Strosahl, K. D. & Robinson, P.J. (2008)
Oakland, CA: New Harbinger
Reader Targets
Social Workers, Counselors, Family Therapists, Psychologists, Physicians, Nurse Practitioners, Physician Assistants, Nurses
Description
The Mindfulness and Acceptance Workbook for Depression is a self-help book for people who are struggling with symptoms of depression. Unlike the dozens of books that try to help readers “overcome” or “put an end to” depression, this book helps patients use symptoms of depression to jump-start their lives. The basic idea is that depression symptoms are often realistic signals that something in life needs to change. Learning to understand and interpret these signals is much more important than finding out how to simply make them go away. The real impact of depression is that it leads people into a cycle of avoiding problems that may help in small ways in the short term but only make the situation worse in the long run. This workbook uses techniques from Acceptance and Commitment Therapy (ACT) to offer a new approach to depression—one that helps people live a productive life by accepting difficult feelings and pursuing meaningful action.
The Mindfulness and Acceptance Workbook for Depression is a workbook that comes with a CD recording of experiential exercises presented and forms used in case examples in the book. Readers may use the book alone or with the support of a health care provider. The book also provides a practical curriculum for psychoeducational classes, and a class session guide is provided below.
About My Co-Author
Kirk D. Strosahl, Ph.D., is a co-founder of acceptance and commitment therapy and an internationally recognized expert on managing depression and suicidal behavior. Strosahl has practiced as a psychologist for more than twenty-eight years, working with depressed patients in both mental health and primary care settings. He is coauthor of several books, including Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Strosahl currently lives and operates a vineyard in central Washington.
Acknowledgements / Awards / Review
The Mindfulness and Acceptance Workbook for Depression received a “Self-Help Merit Award” from the Association for Behavioral and Cognitive Therapy at the 2010 annual conference in San Francisco, CA.
Table of Contents
Introduction: A New Perspective on Depression
A Different Perspective
- What If Controlling Your Depression Is Not the Goal?
- What If the Goal Is To Feel What You Feel and Pursue a Life Worth Living
- A Little About Acceptance and Commitment Therapy
- The Two Worlds of Depression
- ACT Fosters Acceptance
- ACT Fosters a Mindful Lifestyle
- ACT Focuses on Valued Actions
- The Goal of ACT: Psychological Flexibility
- A Mantra: Accept, Choose, Take Action
- The ACT-On Depression Approach
- How to Use This Book
- Rally Your Social Support
- A Little Story
SECTION I: CREATING A CONTEXT FOR CHANGE (4)
1. Getting Your Feet on the Ground: Depression Isn’t What You Think It Is
- The ACT Perspective
- The Meaning of Depression
- Depressive Experiences
- Myths about Depression
- Myth 1: Depression Is Abnormal
- Myth 2: Depression Is an Inevitable Response to Life Stress
- Myth 3: Depression Is about Experiencing Emotions
- Myth 4: Depression Is a Biological Illness
- Myth 5: Medicine is the Best Treatment for Depression
- Myth 6: Depression is Something You Have
- Trading Illusions for Actions
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
2. Pathways Into and Out of Depression
- Pathways into Depression: Triggering Events
- Dealing with Loss
- Coping with Trauma
- Health Problems
- Pathways into Depression: Control Your Mood, Loose Control of Your Life
- Pathways into Depression: The Sirens
- The First Siren Song: Emotional Avoidance
- The Second Siren Song: Fusion
- Pathways into Depression: Hidden Benefits
- Pathways Out of Depression: Three Roads to Vitality
- Route 1: Acceptance Versus Rejection of Unwanted, Internal Experiences
- Route 2: Intentional Versus Auto-Pilot Lifestyle
- Route 3: Approach Versus Avoidance Orientation to Problem Solving
- The Fuel of Psychological Flexibility
- Pathways Out of Depression: Dare to Imagine
- Exercise: Imagine A Better Future
- Debriefing
- Today’s Dreams Can Become Tomorrow’s Reality!
