Acceptance and Commitment Therapy (ACT) is a “third-wave” cognitive behavioral intervention aimed at enhancing our psychological flexibility (Hayes et al., 2006). Rather than suppress or avoid psychological events, ACT is based on the belief that acceptance and mindfulness are more adaptive responses to the inevitabilities of life.
By experiencing our thoughts, physical feelings, and emotions in more flexible ways, acceptance commitment therapists argue, we can reduce the negative behaviors they often lead to (Hayes et al., 1996; Bach & Hayes, 2002).
As an intervention, ACT has empirical bases and has become a relatively well-established part of applied positive psychology in recent decades. If you’re hoping to add ACT approaches into your professional practice or your personal life, read on for an extensive collection of ACT worksheets, assessments, questionnaires, and activities.
This article contains:
- 9 ACT Worksheets and Useful Resources for Application
- 3 ACT Assessments and Questionnaires
- 3 Useful Acceptance & Commitment Therapy Interventions
- 3 Acceptance & Commitment Therapy Metaphors
- 3 Exercises and Activities
- Other Ways to Apply ACT
- A Take-Home Message
9 ACT Worksheets and Useful Resources for Application
To put things into further context, ACT has 6 central processes (Harris, 2006). If you’re already familiar with these as a helping professional, feel free to skip ahead to the worksheets in this section.
- Acceptance – Sometimes called Expansion, this process is about creating space for emotions, impulses, and feelings that we might otherwise suppress or avoid (experiential avoidance, Hayes et al., 2012). This allows us to avoid over-inflating them or wasting too much energy on them so that we can move on more easily.
- Cognitive Defusion – This is a mindfulness strategy that involves recognizing our psychological experiences objectively rather than perceiving them as perceived threats or realities. Our feelings, therefore, are simply feelings and not omens of impending doom. Thoughts are thoughts and not necessarily true, clever, or important. Guided meditations and scripts are useful for cognitive defusion.
- Being Present – Fostering an awareness of how we’re currently feeling, both physically and mentally. Rather than dwelling on the past or worrying about the future, connecting with the present is about engaging completely with ‘right now’. ACT exercises and activities on mindfulness are helpful in this respect.
- Self as Context or The Observing Self – Quite similar to the Common Humanity construct of Self-Compassion, this process is viewing our psychological and physical experiences as transient and ever-changing (Neff, 2003; Neff & Tirch, 2013). Becoming self-transcendent so that we perceive our emotions, sensations, thoughts, and more as peripheral and dynamic is to step away from the alternative—where they define us (Koltko-Rivera, 2006).
- Values Clarification – A process in which we explore and clarify the things that we hold personally meaningful. Values Clarification worksheets in ACT are often self-reflection exercises that help clients find direction and motivation, and coaching discussions can also be very helpful.
- Committed Action – This principle or process is about goal-setting, and the idea is that these are long-term life goals which are values-based. ACT practitioners can thus help clients commit to and work with engagement toward goals through action.
You can read more about how Acceptance and Commitment Therapy works.
With these processes and principles in mind, here are some useful ACT worksheets.
Expansion and Acceptance Worksheets
1. Don’t Think About Your Thoughts Worksheet
Suppression and avoidance have detrimental effects over time. As maladaptive strategies, they often tend to work against us rather than in our favor—amplifying the psychological experience we’re trying to escape. By eliciting this ‘rebound’ effect, this acceptance exercise allows therapists to help clients recognize this.
This worksheet has two parts. First, however, it helps to explain the role of mindfulness in coping with unwanted thoughts, feelings, and memories. Then, the client is instructed to:
- Recall or identify an undesired thought that is causing them to feel negative – often, this tends to be thought of as “A Problem”;
- Have them estimate and write down how frequently it has crossed their mind throughout the week;
- Then, over a period of several minutes, invite them to try and suppress the unwanted thought, any way they might like to go about it. The third prompt on this worksheet asks them to approximate how often it crossed their mind through that brief period. In this space, make a note of it so this figure is visual.
- The last step takes a different approach. Rather than actively attempting to suppress the thought, have your client spend the same amount of time thinking of anything else they like—tell them to walk around or do whatever comes naturally. After this, they estimate how many times the thought popped into their mind. This figure can now be compared with the figure from the previous step.
It also helps to debrief your client after this exercise. Some good prompts include:
- “Tell me about your experience while you were consciously trying to suppress the thought…” and
- “During that period, did the thought lose any perceived importance or become less salient? Or did it become more restricting and more prominent?”
Download the Don’t Think About Your Thoughts worksheet from our Positive Psychology Toolkit.
2. Identifying Emotional Avoidance Strategies Worksheet
Emotional avoidance is another ineffective strategy that people tend to use when uncomfortable thoughts or feelings arise. As short-term responses avoidance may seem helpful, but over the longer term it reinforces the seeming intolerability of these mental experiences.
