Depression and rumination

Values-based behavioral activation vs. apathy

Depression is often characterized by crippling inertia and anhedonia (inability to feel pleasure).

The death trap of depression is the verbal rule: "I can't do anything until I have energy or motivation."

ACT addresses this through rigorous behavioral activation, but with a crucial nuance: action is not taken to "feel good" (which might not happen right away), but to "be true to what matters."

This is an "outside-in" approach: we change what we do to eventually change how we feel.

Suppose a gardening enthusiast has stopped tending his plants due to severe depression.

His mind says, "Why bother? It's all going to die anyway." The therapist does not debate the veracity of that pessimistic thinking.

Instead, he validates the heaviness and apathy, and proposes a little values-based movement: "I know your mind tells you it's useless and your body weighs a ton.

Would you be willing to take that heaviness with you into the garden and water just one pot, not because you feel like it, but because taking care of living things is important to you?"

By acting in the presence of depressive thoughts, the fusion with the idea that "depression keeps me from moving" is broken. The person discovers that he or she can be depressed and water plants simultaneously.

Working with thoughts of futility and the narrative of failure

The depressive mind is a machine for generating self-criticism and hopelessness: "I am a burden", "I will never be happy", "I am broken".

In traditional therapy, one would attempt to restructure these thoughts by looking for evidence to the contrary.

In ACT, we assume that trying to argue with depression is exhausting and fruitless. Instead, we practice aggressive defusion of these narratives.

We teach the client to see these thoughts not as descriptions of their essence, but as "the story of failure" that their mind is radiating.

If a client says, "There is no hope for me," the therapist might respond, "I appreciate your mind sharing that prediction. It is a very heavy, dark thought.

Can you notice where you feel it in your body? Does it have a shape? Now, while that thought is there screaming that there is no hope, can we take a step toward something you value, like preparing a healthy meal?" It's about taking away the thought's veto power.

The person learns to treat their suicidal or futility