E-ISSN : 2733-4538
The present study examined the effectiveness of group therapy based on acceptance commitment therapy for women’s depression. In screening evaluation for depression, thirty one young adult females with depression were selected as participants in group therapy from volunteers. Sixteen of them attended group therapy of acceptance commitment therapy for depression, which consisted of 10 weekly 120 min sessions. The other fifteen were assigned to waiting list control. Participants completed a self-report questionnaire comprised of Beck’s depression inventory, acceptance action questionnaire, self-compassion scale, and mindfulness attention awareness scale at pretreatment, middle term, and posttreatment. In the ACT group, outcome variable (depression) and process variables (acceptance, self-compassion, and mindfulness) were assessed at two week intervals for ten weeks, as well as twice at follow up. The ACT group not only showed remarkable reduction of depression, but also process variables (acceptance, self-compassion, and mindfulness) showed significantly greater change at the time of entry. Further, their changes were maintained until follow up after a four month lapse. In particular, mediational analysis verified that change of acceptance and self-compassion mediated the effect of intervention on depression at follow up. The results of this study suggest that group therapy of ACT for depression is not only effective for reduction of women’s depression, but also contributes to prevention of relapse of women's depression because of the persisting effect of acceptance commitment therapy. Finally, implication and limitation of this study, and recommendation for a future study were discussed.
권석만, 윤호균 (1994). 한국판 자동적 사고 척도의 개발과 활용. 학생연구, 29, 10-25.
권선중, 김교헌 (2007). 한국판 주의 알아차림 척도(K-MAAS)의 타당화 연구. 한국심리학회지: 건강, 12(1), 269-287.
김경의, 이금단, 조용래, 채숙희, 이우경 (2008). 한국판 자기 자비척도의 타당화 연구. 한국심리학회지: 건강, 13(4), 1023-1044.
문현미 (2006). 심리적 수용 촉진 프로그램의 개발과 효과: 수용-전념 치료 모델을 중심으로. 가톨릭대학교 박사학위청구논문.
이선영 (2009). 수용-전념 치료에서 과정변인이 불안에 미치는 매개효과. 고려대학교 박사학위청구논문.
이영호, 송종용 (1991). BDI, SDS, MMPI-D 척도의 신뢰도 및 타당도에 대한 연구. 한국심리학회지: 임상, 10(1), 98-113.
이우경, 방희정 (2008). 성인기 여성의 스트레스, 마음챙김, 자기-자애, 심리적 안녕감 및 심리증상 간의 관계. 한국심리학회지: 발달, 21(4), 127-146.
이지현, 장정기, 박지홍, 안준호, 이 철, 김창윤(2003). 해밀턴 우울증 평가척도의 요인구조. 정신병리학, 12(1), 3-16.
이훈진 (2009). 수용이 심리적 증상, 자존감 및 삶의 만족도에 미치는 영향. 인지행동치료, 9(1), 1-23.
전겸구, 양병창, 최상진 (2001). 통합적 한국판 CES-D 개발. 한국심리학회지: 건강, 6(1), 59-76.
조용래 (2011). 자기 자비, 생활 스트레스 및 탈중심화가 심리적 건강에 미치는 효과: 매개중재모형. 한국심리학회지: 임상, 30(3), 767-787.
조현주 (2012). 자애명상 기반 수용전념치료 프로그램 개발과 효과: 우울경향 대학생을 중심으로. 한국심리학회지: 상담 및 심리치료, 24(4), 827-846.
조현주, 임현우, 조선진, 방명희 (2008). 성인 남녀의 우울감 특징과 전문적 도움추구에서의 차이. 한국심리학회지: 여성, 13(3), 283-297.
최예종, 조용래 (2009). 정서조절곤란과 수용처치가 대학생의 우울기분 변화에 미치는 효과. 한국심리학회지: 임상, 28(4), 1107- 1134.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27-45.
Barlow, D. H., Allen, L. B., & Choate, M. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35(2), 205-230.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173- 1182.
Bishop, M., Lau, S., Shapiro, L., Carlson, N. D., Anderson, J., Carmody Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241.
