Treating Depression with ACT

It largely appears as though Jacob is experiencing signs of depression. There are a number of telltale signs which point to this assessment. One of these signs is he has recently experienced a life-altering event with the loss of his business. Such a loss is especially devastating for this individual because it was his sole source of income, which lends a degree of pragmatism to the sort of anxiety which can rapidly lead to depression (Cadigan and Skinner, 2015, p.293). This notion is compounded by the reality that he seems somewhat unilateral in his interests, claiming his former business was his sole hobby. As such, it appears he feels he has nothing else to turn to in such a time, which might heighten any feelings of depression. It is important to realize such perceptions on his part are likely aggravated by the frustration of being in the prime of his life (at 35) with his professional expectations floundering. Additionally, he is implying he is spending longer periods in bed and finding little motivation to arise, which is another trait frequently linked to clinical depression. Moreover, the feelings he is experiencing point towards this trajectory as well. His sensations of physical fatigue may be indicative of a greater emotional and psychological one related to his recent loss. Also, the increased perceptions of stress and sadness he feels are aligned with clinical depression due to the traumatizing loss of both his income and his primary interest in life.

The foundation of the treatment plan with which to counteract the feelings of depression consuming Jacob is therapy substantially influenced by Acceptance and Commitment Theory. This theory is an example of some of the more progressive aspects of interpersonal psychotherapy, particularly for adaptations involving multiple randomized controlled trials (Weissman et al., 2007, p. 88). Initially, the nature of that therapy will be individual. However, as sessions progress and the client becomes more acclimated to the fundamental concepts of this type of therapy, he will eventually supplement individual sessions with group ones. The final third of the treatment plan will exclusively necessitate group sessions, in turn followed by follow up sessions as needed. The focus of these sessions will be a "mindfulness" (Hayes and Lillis, 2012, p.3) in which Jacob is able to gain acceptance about facets of his life which are immutable, and a growing awareness of those which are. Specifically, treatment will center on getting the patient to effectively live in the moment. The acceptance component of these therapy sessions is pivotal to their success. The clinician will attempt to use a number of different constructs associated with language to help the patient understand that failure is acceptable and merely provides fodder for the next attempt and, ideally, success. The manifestations of language utilized will involve both metaphor and paradox as a means of getting the client to understand his feelings in relation to existing in the present and discerning that which is or is not mutable.

DSM V The DSM V diagnosis of Jacob is Major Depressive Disorder which borders on the differential diagnosis of adjustment disorder. The latter is identifiable because the patient is evincing difficulty of adjusting to the reality that his business failed. The core symptoms of this order as identified in this manual are a general disinterestedness coupled with signs of depression. The latter include a propensity to remain in bed longer than usual. Moreover, the feelings of little self-worth displayed by the patient are aligned with this diagnosis as well (Huprich et al., 2016, p. 743). Similarly, experiential exercises will be deployed to produce the same result: reflection and cognizance on the part of the patient of his situation and the opportunities which still lie at hand.

Once the client becomes accustomed to leveraging these exercises individually, group settings should help to expand his awareness through the vicarious experiences shared by others. Additionally, there is a social element of group therapy which helps to contextualize understand one's own issues in relation to those of others, which yields benefit.