Acceptance and Commitment Therapy (ACT) for Treating Major Depressive Disorders

All human beings experience negative or sad moods at times. However, if these or other symptoms are making it hard to function, you may be suffering from clinical depression. A clinical diagnosis of Major Depressive Disorder (MDD) requires five or more symptoms over the same two-week period, including either a depressed mood or loss of interest or pleasure, plus significant distress, or impaired functioning.

Although not a complete list, symptoms may include agitation, fatigue, feelings of worthlessness or excessive guilt, problems with thinking, concentrating, or making decisions, recurring thoughts of death, suicidal thoughts, or suicide attempts.

These symptoms are a change from prior functioning and are not due to another medical condition or substance use. Whether or not you meet the full clinical criteria, seeking out therapy is appropriate if you are experiencing symptoms that distress you or limit your full engagement in life.

Medication for Major Depressive Disorders

Antidepressant medications have been a profoundly helpful tool for managing or recovering from Major Depressive Disorder (MDD). Yet some patients prefer tapering off medications after symptoms decrease, due to unwanted side effects, expense, or other concerns. Other individuals have not experienced a substantial response even after trials of several different medications or prefer non-pharmacological approaches for other reasons.

Because some patients do not respond optimally to the first antidepressant, adding or switching to a different type of antidepressant is also a common scenario. Per the National Institute of Mental Health, even when some symptoms start to improve quickly, full therapeutic effects may take 4-8 weeks for many individuals.

Thankfully, medications are not the only effective depression treatment. Many MDD studies have reported that combining psychotherapy with antidepressant medication yields better outcomes than medication alone, especially for moderate to severe depression. Psychotherapy can help with initial symptom remission, maintaining progress, treatment satisfaction, and preventing relapses.

Therefore, evidence-based psychotherapies can be a powerful ally for recovery from depression, even for those already on medication. Research also indicates that the quality of the working relationship is more important to depression treatment outcomes than theoretical orientation by itself. It is vitally important to find a therapist with whom you are comfortable and can build a strong, trusting rapport.

Cognitive Behavioral therapies for depression have been particularly well studied. Generally speaking, these therapy approaches consider the impact of thinking and behaviors upon mood. Original Cognitive Behavioral Therapy (CBT) emphasized that automatic errors in thinking, such as catastrophizing or predominantly focusing on the negative aspects of situations, contribute to depressed mood.

CBT suggested that depressed individuals have disproportionately negative views of themselves, others, and their futures. Learning to correct thinking errors while also increasing constructive, rewarding behaviors are central components of CBT work. Well-implemented CBT has held up over decades as an effective depression treatment, albeit not the only one.

Today, many clinicians employ newer-generation cognitive behavioral therapies, which still consider depressive thought patterns. Instead of correcting faulty thoughts, however, the client’s focus is on changing their relationship to these thoughts.

Acceptance and Commitment Therapy

For example, Acceptance and Commitment Therapy (ACT) helps clients reduce attachment to unhelpful thinking by learning to observe thoughts as passing mental events rather than facts. Clients also work on acceptance of internal experiences and feelings. Acceptance does not mean that one must like all thoughts and emotions – only that their existence is observed and acknowledged.

Importantly, the next step is to take committed actions that are consistent with personal values, regardless of the current thoughts, internal sensations, and feelings. Rather than battling negative internal thoughts, the thoughts are noted, but energy is consciously redirected toward pursuing personally meaningful goals.

More specifically, six core processes are addressed by the therapist during the process of Acceptance and Commitment Therapy.

Work revolves around accepting the full range of thoughts and emotions, identifying and distancing from transient thoughts and emotions, increasing mindful awareness of the present moment, understanding one’s broader life context and the roles and meaning within it, identifying personal values, and taking committed action toward personally valued goals.

Throughout the process, clients are encouraged to observe patterns and track thoughts and behaviors that move them toward or away from desired goals. In this way, clients learn to improve psychological flexibility, giving them a healthier range of responses to life events and difficult emotions.

If you are struggling with symptoms of depression and these principles appeal to you, I encourage you to seek out a therapist trained in ACT. A skilled clinician can partner with you, using this evidence-based approach to treating depression and other mood disorders.