Using ACT self-help manual with depression: experiences and

observations

Raimo Lappalainen

Anna Granlund

Aino Kohtala

Department of Psychology

University of Jyväskylä, Finland

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Introduction

Depression is one of the most common psychological problems. In Finland, the prevalence of at least moderate depressive episodes within the last 12 months is about 4% among men, and 8% among women.

Overall, to our knowledge, few studies have examined the effects of brief interventions delivered by novice therapists using self-help manuals

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The aim

The purpose of this study was to increase our knowledge of using self-help manuals in brief ACT interventions delivered by psychology students.

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Method

Clients– Newspaper advertisement: 59 contacted the clinic

44 interviewed by phone– 36 started, 30 completed to Post-measurements

Criterias:– Self-reported mood problems– No other treatments

18.04.23 4anna.a.granlund@jyu.fi

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Method

30 subjects reporting depressive symptoms were treated either by 6-week ACT treatment alone or with 6-week ACT treatment combined with self-help manual (Get Out of Your Mind).

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The self-help manual

Get Out of Your Mind & Into Your Life

Steven C. Hayes & Spencer Smith (2009)

Translated into Finnish

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Clients (n=30)Clients (n=30)

Women = 21 (70 %), men = 9 (30 %)

Age mean = 49 years

No psychiatric diagnoses = 60 %

Depression diagnoses = 27 %

No prior psychotherapy = 70%

No medication for depression = 73 %

The therapists

N = 15 master’s level psychology students (women/men 14/1)

Mean age = 25-years (SD=4.20; vaihteluväli 22–37)

Mean time for psychology studies = 4.13; SD=1.06; range 2–6)

Training CBT = 10 hours, ACT = 14 hours

Manual in ACT (Lappalainen ym., 2009 including 32 metaphors ja 18 exercises)

Supervision every week

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Intervention

Case formulation, value work, exercises, for example, mindfulness exercises, the observer exercise, metaphoras (during every session), home work

Student therapist treated one client with the manual and one without

The therapists in the manual group were instructed to use three Chapters: Introduction, Human Suffering and What Are Values?

Rest of the manual was used individually

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Method

Pre-Post measurements presented

Time between Pre-Post: 6-8 weeks

Therapists recorded after every session if they had worked with a particular ACT core prosess

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Results

Both treatments showed significant symptom improvement. But there were no clear differences between the groups.

The majority of the students reported that the manual is useful part of the treatment, but only about half of the students estimated that the client had benefitted of the manual.

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12Pre-Post

ACT+Manual (n=14) ACT (n=16)

Pre Post Pre Post

BDI 22.79 (8.07) 10.64 (6.73)***

19.75 (8.40) 7.88 (6.29)***

AAQ-II 34.86 (9.02) 45.21 (11.80)**

40.19 (7.80) 50.87 (10.21)***

KIMS 113.00 (9.59)122.79 (15.05)*

117.56 (13.45) 130.12 (11.81)**

BAI 16.21 (8.75) 11.86 (10.28) 13.94 (9.13) 7.81 (6.86)**

SCL-90 1.17 (0.41) 0.71 (0.42)**

1.01 (0.47) 0.47 (0.36)**

Social funct 32.29 (7.26) 36.57 (7.15)* 33.81 (7.98) 41.38 (7.30)**

SelfConfid 46.14 (15.02) 55.21 (17.34) 55.53 (14.53) 71.13 (16.03)**

Satisfaction 39.71 (14.90) 57.00 (18.32)**

51.07 (20.15) 70.47 (18.60)**

Mood 32.93 (13.29) 53.79 (19.39)**

43.19 (21.67) 64.19 (19.51)**

***p< .001, **p <.01, *p <.05

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Depression (BDI) change over time

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ACT

ACT+Manual

Relationships between treatment change and ACT core processes

In the ACT+manual group the change in depression scores during the treatment correlated significantly (ρ = .73) with how often mindfulness skills had been addressed

The change in anxiety level was correlated with how often defusion skills had been addressed (ρ = .63)

Change in mindfulness skills (KIMS) correlated with how often being present skills (mindfulness) had been addressed (ρ= .54)

These relationships were observed in the ACT+manual group only

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Use of the manual

According to the therapists, 43 % of the clients had completed weekly homework assignments from the manual

36 % had seldom completed homework assignments

43 % of therapists reported that they had used the book relatively seldom during the sessions

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Impact of the manual

There were 236 pages in the manual

Of which the clients in the ACT+manual group read 133 pages

Reading the manual was positively associated with the change in psychological symptoms (ρ= .59, p=0.03), depression (ρ= .50, p=0.07), anxiety (ρ= .51, p=0.06), and social functioning (ρ=.68, p=0.01).

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Experiences of using the manual88 % of the clients felt that the manual had been a useful part of their treatment

86 % of the therapists reported that practical therapy worked better with the manual than without it

Clients were able to study once more topics addressed in sessions, but the manual also gave support to the therapists

Those clients who actually had used the manual actively were also satisfied with it

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Conclusions

In general, 40-50 % of the clients and of the student therapist used the manual actively during the treatment.

Active manual use was associated with better treatment outcome

There were some indications that the processes of change were different when the manual was used or the therapists observed the core processes differently

This study suggests that Master’s level psychology students and their clients may benefit of the use of the manual, but use should be planned carefully

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