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
3. Depression Experiences: Taking Inventory
- Depressive Behaviors in Three Areas of Living
- Exercise: Inventory of Health, Relationships, Work and Play
- Coping Strategies: Part of the Solution or Part of the Problem
- Short- Vs. Long-Run Results
- A Paradox
- What Works and What Doesn’t Work
- Exercise: Inventory of Short- Versus Long-Run Results
- Does Depression Protect You?
- Exercise: Depression Risk Inventory
- Exercise: Depression and Avoidance Inventory
- Are Depression Behaviors a Choice?
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
4. The Depression Trap: Control Your Depression or Control Your Life
- Understanding Emotions and How They Work
- Emotions Are A Form of Intelligence
- The Culture of Feel-Goodism
- The Costs of Feel-Goodism
- The Song of the First Siren: Emotional Avoidance
- The Depression Trap
- Snap! Trying to Control the Way You Feel Is the Problem
- Snap! Mental Events Are Uncontrollable
- Snap! Mental Events Become Bigger When You Try to Suppress Them
- Exercise: Learning to Spot the Depression Trap
- Exercise: Avoidance and Suppression
- When Managing Your Mood is the Goal, Managing Your Life is Impossible
- Emotional Control Behaviors: Decreasing Positive Activities
- Emotional Control Behaviors: Avoiding Personal Problems
- Emotional Control Behaviors: De-Normalizing Normal Activities
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
5. Understand Your Mind, Trust Your Experience
- The Song of the Second Siren: Fusion
- The Uncarved Block
- How Your Mind Is Carved Up
- Rule Governed Behavior
- Relational Frames
- The Diectic Frame
- Caution: Relational Frames at Work
- Programming is Automatic and Resists Change
- Programming Controls Behavior Outside of Awareness
- Exercise: Revealing the Brittle Shell
- Exercise: Cracking the Shell
- Learning to Mind
- Reactive Mind and Wise Mind
- Reactive Mind
- Wise Mind: The Companion of Reactive Mind
- Which Will You Trust? Reactive Mind or Wise Mind
- When Your Mind is Incompetent, Hold It Softly
- Workability: Learning to Use Wise Mind
- Workability Is About Results
- Workability Is A Process Not An Outcome
- Workability Plays No Favorites
- Exercise: The Workability Yardstick
- Exercise: When Life Was Working Better
- Exercise: Workability Analysis
- Staring Into Darkness
- Exercise: In a Hole
- Creative Hopelessness
- To Dig or Not to Dig?
- An Alternative to Digging
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
SECTION II: STEPPING OUT OF DEPRESSION AND INTO A VITAL LIFE
6. Step One: Define Your Values Compass
- ACT: A Values-Based Approach
- Accepting the Uncertainty of Change
- Values Are the Fuel
- The Cost of Values Vacancy
- How Values Get Lost in the Shuffle of Living
- Values and Depression
- Exercise: Stranded on a Deserted Island
- Exercise: Write Your Epitaph
- Exercise: Aim For The Bull’s Eye
- Health
- Relationships
- Work and Play Behaviors
- Amy’s Journey to a Vital Life
- Be Gentle With Yourself
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
7. Step Two: Accept What You Cannot Change
- Acceptance As a Lifestyle Goal
- What Can Be Controlled and What Must Be Accepted
- Exercise: What Can’t Be Changed . . .
- . . . Must Be Accepted
- Unwanted Private Events Are Not Toxic
- What Acceptance Is . . . and Is Not
- Acceptance Is Not Resignation
- Acceptance Does Not Mean You Have Failed
- Acceptance Is Not Tolerating Personal Pain
- Acceptance Is Allowing
- Excessive Suffering
- Exercise: Sorting Out the Excess
- Willingness: An Alternative To Avoidance
- Willingness Is Not Wanting Pain
- Exericse: Suffering and Willingness Plan
- Willingness, Depression, and Vitality
- Exericse: Willingness, Depression, and Vitality Diary
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
8. Step Three: Become a Mind Watcher
- Rule Following: The Arch Enemy of Acceptance
- Your Mind is Phishing You
- Phishing for Fusion Phish
- Signs You Are Being Phised
- Exercise: Phishing Lures
- How Fusion Begets Fusion
- Mind: A Tantrum-Throwing Child
- Exercise: Railroad Crossing
- Exercise: Off the Track
- Exercise: Thank Your Mind
- Example: Helen’s Responses
- Exercise: Then And There, When And If
- Example: Helen’s Responses
- Exercise: Take Your Mind for a Walk
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
9. Step Four: Get to Know the Right and Wrong Trap
- The Pull of Reactive Mind
- Having Thoughts, Holding Thoughts, And Buying Thoughts
- Are You a Thought Buyer?
