Background
Attention Bias Modification
The Attentional Bias Modification procedure
Acceptance and Commitment Therapy
The ACT model of depression
Combining ACT and ABM to reduce the likelihood of recurrence of depression
Hypotheses
Methods/design
Overview of study design
Participants
Inclusion criteria
Exclusion criteria
Sample size and power
Procedures
Randomizing and treatment allocation
Assessments and measurements
-
Recurrence of major depressive episodesMeasured by the MINI structured interview [41] 12 months after baseline
-
Changes in symptoms of anxiety
-
Changes in quality of life
-
FlourishingThere is increasing interest in investigating what promotes positive mental health and well-being as a continuum, separate from, albeit related to, mental illness. Flourishing is a term describing subjective well-being [54] which has been operationalized as encompassing facets of (1) emotional, (2) psychological, and (3) social well-being ([55], p. 99). The study uses The Mental Health Continuum – Short Form (MHC-SF) [55], which has been found to have good psychometric properties [55], to measure these three main dimensions of well-being
-
Early morning cortisol responseIt is well established that dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis with elevated plasma cortisol levels is characteristic of MDD [56]. Increased secretion of cortisol has also been reported to be present in depressed subjects after clinical recovery [57], and has been suggested to be a vulnerability marker. This study will collect early morning cortisol response, as a natural neuroendocrine challenge test to assess the hypothesis that reduced HPA activity will be a surrogate marker of residual symptoms and thus relapse prevention following ABM and ACT.
-
Acceptance
-
Values
-
Engaged livingEngaged living is a term that is used to describe ways in which valued life activities are pursued [60]. Engaged Living Scale (ELS) [61] is a newly developed measure that addresses the processes of values and committed action from the framework of ACT. A study by Trompetter et al. [61] found ELS to be a valid and reliable measure of an engaged response style
-
Mindfulness
-
Cognitive fusion
-
Psychological stress
-
Automatic thoughts
-
Other cognitive measures
Data analysis
Therapists and treatment adherence
Interventions
-
First meetingThe first meeting provides an introduction to the central components of ACT and seeks to create an atmosphere of safety, trust, openness and willingness for participants. The objective is to ready for the journey we as a group are to undertake together. This journey involves inviting and making room for difficult emotions and thoughts, in order to focus on what participants want their lives to be about. An engaging and flexible contact with emotions and thoughts has the potential of providing valuable information about oneself, and, furthermore, of releasing energy that previously would be used to try to contain these difficult emotions and feelings. For most of the participants, this perspective represents a shift of paradigms
-
Second meetingThe second meeting has acceptance as a headline, and participants are early on invited into a process of reflection. Acceptance is introduced as an alternative to controlling and avoiding unwanted thoughts, feelings, and sensations. Metaphors and exercises are used to create several experiential examples of acceptance. To make acceptance personally relevant participants are challenged to share personal examples with the group that underscores the workability of acceptance versus avoidance
-
Third meetingThe third meeting has values as a headline. Participants are invited to reflect on what is, and what could be, important and meaningful in their lives. Some perspectives on values are introduced, but not in the sense that we as group leaders have the power of definition. Rather, participants are invited to share their own viewpoints to co-create what values mean, and to make them personally relevant. The connection between acceptance and values is made more explicit and exemplified. Values are often nonverbal (implicit), and this meeting seeks to start the process of identifying values and making them more explicit
-
Fourth meetingThe fourth meeting has defusion as a headline. Defusion is a process of being able to create some distance between ourselves and unwanted psychological experiences in the service of doing what is important, valuable, and meaningful. The process is highlighted by reflecting on how stories about ourselves affect us. The participants engage in exercises designed to increase awareness of the kind of life stories they construct and choose to represent themselves. The life story is then challenged and deconstructed
-
Fifth meetingHeadlines for the day are actions and engagement. Participants are introduced to the notion that people’s lives can be usefully divided into four different central areas or domains: (1) relationships, (2) education and work, (3) health and personal development, and (4) spare time. The remaining meetings will examine participant goals and aspirations in a different life area each time. In this meeting, participants are challenged to select a focus important to them within the broader domain of relationships (e.g., being a loving spouse), and choose congruent short- and long-term goals. Participants are encouraged to set small goals and plan concrete small actions that would bring them a step closer to their values
-
Sixth meetingThe theme for this day is the observing self, which describes a transcending perspective that emerges from noticing our on-going stream of both internal and external experiences. It can be thought of as an invariant vantage point from which we can notice that we notice and see that we see. The observing self explicitly builds around the capacity to see ourselves having thoughts and feelings while not being defined by them. The work with value-based actions continues in the domain of health and personal development
-
Seventh meetingHeadline for the seventh day is self-compassion, which is the capacity to direct kindness and warmth towards yourself and your inner experiences. In this meeting value-based actions are explored within the area of work and education
-
Eight meetingThe eighth session features summarizing and strengthening constructive processes that have been initiated and activated in earlier meetings. Participants are also challenged to investigate and choose value-based actions in the life domain of spare time. An important theme is how to continue the work of developing, exploring, and internalizing the processes that have been most helpful for them