ACT Treatment Interventions for Depression: Experiential Work

miranda_morris

True North Therapy and Training

Key Points

  1. Experiential work is a core component of ACT for depression.
  2. The therapist aims to create practical learning opportunities instead of theoretical explanations.
  3. Activities might include breathing exercises, noticing thoughts and feelings, defusion work, and exploring self-stories.
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Actions Not Words

Experiential work is core to ACT so, while the language we choose to use is itself part of therapy, we must look for every opportunity for clients to engage in experiential learning; not theory but practice.

  • Breathing exercise

Some experiential work is very simple. It might just be, as you start a session, both therapist and client taking a moment to close their eyes and breathe, noticing the sensations of their seating and the physicality of their breath.

  • Sensory exercise

This might involve asking a client to notice everything about their own sensory state and their surroundings when they enter a session: their mood, their breathing, their weight in the chair, the sound of the therapist’s voice. This invites them to be present, and noticing; to place attention on what’s important, not necessarily what’s in their mind.

  • Noticing thoughts and feelings

At any appropriate time, clients can be invited to take a moment to notice their internal experiences, their thoughts and feelings. Here language is important once more: not, ”What are you thinking about, what are you feeling?”, but, “What thoughts and feelings can you notice? Can you label them?”

  • Defusion work

Defusion is relevant to experiential work because it is the experience of getting distance from experience. We give clients practice in getting out of a fused place by adopting some distance from which to look at their experience and say, “That’s the experience I’m having.” This is as opposed to the narrow views distress can bring, such as, “This is how it is, who I am, who I will always be.” Thoughts, feelings, and sensations come and go. Can we notice them?

  • Self-stories

Relatedly, and particularly for those with depression, defusion as part of experiential work allows clients to see persistent and unhelpful thoughts from a more distant perspective: as self-stories, and how they control behaviors. Hannah’s self-stories were, “I’m broken, there’s no point, I’m not going to get well, there’s something wrong with me.”

  • Time travel exercise

We can ask Hannah to look into the future, asking, “If such self-stories keep deciding how you live, what does your life look like a year from now? If you sleep a lot, and don’t work or socialize, every day for a year, how does future you feel about that?” Then imagine a year spent being more active, getting a job. “What would future you say then?”

Using other versions of the self to interact with possibilities can open up narrow, distressed narratives. However, depressed clients might respond with, “But I have no choice.” So it may be an ongoing experience and process.

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ACT Treatment Interventions for Depression: Experiential Work

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