ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression


Psychological research suggests that cognitive behavior therapy (CBT), used alone or in combination with medical therapy, is the most effective treatment for depression. Recent finding, though, suggest that CBT for depression may work through different processes than we had previously suspected. The stated goal of therapeutic work in CBT is the challenging and restructuring of irrational thoughts that can lead to feelings of depression. But the results of recent studies suggest that two other side effects of CBT ...

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ACT for Depression: A Clinician's Guide to Using Acceptance and Commitment Therapy in Treating Depression

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Psychological research suggests that cognitive behavior therapy (CBT), used alone or in combination with medical therapy, is the most effective treatment for depression. Recent finding, though, suggest that CBT for depression may work through different processes than we had previously suspected. The stated goal of therapeutic work in CBT is the challenging and restructuring of irrational thoughts that can lead to feelings of depression. But the results of recent studies suggest that two other side effects of CBT may actually have a greater impact that thought restructuring on client progress: Distancing and decentering work that helps clients stop identifying with depression and behavior activation, a technique that helps him or her to reengage with naturally pleasurable and rewarding activities. These two components of conventional CBT are central in the treatment approach of the new acceptance and commitment therapy (ACT). This book develops the techniques of ACT into a session-by-session approach that therapists can use to treat clients suffering from depression.

The research-proven program outlined in ACT for Depression introduces therapists to the ACT model on theoretical and case-conceptual levels. Then it delves into the specifics of structuring interventions for clients with depression using the ACT method of acceptance and values-based behavior change. Written by one of the pioneering researchers into the effectiveness of ACT for the treatment of depression, this book is a much-needed professional resource for the tens of thousand of therapists who are becoming ever more interested in ACT.

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Editorial Reviews

From the Publisher
This book is a masterful contribution to the literature on the psychological treatment of depression. In exquisite detail, and full of wonderful metaphors and moment-by-moment description of the process of therapy, it will become required reading for all therapists who seek to help people find a way through their struggles with depression.
—Prof. Mark Williams, professor of clinical psychology and Wellcome Principal Research Fellow at the University of Oxford, holding a joint appointment in the Departments of Psychiatry and Experimental Psychology

Depression is the number one mental health problem seen in clinical practice and any clinician interested in practicing acceptance and commitment therapy is going to want to have this book within easy reach. Zettle provides a well thought out, easy to understand approach to treating the depressed client using the ACT framework. Capitalizing on his many years of clinical experience using the ACT model, Zettle offers numerous practical insights into managing the ongoing process of therapy, and uses brief case examples to highlight key points. The session by session ACT protocol described in the second half of the book will be a fantastically useful aid to clinicians in the field.
—Kirk Strosahl Ph.D., coauthor of Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change and A Practical Guide to Acceptance and Commitment Therapy

This professional book is the first to outline the conceptual roots, empirical basis, and practical application of acceptance and commitment therapy (ACT) for unipolar depression. In a clear and accessible style, the author guides mental health professionals and students alike in the strategic application of ACT as a supplement or alternative approach to available treatments for depression. Readers learn how to integrate and use acceptance and mindfulness strategies with commitment and behavior change strategies to help depressed clients live better, not simply to feel better. The book includes several well-crafted examples, clinical dialogues, and practical exercises, and a step-by-step integration of the material into a twelve-session protocol. It is a vital clinical resource for professionals who are committed to helping restore the lives of those who are stuck and wallowing in depression and misery.
—John P. Forsyth, Ph.D., associate professor of psychology and faculty director of the Anxiety Disorders Research Program at the University at Albany, SUNY, and author of Acceptance and Commitment Therapy for Anxiety Disorders and ACT on Life Not on Anger

This book provides more than an excellent explication of applying ACT to depression. Zettle’s presentation of the fundamental ACT principles and processes is so clear and comprehensive that readers will almost certainly see the potential application of them to many other forms of human suffering in addition to depression. I give this book my highest recommendation.
—Hank Robb, Ph.D., ABPP, past president of the American Board of Counseling Psychology and founding board member of SMART Recovery™

I enthusiastically endorse Zettle’s ACT for Depression. Well-written and comprehensive, this text is a valuable addition to the ACT literature. Addressing one of the most widespread difficulties encountered in clinical practice, this resource details a robust treatment which will be well-received by practicing clinicians with both behavioral and non-behavioral backgrounds alike.
—R. Trent Codd, III, Ed.S., LPC, LCAS, president of the Cognitive-Behavioral Therapy Center of WNC, P.A., in Asheville, NC

