Depression: Effective Treatments including Acceptance and Commitment Therapy and Behavioral Activation

Depression: Effective Treatments including Acceptance and Commitment Therapy and Behavioral Activation

You know that you feel depression, and you may have even gotten treatment with pharmaceuticals or therapy. But what works to treat depression? We will look at the evidence behind Acceptance and Commitment Therapy (ACT) and Behavioral Activation (BA). Both are empirically supported treatments for depression, which means they’ve been shown in research studies to help people with this mental health issue. Let’s take a closer look at these two therapies, plus some other treatment options. 

What Is Depression? 

According to the National Institute of Mental Health, depression is a mental illness that includes feelings of sadness, worthlessness, and hopelessness. Depression can cause a person to have trouble sleeping, have no appetite for food or sex, or lose interest in things they once enjoyed. Some people who are depressed may also experience delusions (believing something that isn’t true), hallucinations (seeing things that aren’t there), or thoughts about death or suicide. Depression is a serious condition that needs medical attention from a mental health professional. 

What Causes Depression? 

While depression is a complex condition that has many causes, certain factors are known to increase the risk of developing it. These include childhood trauma or abuse, chronic stress or anxiety, genetic predisposition, brain structure and chemistry changes over time. In addition, a traumatic event in adulthood such as death of spouse, bankruptcy or divorce can lead to depression in some people. Depression may also be caused by medical conditions such as thyroid problems, cancer treatment, diabetes or other illnesses.  

Symptoms of Major Depressive Disorder (MDD) 

MDD is characterized by a combination of depressive symptoms that interfere with social, occupational, or other important areas of functioning. Symptoms include depressed mood most of the day, nearly every day; significant weight loss when not dieting or weight gain; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation nearly every day; fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive guilt nearly every day; diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts about death (not just fear of dying), recurrent suicidal ideations without a specific plan, or suicide attempt or threat. 

Diagnosing MDD 

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) defines Major Depressive Disorder as a period of at least two weeks where one or more symptoms are present. Common symptoms include low mood, anhedonia (reduced pleasure in activities), disturbed sleep or appetite, reduced energy, feelings of worthlessness or guilt, thoughts of suicide. The person must also have some degree of impaired function. Other conditions such as anxiety disorders can share these symptoms with MDD and could result in misdiagnosis. These diagnoses often result from many years of chronic depression that has gradually worsened over time. 

How Is MDD Treated? 

There are a number of effective treatments for depression, which is usually managed with medications, psychotherapy, or a combination of the two. Medications may include antidepressants (such as selective serotonin reuptake inhibitors or SSRIs) to increase the amount of neurotransmitters in the brain. Psychotherapy includes cognitive-behavioral therapy (CBT) that can help people challenge their negative thoughts and beliefs about themselves. Other types of psychotherapy such as interpersonal therapy and behavioral activation might also be helpful. CBT has been found to be most effective when delivered individually and over a period of several months. However, it’s important not to give up too soon on any treatment because not everyone benefits from them at first try. Acceptance and Commitment Therapy (ACT) and Behavioral Activation (BA) are also evidenced-based treatments of depression. They focus on changing how one reacts to life events rather than how they interpret them, by helping the person identify what is meaningful to them and making concrete plans around those goals. In contrast to CBT, these therapies are typically delivered in groups once or twice a week and last 10–12 weeks. 

Can mindfulness help with anxiety and depression?

Can mindfulness help with anxiety and depression?

According to Google Trends, “Mindfulness” has become an increasingly popular search term over the past decade, and a variety of resources are available to date, including books, blogs, videos, and courses. In addition to its popularity, mindfulness has been studied empirically and become an evidence-based treatment for common problems such as anxiety and depression. Generally speaking, mindfulness involves bringing intentional focus to the present moment and observing the things you are experiencing at that moment for what they are, without judgment. Your observations may involve noticing thoughts, feelings, or bodily sensations. Mindfulness interventions are commonly carried out in person, but this form of intervention is difficult for people who live in rural areas and has become particularly challenging due to the COVID-19 pandemic which has restricted social interactions. Fortunately, a group of researchers found that the positive effects of mindfulness could also be achieved via an online platform.

In 2013, Krusche and colleagues evaluated the effects of a web-based mindfulness course for stress, anxiety, and depression with 273 participants. The authors developed 10 online interactive sessions led by mindfulness instructors, and participants participated for at least 4 weeks, but the course was designed to follow the same sequence as an 8-week mindfulness course. Participants were also given audio and video clips for guided meditation and assigned work to complete outside of sessions, including informal practice of mindfulness (i.e., being present while doing an everyday task such as washing the dishes). After the course had ended, results showed significant decreases in scores related to stress, anxiety, and depression, and these effects maintained at a 1-month follow up. The results of this study are promising and suggest that many people experiencing emotional challenges during this time might benefit from online interventions such as telehealth and video-based mindfulness instruction and guide practice.

Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013). Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open Science. doi:10.1136/bmjopen-2013-003498

Evidence-based Treatments for PTSD: Prolonged Exposure and Behavioral Activation

Evidence-based Treatments for PTSD: Prolonged Exposure and Behavioral Activation

Many people witness or experience some kind of traumatic event during their lifetime; however, these events affect people in different ways. It is common for people who have witnessed or experienced a traumatic event to have some difficulty adjusting and coping, but symptoms such as flashbacks and anxiety typically improve with time (Mayo Clinic). However, for some people, symptoms get worse or persist for several months or years and interfere with daily functioning, which is usually an indication of Post-Traumatic Stress Disorder (PTSD; Mayo Clinic). A common form of treatment for PTSD is exposure-based therapy which involves intentionally imagining the traumatic experience and interacting with people, places, or things that are associated with or related to the traumatic event (Gros et al., 2012). However, some individuals with PTSD also have symptoms of depression which sometimes persist after treatment for PTSD (Gros et al., 2012). Due to this concern, Gros and colleagues (2012) sought to evaluate the effects of a treatment package for individuals with PTSD and depression which included evidence-based therapies for each of these conditions.

Eighty-two combat veterans completed participation in the current study which incorporated exposure therapy and behavioral activation (BA)—an evidence-based treatment for depression involving planning activities that are aligned with personal values. Each treatment session was 90 minutes, and participants completed eight treatment sessions. Treatment consisted of encouraging participants to plan activities consistent with personal values—some of which involved exposure to feared situations such as shopping in a crowded mall—and writing or speaking about the traumatic event (i.e., imaginal exposure). In this way, participants used behavioral activation combined with exposure therapy. Throughout the study, participants completed a variety of questionnaires designed to assess the severity of symptoms of PTSD and depression. Overall, researchers observed improvements in PTSD and overlapping symptoms of PTSD and depression; however, similar effects were not observed for nonoverlapping symptoms of depression. The authors concluded that more research is needed to determine the effects of specific treatment components on specific symptoms of PTSD and depression, and which additional treatment components may enhance treatment effects.