Bohlmeijer, E. T., Fledderus, M., Rokx, T. A. J. J., & Pieterse, M. E. (2011). Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(13), 62-67.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848.
Cash, M., & Whittingham, K. (2010). What facets of mindfulness contribute to psychological well-being and depressive, anxious, and stress-related symptomatology? Mindfulness, 1(3), 177-182.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670.
First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (2000). DSM-Ⅳ의 제1축 장애의 구조화된 임상적 면담 SCID-Ⅰ. (한오수, 홍진표 공역). 서울: 하나의학사.
Folke, F., Parling, T., & Melin, L. (2012). Acceptance and commitment therapy for depression: A preliminary randomized clinical trial for unemployed on long-term sick leave. Cognitive and Behavioral Practice, 19(4), 583-594.
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31(6), 772-799.
Forsyth, J. P., Parker, J., & Finlay, C. G. (2003). Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance abusing veterans. Addictive Behaviors, 28(5), 851-870.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44(9), 1251-1263.
Dekeyser, M., Raes, F., Leijssen, M., Leysen, S., & Dewulf, D. (2008). Mindfulness skills and interpersonal behaviour. Personality and Individual Differences, 44(5), 1235-1245.
Ge, X. J., Lorenz, F. O., Conger, R. D., Elder, G. H., & Simons, R. L. (1994). Trajectories of stressful life events and depression during adolescence. Developmental Psychology, 30(4), 46-483.
Germer, C. K. (2009) The mindful path to self- compassion: Freeing yourself from destructive thoughts and emotions. New York: Guilford Press.
Gilbert, P. (2005). Compassion and cruelty: A biopsychosocial approach. In P. Gilbert(Ed.), Compassion: Conceptualizations, research and use in psychotherapy. Hove: Routledge.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379.
Hagan, J., & Foster, H. (2003). She’s a rebel: Toward a sequential stress theory of delinquency and gendered pathways to disadvantage in emerging adulthood. Social Forces, 82(1), 53-86.
Hayes, S. C. (1994). Content, context, and types of psychological acceptance. In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and change: Content and context in psychotherapy (pp. 13-32). Reno, NV: Context Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. New York: Guilford Press.
Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553-578.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. D. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152-1168.
Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28(1), 1-16.
Huffziger, S., & Kuehner, C. (2009). Rumination, distraction, and mindful self-focus in depressed patients. Behaviour Research and Therapy, 47(3), 224-230.
Kabat-Zinn, J. (1994). Wherever you go there you are. New York: Hyperion.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156.
Kashdan, T. B., Barrios, V., Forsyth, J. P., & Steger, M. F. (2006). Experiential avoidance as a generalized psychological vulnerability: comparisons with coping and emotion regulation strategies. Behaviour Research and Therapy, 44(9), 1301-1320.
Kashdan, T .B., Breen, W. E., Afram, A., & Terhar, D. (2010). Experiential avoidance in idiographic, autobiographical memories: Construct validity and links to social anxiety, depressive, and anger symptoms. Journal of Anxiety Disorders, 24(5), 528-534.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Walters, E. E. (2005). Lifetime prevalence and age of onset distributions of DSM-Ⅳ disorders in the national comorbidity survey replication. Archives of General psychiatry, 62(6), 593-602.
Krieger, T., Altenstein, D., Baettig, I., Doerig, N., & Holtforth, M. G. (2013). Self-compassion in depression: Associations with depressive symptoms, rumination, and avoidance in depressed outpatients. Behavior therapy, 44(3), 501-513.
Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Radford, S., Teasdale, J. D., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behavior Research and Therapy, 48(11), 1105-1112.
Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92(5), 887-904.
Malone, D. A., & Lartey, P. (2004). Depression and suicide. In R. S. Lang & D. D. Hensrud (Eds.), Clinical preventive medicine Ⅱ(pp.69-80). American Medical Association.
Marx, B. P., & Sloan, D. M. (2005). Posttraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43(5), 569-583.