Therapists can work with clients to recognize when they are cognitively trying to escape distress through common habits like distraction or rumination (Moulds et al., 2007; Wolgast & Lundh, 2017).
This exercise is best worked through after you have introduced the concept of emotional (or experiential) avoidance to your client. If you are engaging with this exercise for yourself, you’ll find a helpful theoretical background and examples to get you started.
In the main section of this worksheet, you’ll find some writing space.
- Begin by recalling some previous experiences where you have avoided an unwanted feeling, event, or memory rather than acknowledging or engaging with it.
- Think of different domains in your life if this helps, such as at work, with your family, or with friends. Perhaps you’ve played video games rather than having a serious conversation about something which upsets you. Or, maybe you’ve turned down a great new role at work because it involved public speaking.
- Whatever it is you recall, write down your responses as you reflect on three things:
- The feelings that experience conjured up (Difficult Emotions);
- How you attempted to avoid those feelings, mentally or through certain behaviors (Emotional Avoidance Strategy); and
- The extent to which that avoidance was useful (Result/Effectiveness).
After you or your client have filled out the sheet, it is generally useful to reflect on the insights gleaned from the exercise. Can you spot any patterns? Any alternative behaviors or approaches you could have adopted?
Download this worksheet on Identifying Emotional Avoidance Strategies to use with your clients.
Being Present Worksheets
‘Being present’ is one of the most difficult yet central facets of mindfulness. In ACT, as noted, the goal is to accept what we’re feeling without over-inflating or over-identifying with it. Being honest about our mental experiences helps us create space for thoughts, memories, and sensations that inevitably arise as a natural part of life.
3. Five Senses Worksheet
Starting with some basic mindfulness exercises is a good approach if your client isn’t familiar with the concept. This Five Senses Worksheet offers a simple practical sequence that encourages you to bring your awareness to what’s right here, right now.
- First, by noticing five things you see. Rather than getting caught up in feelings or thought patterns that might seem overwhelming, try to tune in visually – what’s here, outside your head?
- Second, by shifting your awareness to four things that you can feel. Draw your focus gently away from internal processes and start to notice sounds that you might not otherwise have paid attention to. As you step more and more into a mindful state, we can become more detached from a negative thought or painful emotion.
- Try noticing three things you can hear; then
- Two things you can smell.
- Lastly, focus on one thing you’re able to taste at this precise moment in time. As you gently draw this mini-exercise to a close, try to remember how this mindful state feels whenever you feel yourself over-identifying with a thought or emotion throughout the day.
Being present is very helpful in appreciating what’s actually taking place in reality rather than simply in our heads. It empowers us to commit to bigger goals rather than getting caught up in past events and internal ongoings while strengthening our ability to accept and overcome our struggles.
We have a huge array of mindfulness exercises that you can browse and draw from if you feel it will help your client or your personal practice.
Cognitive Defusion Worksheets
4. Moving from Cognitive Fusion to Defusion Worksheet
Cognitive defusion exercises are designed to address the (sometimes overwhelming) perceived credibility of painful cognitions and feelings. Taking thoughts like “I’m terrible” or “I’m useless” too literally makes it much more difficult for us to see them as what they are—to see thoughts as thoughts.
- Start by identifying an unhelpful or hurtful self-criticism that you or your client would like to defuse, for instance, “I’m an uncaring partner”. It may be hard to articulate at first, but try shortening it into a sentence that really gets to the heart of the issue.
- Let yourself engage with and truly relate to the thought you’ve identified. It might help if you verbalize the sentence you’ve landed on or repeat it mentally.
- Then, replay the thought but precede it with “I’m having the thought that…”, so your sentence will become “I’m having the thought that I’m an uncaring partner”.
- To further defuse this thought, we take another mental step back. This time precede the painful thought with “I notice I’m having the thought that...”; so, “I notice I’m having the thought that I’m an uncaring partner”.
- Give yourself a chance to reflect on the mental shift which likely occurred, or at least started to take place. How would you describe the experience as you moved from ‘fusion with’ to ‘defusion from’ the thought?
Self as Context Worksheets
5. The Observer Worksheet
More immersive exercises often help with learning to become an observer of yourself. The Observer Meditation is both a guided script and a PDF—use this to help your client transcend memories, emotions, or personal experiences that they might feel absorbed or preoccupied with.
As an example, one instance of becoming an Observer might look like this:
- Reflect on the roles that you play daily—are you a mother? A leader at work? Sometimes a team player? A daughter? A caregiver? Even when we aren’t consciously adopting a role in the world around us, we are doing so. And yet, a part of us remains constant despite this role shifting.
- Your Observer Self means is not defined by the roles you have identified; rather, it’s the constant that can view the changes taking place. The Observer experiences what you’re doing, thinking, and feeling, and simply watches.
