

15. 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 15

16. Exercise: Railroad Crossing We will take you through a very simple defusion/acceptance exercise Complete the exercise Discuss your reactions with your partner 16

17. 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 17

18. Exercise: Moonrise Mountain We will now take you through one of our favorite mindfulness exercises Complete the exercise Discuss your reactions with your partner 18

19. 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 19

20. 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! 20

21. 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 21