- Rules About Life
- Exercise: Favorite Life Sayings
- Exercise: True-False Test on Reality
- Four Poison Pills: How your Evaluations Make You Suffer
- Right and Wrong
- Good and Bad
- Fair and Unfair
- Responsibility and Blame
- Exercise: Poison Pills
- Description Versus Evaluation
- Evaluation: Going Beyond Description
- Why Do People Commit Suicide?
- Exercise: Observe Your Evaluations
- Study An Object
- Study A Person
- Study An Event
- Caring
- Notice Your Evaluations, Choose What You Care About
- Exercise: What Do You Care About?
- Example: Gloria
- Gloria’s Journey to a Vital Life
- Secrets to ACT On
- The Coach Says
- Sneak Preview
10. Step Five: Learn That Sense Making Doesn’t Make Sense
- Sense-Making
- Reason Giving
- The Illusion Of Cause And Effect
- Reasons Maintain Social Control
- Reasons Are Easily Programmed
- The Myth Of Emotions As Reasons
- Exercise: Look At Your Reasons
- The Unworkable Change Agenda
- The Cart And The Horse
- So, What’s Not To Like About Reasons
- Pre-Conscious Bias
- The Depressive Skew
- Exercise: Play With Review
- Bottom Line: Be Aware of and Weary of Reasons
- Secrets to ACT On
- The Coach Says
- Sneak Preview
11. Step 6: Hold Your Story Line Lightly
- Your Story Line: The Perfect Storm Of Sense-Making
- How Story Lines Work
- The Problem With Remembering The Past
- Rumination And Memory Suppression
- Autobiographical Memory Deficits
- Exercise: Spin the Story Wheel
- Exercise: Write Your Autobiography
- Exercise: Deconstruct Your Autobiography
- Exercise: Re-Write Your Autobiography
- How Many Stories Do You Have
- Four Poison Story Lines
- Victimization
- Silent Martyrdom
- Self-Imposed Exile
- Righteous Indignation
- The Fatal Flaw
- Exercise: Your Fatal Flaw
- Time For A Thank You Note
- Gary’s Journey to a Vital Life
- Secrets to ACT On
- The Coach Says
- Sneak Preview
12. Step Six: Be Present
- The Longest Trip
- Mindfulness
- Benefits Of Mindfulness
- Increased Willingness And Acceptance
- Decreased Rumination
- Increased Mental Efficiency
- Living With Greater Awareness
- Healthy Forms of Self Experience
- Observer Self
- Silent Self
- Expanding The Observer Self
- Exercise: Where Do You Live?
- Exercise: Mindful Eating
- Exercise: The Breath of Life
- Exercise: Peel An Orange
- Exercise: Choose Every Step
- Exercise: Reveille
- Expanding The Silent Self
- The Mind Is No Mirror
- Exercise: Consciousness Is No Thing
- Example: Ted’s Experience
- Exercise: Inside And Outside
- Exercise: Consciousness Is No Thing
- Exercise: Moonrise Mountain
- Example: Leslie’s Experience
- Exercise: The You That Is Left Behind
- Wise Mind And Vital Living
- Exercise: Mystery, History, Gift
- Health
- Relationships
- Work And Play
- Example: Charlie’s Experience
- Health
- Relationships
- Work And Play
- Secrets to ACT On
- The Coach Says
- Sneak Preview
13. Step Eight: Create A Life Vision and Plan
- What Is A Life Vision?