- As the Observer of yourself, watch, listen, and simply notice any turbulence you might otherwise allow to consume or define you. Note how these experiences are constantly shifting, and try letting go. Recognize that ‘you’ remain unaltered.
Try The Observer meditation yourself to practice decentering and reappraising your cognitions (Hayes-Skelton & Graham, 2013).
Values Clarification Worksheets
6. Values and Problems
Author and ACT practitioner Russ Harris suggests that we can think about two critical categories when we’re aiming to reduce struggle and suffering in our lives. We can also use two equally important categories when thinking about how to create a meaningful, rich life. Using these following four categories, reflect on and write down your thoughts.
- Problem Emotions and Thoughts: What self-criticisms, worries, thoughts, fears, memories, or other thoughts tend to preoccupy you? List some feelings, sensations, or emotions that you find hard to deal with.
- Problem Behaviors: Describe some actions that you engage in which are harmful over time—things that:
- sap your energy, time, or finances;
- prevent you from moving forward in life;
- keep you from things you’d rather be doing; or
- have a detrimental impact health-wise?
- Values: List some things that matter personally to you in the long run. Which of your character strengths and qualities would you like to build on? What things do you (or do you want to) represent/stand for? In what ways do you hope to further yourself by tackling your problems? What are some ways you’d like to enhance or boost your relationships?
- Goals and Actions: List some of your present behaviors or actions which are designed to enhance your life over the longer term. What are some things you’d like to do more or new things you’d like to begin? Can you think of some steps you want to make to improve your life? Skills you aspire to build on further?
This Values and Problems worksheet is adapted from Russ Harris’ Complete Happiness Trap ACT Worksheets.
7. Values Worksheet
This values discussion sheet, resource, or handout offers a framework that clients can use to explore and reflect on their personal values. As well as helping them (or you) get some clarity, they stimulate thinking about potential life goals in ten different areas (Wilson & Murrell, 2004). After the first few examples, you’ll be able to create your own questions along the same lines.
The categories and some example questions are:
- Romantic relationships – What sort of partner would you ideally like to be? How would you describe your ideal relationship? What sort of behaviors do you aspire to show toward a significant other?
- Leisure and fun – What kinds of activities appeal to you for fun? How would you enjoy spending your downtime? What’s exciting for you? Relaxing?
- Job/career – What career goals matter to you? What kind of employment? Do you aspire to particular qualities as a worker? What sort of professional relationships do you want to develop?
- Friends – What social relationships do you consider important to develop? What do you consider an important social life to have? How would you like your friends to see you as a person?
- Parenthood – What kind of mother or father do you aspire to be? Are there particular qualities you’d like to role model for your kids? How would you describe your ideal relationships with them?
- Health and physical wellness – These questions will be based on fitness goals, aspirations, as well as the importance of personal health, physical well-being, and personal care.
- Social citizenship/Environmental responsibility – This category is about being part of the community, environmental aspirations, and can include volunteer work.
- Family relationships – Like parenthood above, these values pertain to relatives like siblings, extended family, and so forth.
- Spirituality – Relevant questions here will concern religion, personal beliefs about anything that’s meaningful at a deeper or bigger level.
- Personal development and growth – Reflections in this category should relate to personal capabilities, competencies, skills, knowledge, and growth.
Use this free Values Clarification Worksheet to help you.
Committed Action Worksheets
8. Commitment, Obstacles, and Strategies
Commitment is about maintaining motivation to the continuing pursuit of a client’s life goals over time. Drawing on goal-setting theory, therefore, it helps to have clear, concrete objectives for positive ‘approach’ goals (Locke, 1968; Locke & Latham, 2002).
Using these three headings, create a 3-column grid like the following:
|Commitment||Potential Obstacles||Strategies for Boosting Commitment|
|In this column, your client designs goals that reflect the values from any of the above exercises.||Alongside each commitment from the list, identify the possible roadblocks…||…so that you can come up with potential alternative pathways in this column.|
The Commitment, Challenges, Strategies worksheet can be accessed here.
9. Willingness and Commitment Worksheet
This worksheet focuses in on one value that you or your client have identified. Whether it’s being a more patient father or working toward more integrity, single out one commitment and work through the following questions.
- What is the value that you’d like to bring more of into your life? A note: this should not be a goal, but rather something that you or your client find personally meaningful and important.
- Then, choose a goal which is related to this value—one which you’d like to accomplish, and which allows you to evaluate your progress.
- Next, choose one or more actions that you feel will take you closer to achieving the goal.
- What personal ‘stuff’ might your committed action cause to arise? Try to break these down into three areas: a) physical and psychological feelings, b) unproductive/unpleasant self-criticisms or thoughts, and c) visuals and memories.
