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Acceptance and Commitment Therapy for Depression in Veterans

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Acceptance and Commitment Therapy for Depression in Veterans Acceptance and Commitment Therapy For Depression in Veterans Therapist Manual Robyn D. Walser, Ph.D. Katie Sears, Ph.D. Maggie Chartier, M.P.H., Ph.D. Bradley E. Karlin, Ph.D. 13342_VA ACT_D manual v5.indd 1 8/7/15 9:06 AM The image on the cover .....info to come 2 Acceptance and Commitment Therapy For Depression in Veterans 13342_VA ACT_D manual v5.indd 2 8/7/15 9:06 AM Acceptance and Commitment Therapy For Depression in Veterans Therapist Manual Suggested Citation: Walser, R. D., Sears, K., Chartier, M., & Karlin, B. E. (2012). Acceptance and Commitment Therapy for Depression in Veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs. Therapist Manual 3 13342_VA ACT_D manual v5.indd 3 8/7/15 9:06 AM 4 Acceptance and Commitment Therapy For Depression in Veterans 13342_VA ACT_D manual v5.indd 4 8/7/15 9:06 AM Table of Contents Acknowledgments ................................................................................................................................................................................7 Preface ..................................................................................................................................................................................................8 Introduction .....................................................................................................................................9 ACT-D Overview ..........................................................................................................................................................................9 The General Flow of ACT-D ......................................................................................................................................................15 Mindfulness and ACT-D .............................................................................................................................................................17 How is Mindfulness Helpful? ..............................................................................................................................................17 Mindfulness and the Clinician .............................................................................................................................................18 The Role of Mindfulness in ACT-D ....................................................................................................................................18 Depression, the Veteran, and ACT-D ..........................................................................................................................................19 Getting Started: ACT-D and Assessing the Depressed Veteran ..................................................................................................20 ACT-D Case Conceptualization with Veterans ...........................................................................................................................25 The Protocol ..................................................................................................................................27 The Big Picture ...........................................................................................................................................................................27 Getting Started with ACT-D .......................................................................................................................................................28 Therapist Orientation ..................................................................................................................................................................28 Therapeutic Stance ......................................................................................................................................................................29 The Structure of ACT-D .............................................................................................................................................................30 Expanding the Protocol from 12 to 16 Sessions ..................................................................................................................30 How to Use the Session by Session Information .................................................................................................................31 Overview of ACT-D Sessions .....................................................................................................................................................32 General Structure of Each Session .............................................................................................................................................32 Session 1: Commitment to Therapy and Assessment .................................................................................................................36 Session 2: Values Assessment .....................................................................................................................................................40 Session 3: Creative Hopelessness ...............................................................................................................................................44 Session 4: Control as the Problem ..............................................................................................................................................50 Session 5: Willingness: Building Acceptance, Defusing Language – Part I ..............................................................................56 Session 6: Willingness: Building Acceptance, Defusing Language – Part II .............................................................................61 Session 7: Self-as-Context – Part I .............................................................................................................................................66 Session 8: Self-as-Context – Part II ............................................................................................................................................72 Session 9: Values – Part I ............................................................................................................................................................78 Session 10: Values – Part II ........................................................................................................................................................82 Session 11: Committed Action ...................................................................................................................................................86 Session 12: Termination ..............................................................................................................................................................90 Conclusion ...................................................................................................................................................................92 Appendices ..................................................................................................................................................................93 Appendix A: Reading List ..........................................................................................................................................................94 Appendix B: Mindfulness Exercises ..........................................................................................................................................98 Appendix C: Case Conceptualization Form .............................................................................................................................102 Appendix D: Homework Assignments .....................................................................................................................................105 Appendix E: Assessment Instruments ...................................................................................................................................... 119 Appendix F: VA Safety Plan .....................................................................................................................................................122 Glossary ....................................................................................................................................................................125 References ................................................................................................................................................................128 Index of Metaphors and Exercises ..........................................................................................................................131 Therapist Manual 5 13342_VA ACT_D manual v5.indd 5 8/7/15 9:06 AM 6 Acceptance and Commitment Therapy For Depression in Veterans 13342_VA ACT_D manual v5.indd 6 8/7/15 9:06 AM Acknowledgments Support for this manual was provided by Mental Health Services, VA Central Office, U.S. Department of Veterans Affairs. Therapist Manual 7 13342_VA ACT_D manual v5.indd 7 8/7/15 9:06 AM Preface When we pause to reflect on what it means to be human, we connect to our own experiences, both personal and shared, including those filled with simplicity and joy, amazement, and belonging. We also realize in those moments that life can be fraught with struggle and pain – that fundamental human experience also contains suffering. For many, this experience comes and goes, but for others suffering and pain may linger, even paralyze, in life-limiting ways. Depression
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