- Exercise: Vision Plateau
- From A Life Vision To A Life Plan
- Exercise: Life Vision To Life Plan
- Examples Of Vision And Values Statements
- Health
- Relationships
- Engagement In Work And Play Activities
- Questions for the Life Vision to Life Plan Exercise
- Vision and Mystery: The Willingness To Plan Flexibly
- Exercise: “Yes and . . .”
- Planning a Vital Life
- Exercise: The Life Plan
- Life Plan: Health
- Life Plan: Relationships
- Life Plan: Work
- Life Plan: Play
- Life Plan Summary Worksheet
- Example: Ruth’s Life Plan
- The Secrets to ACT On
- The Coach Says
- Sneak Preview: Mystery and Planning
14. Step Eight: Make Commitments, Keep Commitments
- The C in Acceptance and Commitment Therapy
- What Is A Commitment?
- Committed Action As A Choice
- Committed Action Is Consistent With Your Values
- Exercise: Qualities Of Committed Action
- Committed Action Is A Process, Not An Outcome
- Committed Action Is Never Perfect
- Exercise: Committed Action In The Presence of Barriers
- Exercise: Making Contact
- Hidden Barriers To Committed Action
- Confidence The Feeling Versus Confident Action
- Trauma And Forgiveness
- I’ve Wasted My Life
- Dealing With Failed Commitments
- Can’t Versus Won’t
- Re-Committ
- The Secrets to ACT On
- The Coach Says
- Sneak Preview: Mystery and Planning
SECTION III: A COMMITMENT TO VITALITY
15. Maintaining Your Life Direction (34)
- Life Is A Marathon, Not A Sprint
- The Honeymoon Trap
- Reactive Mind Is A Relentless Phisher
- Turning Your Mind On What Works
- Developing Habits For Vital Living
- The ACT Habit
- Developing An ACT Lifestyle
- Exercise: Favorite ACT Habits
- Exercise: My Practice Plan
- Exercise: My Rewards
- Exercise: Expanding My Habits
- Exercise: A Plan For Reviewing Results
- Monitoring Depression Compression Experiences
- Life Challenges: Nothing To Control
- Exercise: Identify Risk Situations
- Exercise: Monitor Depressive Behaviors
- Exercise: Depression Prevention Planning
- Spring Into ACTion
- Developing Intention
- Exercise: Take A Hike
- Express Your Attitude
- Be True To Yourself
- The Secrets to ACT On
- The Coach Says
- Sneak Preview
16. Give and Take Support
- Create A Circle Of Support
- What Is Competent Social Support?
- Exercise: Like-Minded People
- Find A Vitality Partner
- I Don’t Want To Be A Burden
- Humiliation And Burden
- Under-Asking
- Exercise: Identify And Ask
- Exercise: Set A Time And Place
- Exercise: A Letter To Yourself
- Enlist Support From Professionals
- Exercise: A Letter To Your Doctor (or Therapist)
- Nationwide Resources
- The Secrets to ACT On
- The Coach Says
Appendices
- References
- CD: Forms List
- CD: List of Audio Clips
Class Session Guide
The Mindfulness and Acceptance Class: A Course about Vitality
The following are session guides for Therapists to use to structure a series of 9 classes for patients suffering from symptoms of depression. The guides reference The Mindfulness and Acceptance Workbook for Depression and the CD packaged with the book (Strosahl and Robinson, 2008).
