Acceptance and commitment therapy — structured clinical viva

You are the psychiatry registrar. A 36-year-old teacher with recurrent major depression and high experiential avoidance says they will rejoin their sports club and rebuild friendships 'when the emptiness and self-critical thoughts are gone.' They ask whether ACT is 'just mindfulness' and whether they must stop sertraline 100 mg to start therapy. Discuss ACT principles, hexaflex processes, experiential avoidance, evidence landmarks (including metas and key trials), comparison with CBT, and combined care.