Acceptance and Commitment Therapy (ACT) for rumination and worry in individuals with anxiety and depression: A randomized control trial

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Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 1999) is a third-wave behavioural therapy that has been receiving greater attention in the empirical literature in recent years. ACT is a mindfulness, acceptance and values-based psychotherapy which proposes different processes of change and outcome compared to traditional cognitive and behavioural treatments (Hayes, Masuda, & De Mey, 2003). In ACT, acceptance, mindfulness and values strategies are used to create a context for an individual to engage in effective and valued behaviours, even in the presence of difficult thoughts and emotions. Within an ACT framework, two key processes are seen as contributing to the development and maintenance of many forms of psychopathology: experiential avoidance (i.e. behavioural and psychological attempts to avoid an unpleasant experience) and cognitive fusion (i.e. responding to a thought or feeling as if it were the actual event it describes; Hayes, Strosahl, & Wilson, 1999; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Chronic worry and rumination are key cognitive processes associated with the onset and maintenance of generalised anxiety disorder (GAD) and depression (Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). Worry and rumination have been considered by researchers to be forms of both experiential avoidance and cognitive fusion. The literature on clinical interventions for rumination is surprisingly scarce, and although there are currently a number of efficacious cognitive behavioural treatments for chronic worry and GAD, it is evident that there is room for improvement as only about half of those treated are achieving high end state functioning (Hayes, Orsillo & Roemer, 2010). To date, beyond case studies (Ruiz, 2010) there has been no research specifically investigating ACT for chronic worry and rumination amongst sufferers of GAD and Depression. A randomised control trial comparing ACT to CBT will address this gap in the literature and inform the treatment and management of anxiety and depression. Furthermore, investigating the mechanisms of change, specifically that of acceptance of psychological experience and greater behavioural engagement with valued areas of life, will enhance our understanding of the predictive elements of ACT and improve its application in the treatment of mood and anxiety disorders.

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