Acceptance, Mindfulness &
Valued Action in the Treatment of
Depression
Kirk Strosahl Ph.D.
Patricia Robinson Ph.D.
Mountainview Consulting Group Inc.
mountainconsult@msn.com
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What we don’t mean by
depression
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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)
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What we do mean by
depression
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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
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An ACT Perspective on
Depression
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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
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The Three Pillars of
Psychological Flexibility
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Acceptance—Fusion polarity contains defusion,
willingness, acceptance—we will call this pillar “OPEN”
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Choose mindfully---automatic pilot polarity contains
self experience, evaluation/reason giving and valuing—
we will call this pillar “AWARE”
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This undermines emotional avoidance
This undermines fusion with rules, hidden evaluations, reason
giving and attachment to the self story
Take 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”
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This undermines behavioral avoidance
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Even More Simply, Think Of
Pillars As Core Response Styles
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OPEN: Accepting Versus Rejecting Stance Toward
Unwanted Experience
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AWARE: Chosen Versus Automatic Behavior Style
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Willingness to stand with all forms of personal experience
Defused, non-judgmental witnessing stance
Balance between present moment experience & absorption
in self process
Ability to take perspective, identify values and pick
responses
ENGAGED: Taking Action Versus Avoiding Action
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Willingness to put self in harms way based upon values
Ability to persist with value based commitments and change
strategies based upon results
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A Self Assessment Exercise
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Complete the Depressive Behaviors
Inventory
Score it and profile yourself on the
three pillars
Discuss your findings with your partner
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The Role of the Open Pillar in
Depression
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Fusion is a major problem in depression
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Ruminative processing
Fusion with self evaluations
Fusion with self story
Fusion with provocative evaluations (rightwrong, good-bad, fair-unfair, responsibility
versus blame)
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The Role of the Open Pillar in
Depression
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Depressed patients tend to take a
rejecting stance toward unpleasant
experience
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Actively avoid potentially painful emotional
triggers
Numbness and apathy as defenses against
“caring”
Day dreaming and self distractions
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The Role of the Aware Pillar in
Depression
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Depressed patients have trouble getting
in the present moment
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Meaningless routines such as over
cleaning, napping, watching TV
Rumination as a form of distraction
Out of contact with personal values
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The Role of the Aware Pillar in
Depression
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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
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The Role of the Engaged Pillar
in Depression
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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
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The Role of the Engaged Pillar
in Depression
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There is not only emotional avoidance
in depression but behavioral avoidance
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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
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Video Demonstration
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Young man recovering from drug
addiction, presenting with depression
Two Groups
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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?
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Acceptance-Willingness
Interventions with Depression
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Goal is to establish a stance of standing
with difficult material
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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
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Exercise: Railroad Crossing
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We will take you through a very simple
defusion/acceptance exercise
Complete the exercise
Discuss your reactions with your partner
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Present Moment Interventions
in Depression
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We are pitting two forms of mental
activity against each other
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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
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Exercise: Moonrise Mountain
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We will now take you through one of
our favorite mindfulness exercises
Complete the exercise
Discuss your reactions with your partner
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Valued Actions in the
Treatment of Depression
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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
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Exercise: Vision Plateau
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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!
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Pulling It All Together: Role
Play Demonstration
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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
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