Depression and ACT

What is depression?

Depression is a mental health condition characterised by persistent feelings of sadness, emptiness, and a loss of interest or pleasure in activities. It goes beyond typical feelings of sadness or temporary emotional lows that everyone experiences from time to time. Depression is a complex disorder influenced by various factors, including genetic, biological, environmental, and psychological factors. It’s important to note that depression can manifest differently in different individuals, and the severity and duration of symptoms can vary.

Core characteristics of depression

People with depression often experience a range of symptoms that can affect their daily lives, including:

  • Persistent sadness or a low mood: Feeling down most of the day, nearly every day.
  • Loss of interest or pleasure: Losing interest in activities and hobbies that were once enjoyable.
  • Changes in appetite or weight: Significant weight loss or gain due to changes in appetite.
  • Sleep disturbances: Insomnia (difficulty sleeping) or hypersomnia (excessive sleepiness) may occur.
  • Fatigue or loss of energy: Feeling tired and lacking energy, even after minimal exertion.
  • Feelings of worthlessness or guilt: Experiencing intense self-blame or a sense of worthlessness.
  • Difficulty concentrating or making decisions: Problems with focus, memory, and decision-making abilities.
  • Recurrent thoughts of death or suicide: Persistent thoughts of death, dying, or suicidal ideation.

Depression is a challenging and often debilitating mental health condition, and it is important to approach it with care and sensitivity.

If you or someone you know is experiencing symptoms of depression, it is essential to seek professional help from a mental health provider. Treatment options for depression may include therapy, medication, or a combination of both.


Different types of depression

Depression can manifest in various forms. Here are some of the different types of depression:

  • Major Depressive Disorder (MDD): MDD, also known as clinical depression, is the most common and well-known form of depression. It involves persistent feelings of sadness, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, difficulty concentrating, feelings of worthlessness or guilt, and sometimes thoughts of death or suicide. MDD typically lasts for at least two weeks and significantly impairs daily functioning.
  • Persistent Depressive Disorder (PDD): PDD, previously referred to as dysthymia, is characterised by a chronic and milder form of depression. Symptoms of PDD are similar to MDD but are less severe and may persist for at least two years. People with PDD may experience periods of more intense depressive symptoms on top of the persistent low mood.
  • Seasonal Affective Disorder (SAD): SAD is a type of depression that occurs cyclically with the change of seasons, most commonly during fall and winter. It is believed to be related to reduced exposure to sunlight and disrupted circadian rhythms. Symptoms may include low mood, fatigue, increased sleep, carbohydrate cravings, and weight gain. SAD typically resolves or improves in the spring and summer months.
  • Postpartum Depression (PPD): PPD is a depressive episode that occurs after childbirth. It can involve feelings of sadness, irritability, difficulty bonding with the baby, changes in appetite or sleep, fatigue, and thoughts of harming oneself or the baby. PPD can affect both mothers and fathers and typically requires treatment and support.
  • Psychotic Depression: Psychotic depression is characterised by severe depression accompanied by psychotic symptoms, such as hallucinations (seeing or hearing things that are not there) or delusions (false, fixed beliefs). These symptoms may involve themes of guilt, worthlessness, or nihilism. Psychotic depression requires specialised treatment.
  • Bipolar Disorder: Bipolar disorder involves periods of depression alternating with episodes of mania or hypomania. During depressive episodes, individuals experience symptoms similar to MDD. Manic or hypomanic episodes may include elevated mood, increased energy, impulsivity, inflated self-esteem, and a reduced need for sleep.

Can the experience of depression result in anything positive?

It is possible for some individuals to develop certain strengths or insights because of their experiences with depression. These may include:

  • Empathy and compassion: Some people with depression develop a deeper understanding and empathy towards others who are also struggling with mental health issues. This can lead to increased compassion and the ability to provide support to others.
  • Resilience and personal growth: Overcoming depression can foster resilience and personal growth. The process of navigating through the challenges of depression can lead individuals to develop coping mechanisms, self-reflection, and a stronger sense of self.
  • Creativity and self-expression: For some people, depression can be channelled into creative outlets such as art, music, or writing. Expressing emotions through these mediums can provide a sense of release and serve as a means of self-expression.

It is crucial to emphasise that these potential positives should not be romanticised or seen as a justification for the experience of depression.

Understanding how ACT can support people with depression

Acceptance and Commitment Therapy (ACT) can be used effectively in the treatment of depression through enhancement of psychological flexibility. An ACT therapist helps clients to develop the skills to defuse from unhelpful thoughts, accept difficult emotions, and choose actions that align with one’s values, using key components and strategies such as:

  • Experiential acceptance: ACT recognises that attempts to avoid or control unwanted thoughts, emotions, or sensations can contribute to psychological distress. It encourages individuals to notice and accept these experiences rather than engaging in avoidance strategies, such as suppression or distraction. Experiential acceptance involves a willingness to fully experience and make room for all internal experiences, whether they are positive, negative, or neutral. It involves adopting an attitude of openness, curiosity, and non-resistance towards one’s internal landscape. Sometimes people who are depressed describe feeling numb or empty, which can be the result of pervasive and ongoing avoidance of emotional experiences. Acceptance work can help people build the ability to reduce over-reliance on emotional avoidance so that they can be more open to the range of their emotional, including difficult emotions such as sadness, anger and grief.
  • Cognitive skills: A core component of ACT is to help individuals distance themselves from distressing thoughts by recognising that thoughts may not always be particularly helpful. By defusing from their thoughts, individuals can reduce their impact on their emotions and behaviours. This can be especially helpful in navigating some of the common thinking patterns that arise in depression, where people can be overly pessimistic, self-critical or hopeless. ACT equips people with the skills to change their relationship with such thoughts so that they are not overly dominated by them.
  • Values-based goal setting: In ACT, individuals are encouraged to identify their core values—what matters to them in life, such as relationships, personal growth, or creativity. By understanding what is truly important and meaningful to them, individuals can set goals and take actions aligned with their values, even in the presence of depression. By setting small, achievable and meaningful goals, people can begin to slowly build helpful patterns of action that move them out of depression. This allows the person to increasingly engage in behaviours that are consistent with their values, leading to a more fulfilling life.
  • Self-compassion: Mindfulness techniques help individuals develop present-moment awareness and non-judgemental acceptance of their experiences. These exercises can help individuals observe their depressive thoughts and emotions with greater clarity but without getting entangled in them. ACT emphasises self-compassion as a way to counter self-criticism and judgment. It involves treating oneself with kindness, understanding, and acceptance, recognising that depression is a challenging experience.

ACT is a flexible and individualised therapy approach. Therapists may tailor the specific techniques and exercises used based on the needs and preferences of each person. The therapeutic relationship and collaboration between the therapist and the individual are also essential components of ACT, developing suitable long-term strategies to prevent relapse and maintain progress.

ACT is just one approach to treating depression, and the effectiveness of therapy can depend on many factors. It is recommended to work with a qualified mental health professional who can tailor the treatment approach to your specific needs.

For individuals:

If you are considering acceptance and commitment therapy as a treatment option for depression, it is recommended to seek the guidance of a qualified mental health professional who can provide a comprehensive assessment and guide you through the therapy process.

For professionals:

We offer a range of live training and on-demand courses covering how ACT therapy can be used to support clients with depression. We also include additional reading and insight on our blog, plus offer plenty of free ACT resources to aid your practice.

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