Having been present at the birth of ACT approximately thirty years ago, Zettle articulates ACT’s basic principles with the ease and clarity that can only come from a seasoned veteran. The rationale and techniques for applying ACT to depression are sensitive, satisfying, and establish Zettle as a true expert on depression as well as a master clinician. The book succeeds at offering both a clear, concise articulation of ACT for depression in terms of core, functional processes, allowing clinicians to apply ACT flexibly and functionally as well as a session-by-session manual for clinicians to follow when the needs for structure and support are a priority. It is easy to read with out sacrificing the philosophical and theoretical complexity of the approach. I recommend it for novice and experienced ACT clinicians as well as other clinicians and clinical students wishing to add acceptance and commitment techniques to their clinical repertoires.
—Jonathan W. Kanter, Ph.D., assistant professor of psychology, director of the Depression Treatment Specialty Clinic, and coordinator of the University Psychology Clinic at the University of Wisconsin-Milwaukee

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Product Details

  • ISBN-13: 9781608821266
  • Publisher: New Harbinger Publications
  • Publication date: 10/1/2010
  • Series: Professional Series
  • Pages: 336
  • Sales rank: 631,721
  • Product dimensions: 6.90 (w) x 10.00 (h) x 0.70 (d)

Meet the Author

Robert D. Zettle, Ph.D., is associate professor in the Department of Psychology at Wichita State University. He completed his predoctoral internship at the Center for Cognitive Therapy in Philadelphia, conducted the first comparative outcome study on what is now known as ACT as part of his dissertation under the supervision of ACT founder Steven Hayes, and has published both basic and applied research relating to rule-governance, experiential avoidance, and ACT for depression for more than twenty years.

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Table of Contents

Series Editor Letter ix

Acknowledgments xi

Chapter 1 What is ACT for Depression and What Makes it Unique? 1

Purpose of this Book

Overview of Act

Relational Frame Theory and ACT

The Goal of ACT: Psychological Flexibility

The "Dark Side" of Human Language

The "Light Side" of Human Language

What Makes ACT Unique?

Chapter 2 What Makes Depression so Depressing? 22

A Primary Pathway to Depression

Unipolar Depression within DSM-IV

Alternative Pathways to Depression

Chapter 3 Pathogenic Processes in Depression 38

Psychological Flexibility vs. Inflexibility

Types of Psychological Inflexibility

Processes Involving Defusion and Acceptance

Processes Involving Commitment and Behavior Change

Common Processes Involving Mindfulness and Self as Context

Chapter 4 Assessment of Core Processes 55

An ACT Approach to Assessment

The Starting Point: The Client's Life Story

Experiential Avoidance and Creative Hopelessness


Committed Action


Three Senses of "Self"

Chapter 5 Case Formulation and Conceptualization 74

Guidelines for Information Processing

Presenting Problem Analysis

Identification of Avoided Content

Analysis of Experiential Control Strategies

Motivational Analysis

Analysis of Environmental Barriers

Factors Contributing to Psychological Inflexibility

Targeting of Core Processes

Identification of Client Strengths

Formulation of the Treatment Plan

Strategic vs. Technical Dimensions of ACT

Chapter 6 Interventions for Promoting Defusion and Acceptance 92

Nature of Defusion and Acceptance

Promoting Defusion

Promoting Acceptance

Chapter 7 Interventions for Promoting Commitment and Behavior Change 114

Valuing and Pathways to Depression

Direct Means of Value Assessment and Identification

Values Clarification

Indirect Means of Value Assessment and Identification

Values Conflicts

Goal Setting

Committed Action

Barriers to Committed Action

Chapter 8 Interventions for Promoting Contact with the Present Moment and Self as Context 134

Increasing Contact with the Present Moment

Considerations in Promoting Mindfulness

Presenting Mindfulness Interventions Progressively

Promoting Self as Context

Chapter 9 Putting it all Together: A Sample Twelve-Session Protocol 157

Pretreatment Issues

Session 1

Session 2

Session 3

Session 4

Session 5

Session 6

Session 7

Session 8

Sessions 9-11

Session 12

Chapter 10 Additional Issues and Concerns 203

Managing Challenging Client Behavior

Concurrent Clinical Issues

Ethical Considerations

Chapter 11 Wrapping it up 227

ACT as a Paradigmatic Approach

Looking Backward

Looking Forward

Appendix A ACT Initial Case Conceptualization Form 240

Appendix B Taking Inventory 242

Appendix C Reasons for Depression Exercise 245

Appendix D Writing your Life Story 247

Appendix E Personal Values Questionnaire (PVQ) 249

Appendix F Valued Living Questionnaire (VLQ) 270

Appendix G Goals-Action Form 272

Appendix H Mindfulness Exercise Diary 273

Appendix I Breathing Mindfully Exercise 274

Appendix J Watching your Thoughts Exercise 276

Appendix K What is Acceptance and Commitment Therapy? 278

Appendix L Mood Regulation Diary 280

References 281

Index 301

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