Class | Class Agenda |
Class One: Understanding the Depression Trap (Chapters 1-4) | 0-5: Introductions5-15: Myths about Depression (Chapter 1) (lecture / discussion)15-25: Pathways into and out of Depression (Chapter 2) (lecture / discussion)25-35: Exercise: Complete “Imagine a Better Future” (see CD for form), share results with a partner35-40: Write quote at beginning of Chapter 3 on white board and facilitate a discussion40-55: Exercise: Complete “Inventory of Health, Relationship, Work, and Play Behaviors” (see CD for form); assist participants with scoring as they complete
55-60: Provide a preview of next class: Looking at how short term solutions work in the long run, understanding how emotions work |
Class Two: Short Term Solutions, How Emotions Work (Chapters 1-4) | 0-5: Introductions, any thoughts about last class?5-10: Short-term and long-term solutions, summary of “Judy” on page 50 (lecture / discussion)10-20: Exercise: Complete “Inventory of Short-Term vs. Long-Term Results” (see CD for form)25-35: Discuss Results of Exercise35-40: Exercise: Complete “Depression Risk Inventory” (print from page 54) and discuss with partner40-50: Brief lecture / discussion concerning How Emotions Work and Why Avoidance Doesn’t(Chapter 4)
50-55: Assign optional homework: Complete “Depression and Avoidance Inventory” (see CD for form) 55-60: Provide a preview of next class: The Problems with Language, The Reactive and Wise Mind, Learning to look at what works |
Class Three: Language, Reactive vs. Wise Mind, Workability (Chapter 5) | 05: Introductions, any thoughts about last class?5-15: Brief lecture about why it’s best to understand your mind and trust your experience, introduce fusion and how programming controls behavior outside of our awareness15-25: Exercise: Play “Cracking the Shell of Language” (use CD to play recording), discuss25-35: Brief lecture on reactive mind and wise mind (pp. 83-85) (If possible, write qualities of wise mind and reactive mind on white board before class to facilitate discussion, see p. 84).35-45: Introduce concept of workability (pp. 87-89) (If possible, write qualities of low workability and high workability on white board before class to facilitate discussion, see p. 89)45-55: Exercise: Complete “When Life Was Working Better” (see CD for form) and discuss with partner
55-60: Assign optional homework: Complete “Workability Analysis” (see CD for form) to see what the reactive mind and the wise mind say about a couple of troubling situations you experience this week; Provide a preview of next class: Step 1 (of 9) for moving out of depression and into a meaningful life. |
Class Four: Define Your Values Compass (Chapter 6) | 0-5: Introductions, any thoughts about last class5-15: Brief lecture about values (chapter 6)15-35: Exercise: Play “Stranded” (see CD) and for recording, ask participants to use a blank sheet of paper to record responses to questions listed on pp. 106-107, as you read them at a slow pace allowing participants adequate time to think through their responses, debrief35-45: Exercise: Complete “Write Your Epitaph” (participants can write response on bottom of page used for “Stranded” exercise)45-55: Introduce bull’s eye concept (pp. 109-116) and assign optional homework: Complete Exercise: “Aim for the Bull’s Eye” (see CD for form)55-60: Provide preview of next class: Acceptance |
Class Five: Accept What You Cannot Change (Chapter 7) | 05: Introductions, any thoughts about last class5-30: Brief lecture on acceptance, excessive suffering, and willingness, give example of Bill (p. 132)30-45: Introduce Exercise: “Willingness, Depression, and Vitality Diary”, ask participants to complete day 1 of form in reference to prior day and day 2 in reference to current day and then to discuss with a partner45-55 Facilitate group discussion of exercise, perhaps review the workability yardstick from class three (on p. 89).55-60: Preview of next class: Mind Watching |
Class Six: Become a Mind Watcher (Chapter 8) | 05: Introductions, any thoughts about last class5-15: Brief lecture about rule following, being phished by your mind15-20: Exercise: Complete “Phishing Lures” (see CD for form), discuss with partner20-30: Exercise: Play “Railroad Crossing”, debrief30-4: Exercise: Play “Down the Track”, debrief, talk about the idea of “thanking your mind” (p. 150)40-50: Exercise “Take Your Mind For a Walk” (5 minutes for each partner)
50-55: Debrief and introduce optional homework assignment: Complete Exercise “There and Then, If and When Worksheet” (see CD for form) 55-60: Provide preview of next class: The Trap of Right-Wrong Thinking |