Melbourne Academic Mindfulness Interest Group (2006). Mindfulness-based psychotherapies: A review of conceptual foundations, empirical evidence and practical considerations. The Australian and New Zealand Journal of Psychiatry, 40(4), 285-294.
Neff, K. D. (2003a). Self-compassion: an alternative conceptualization of a healthy attitude towards oneself. Self and Identity, 2(2), 85-101.
Neff, K. D. (2003b). Development and validation of a scale to measure self compassion. Self and Identity, 2(3), 223-250.
Neff, K. D. (2011). Self-compassion: stop beating yourself up and leave insecurity behind. New York: William Morrow.
Ohayon, M. M., & Hong, S. C. (2006). Prevalence of major depressive disorder in the general population of South Korea. Journal of Psychiatric Research, 40(1), 30-36.
Pauley, G., & McPherson, S. (2010). The experience and meaning of compassion and self-compassion for individual with depression or anxiety. Psychology and Psychotherapy, 83(2), 129-143.
Raes, F., & Williams, M. G. (2010). The relationship between mindfulness and uncontrollability of ruminative thinking. Mindfulness, 1(4), 199-203.
Rasmussen, M. K., & Pidgeon, A. M. (2011). The direct and indirect benefits of dispositional mindfulness on self-esteem and social anxiety. Anxiety, Stress & Coping, 24(2), 227-233.
Roemer, L., Salters, K., Raffa, S., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model. Cognitive Therapy and Research, 29(1), 71-88.
Rosen, G. M., & Davidson, G. C. (2003). Psychology should list empirically supported principles of change(ESPs) and not credential trade marked therapies or other treatment packages. Behavior Modification, 27(3), 300-312.
Ryan, R. M., & Deci, E. L. (2000). Self determination theory and the facilitation of intrinsic modification, social development, and well-bing. American Psychologist, 55(1), 68-78.
Santor, D. A., Zuroff, D. C., Ramsay, J. O., Carvantes, P., & Palacios, J. (1995). Examining scale discriminability in the BDI and CES-D as function of depressive severity. Psychological Assessment, 7(2), 131-139.
Singer, A. R., & Dobson, K. S. (2007). An experimental investigation of the cognitive vulnerability to depression. Behaviour Research and Therapy, 45(3), 563-575.
Steiner, M. (2008). Female-specific mood disorders. Psychiatry, 8(2), 61-66.
Strosahl, K. D., & Robinson, P. J. (2008). The mindfulness and acceptance workbook for depression: Using acceptance and commitment therapy to move through depression and create a life worth living. Oakland: New Harbinger.
Teasdale, J. D. (1988). Cognitive vulnerability to persistent depression. Cognitive and Emotion, 2(3), 247-274.
Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192(11), 754–761.
Turner, R. J., & Avison, W. R. (1989). Gender and depression: Assessing exposure and vulnerability to life events in a chronically strained population. The Journal of Nervous and Mental Disease, 177(8), 443-455.
Turner, R. J., & Lloyd, D. A. (1999). The stress process and the social distribution of depression. Journal of Health and Social Behavior, 40, 374-404.
Twohig, M. P. (2012). Introduction: The basics of acceptance and commitment therapy, Cognitive and Behavioral Practice, 19(4), 499-507.
Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123-130.
Wilson, K. G., Bordieri, M. J., Flynn, M. K., Lucas, N. N., & Slater, R. M. (2011). understanding acceptance and commitment therapy in context: A history of similarities and differences with other cognitive behavioral therapies. In J. D. Herbert & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: Understanding and applying the new therapies. (pp.233-263). New Jersey: Wiley & Sons.
Wilson, K. G., & Dufrene, T. (2009). Mindfulness for two: An acceptance and commitment therapy approach to mindfulness in psychotherapy. Oakland: New Harbinger.
Zettle, R. D. (2007). ACT for depression: A clinician's guide to using acceptance and commitment therapy in treating depression. Oakland: New Harbinger.
Zettle, R. D., & Rains, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45(3), 436-445.
Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011), Processes of change in acceptance and commitment therapy and cognitive therapy for depression: A mediation reanalysis of Zettle and Rains. Behavior Modification, 35(3), 265- 283.