Class Seven: Get to Know the Right-and-Wrong Trap (Chapter 9) | 05: Introductions, any thoughts about last class?5-15: Brief lecture about reactive mind, buying thoughts, rules about living, implicit world view15-30: Exercise: Complete “Favorite Life Sayings” (see CD and “Rules about Life” (see CD for form), discuss with partner30-40: Brief lecture on 4 poison pills (write 4 pill types on white board before class), description and evaluation40-50: Exercise: Read “Observe Your Evaluations” exercise to participants, facilitate discussion 50-55: Brief pep talk regarding noticing your evaluations and choosing what you care about (p. 170)
55-60: No homework this week; Provide preview of next class: The problem with sense-making |
Class Eight: Learn that Sense Making Doesn’t Make Sense (Chapter 10) | 05: Introductions, any thoughts about last class?5-15: Brief lecture about sense-making, reason-giving, the illusion of cause and effect, etc.15-25: Complete Exercise “Look At Your Reasons” (read exercise on p. 180) and facilitate a group discussion25-35: Brief lecture on reason giving and depression35-55: Complete Exercise: “Play with Reasons” (see CD for form)55-60: No homework; Provide preview of next class: Your Story or Stories |
Class Nine: Hold Your Story Line Lightly (Chapter 11) | 05: Introductions, any thoughts about last class?5-15: Brief lecture on story lines, problems with memories15-30: Complete Exercise: The Life Story Wheel” (see CD for form)30-45: Complete Exercise: “Write Your Autobiography” (see CD for form) (encourage participants to write 3 paragraphs in 10 minutes)45-55: Introduce Exercise: “Deconstruct Your Autobiography” (see CD for form), provide example of Gary for participants), assign this as homework, as well as optional “Rewrite Your Autobiography” Exercise (see p. 202)55-60: Introduce common story lines (victimization, silent martyrdom, etc.) and provide a preview of next class: being present |
Class Ten: Be Present (Chapter 12) | 05: Introductions, any thoughts about last class?5-10: Brief lecture on mindfulness and benefits of mindfulness, healthy forms of self experience (If possible, draw diagram on p. 213 on white board before class), introduce idea of developing the Observer Self10-30: Complete Exercise: “Where Do You Live” (see CD for recording and form)30-35: Brief lecture on developing the silent self35-55: Complete Exercise “ Moonrise Mountain” (see CD for audio recording)55-60: No homework assignment; provide preview of next class, how to create a life vision |
Class Eleven: Create a Life Vision and Plan (Chapter 13) | 0-5: Introductions, any thoughts about last class?5-10: Brief lecture on life vision and then introduce exercise10-35: Complete Exercise: Vision Plateau (play recording on CD and then read debriefing questions on p. 240, encouraging participants to use a blank piece of paper to record their responses to the debriefing questions)35-45: Brief lecture on using the life vision to create a life plan45-55: Introduce the “Life Vision and Values Statements Worksheet” (provide copies from original on p. 244), ask participants to choose one area to work on in class and to discuss with a partner55-60: Assign homework of completing the Life Vision and Values Statement Plan started in class, provide preview of next class: making commitments. |
Class Twelve: Make and Keep Commitments (Chapter 14, 15) | 0-5: Introductions, any thoughts about last class?5-15: Brief lecture on commitments and continuing with committed actions in the face of barriers15-35: Complete Exercise: “Making Contact” (play recording on CD), discuss with partner, group35-45: Brief discussion about hidden barriers to keeping commitments and dealing with failed commitments, recommitment45-55: Introduce idea of developing habits for vital living and assign optional homework assignments: Exercises: “Favorite ACT Habits” (see CD for form) and “Expand Your ACT Habits” (see CD for form)55-60: Provide preview of next and last class: Living a Vital Life Style. Also, you might introduce the idea that people could bring food to the next class, as part of the graduation experience |
Class Thirteen: Living a Vital Life Style (Chapters 15, 16) | 0-5: Ask participants to share results of homework with a partner5-10: Brief lecture concerning the importance of staying aware and of offering and taking support to / from like-minded people10-20: Complete Exercise: “Identify Your Risk Situations”, discuss with partner (see CD for form)20-30: Complete Exercise: “Create A Depression Prevention Plan” (see CD for form)30-40: Brief lecture concerning a vitality partner and enlisting support from professionals40-60: Party time: Allow participants to share food (if that was planned), during last 5 minutes, go around the circle and allow each person to make a simple commitment statement (e.g., I commit to showing that I care about other people; I commit to being playful) |