After working on these sections, the focus is the personal ‘stuff’. It’s time to reframe these as ‘stuff’—feelings and thoughts—rather than reality, as powerful or unpleasant as they may seem. Even though they exist, we can still accomplish what we commit ourselves to. There is one more question on this worksheet:
- Are you prepared to create space for the emotions and thoughts that come up from your action?
If the answer is no, start again with another valued goal. If it’s yes, then go for it.
This worksheet comes from Letting a Little Non-verbal Air Into the Room, an academic publication by Ciarrochi & Robb (2005).
3 ACT Assessments and Questionnaires
1. Revised Acceptance and Action Questionnaire
Bond and colleagues’ (2011) Acceptance and Action Questionnaire-II (AAQ-II) was designed to measure various core ACT constructs. This 10-item instrument uses a 7-point Likert Scale to assess psychological flexibility, acceptance, action, and experiential avoidance and can be used as part of therapy.
Especially helpful in interventions that adopt acceptance and mindfulness approaches, the Revised Acceptance and Action Questionnaire is a simple self-report tool to administer and score. With 1 representing “Never True” and 7 for “Always True”, some example items include:
- I worry about not being able to control my worries and feelings;
- It seems like most people are handling their lives better than I am; and
- My painful memories prevent me from having a fulfilling life.
Find the acceptance and action questionnaire in our Toolkit.
2. The Brief Experiential Avoidance Questionnaire (BEAQ)
Avoidance, or more technically experiential avoidance, describes behavior which aims to
“alter the frequency or form of unwanted private events, including thoughts, memories, and bodily sensations, even when doing so causes personal harm” (Hayes et al., 2012: 981).
Developed by Gámez and colleagues (2014), the Brief Experiential Avoidance Questionnaire is one psychometric assessment of experiential avoidance that has demonstrated good internal consistency. It comprises 15 6-point Likert Scale Items and has stronger construct validity than the (perhaps) better-known Acceptance and Avoidance Questionnaire-II (AAQ-II) (Tyndall et al., 2018).
With 1 being “Strongly Disagree” and 6 representing “Strongly Agree,” this self-report measure includes the following example items (Gámez et al., 2014):
- I try to put off unpleasant tasks for as long as possible;
- I work hard to keep out upsetting feelings;
- Fear or anxiety won’t stop me from doing something important (reverse scored);
- I rarely do something if there is a chance it will upset me; and
- When unpleasant memories come to me, I try to put them out of my mind.
The full and original BEAQ is available in this publication.
3. The Bull’s-Eye Values Survey
This personal values questionnaire is similar to the Values Worksheet given above, however, it provides more background theory and uses different domains. Somewhat more structured and extensive, therefore, it’s a useful way to help your client both explore their values and identify any discrepancies with actual valued living.
Throughout the course of ACT therapy, it is a helpful method for tracking progress once a commitment is established.
Part One of this tool introduces four broad domains in which your client can identify personally meaningful ways of living—this is a Values Identification exercise. Included domains are Work/Education, Leisure, Relationships, and Personal Growth/Health. Below this, you and your client can work with a ‘dartboard’ visualization where they mark how they are living their life in relation to the ‘Bulls Eye’; their ideal way of living.
In Part Two, you’ll find space for writing down any perceived barriers between your client’s current and ideal life. In this same space, there is a rating system that can be used to estimate how powerful this barrier is perceived to be, from “Doesn’t prevent me at all” to “Prevents me completely”.
The final part of this survey is a Valued Action Plan—here is a designated space for your client to write down actions that will take them from where they are to the metaphorical Bulls Eye. Work through this space by considering what values-based action your client would willingly take to tackle or overcome the obstacles from Part Two above.
Find the Bulls-Eye Values Survey here.
3 Useful Acceptance & Commitment Therapy Interventions
There is no one type of ACT intervention—Acceptance and Commitment Therapy can vary from the very-short, lasting a few minutes, to lengthy interventions that span numerous sessions. Typically, they involve techniques based on the six core processes we looked at above.
For instance, expansion and acceptance interventions might include one or more exercises to challenge over-identification; similarly, they may introduce or encourage the client to practice ‘unhooking’ from negative thoughts (Ciarrochi & Robb, 2005). As an intervention, the former could be a single exercise, or it could involve practice over a period of time.
Self as Observer interventions might incorporate any number of defusion exercises, such as The Observer meditation we considered above, or they might involve working with metaphors—perspective shifting exercises for ‘creative hopelessness’ (Hayes et al., 1999).
There are myriad mindfulness techniques that form part of Being Present interventions, and Cognitive Defusion Interventions for reappraising painful thoughts, and the list goes on. It’s impossible to provide an exhaustive list of ACT interventions in this one article, but here are a few that you might find useful as a helping professional.
1. Increasing Awareness of Cognitive Distortions
Both ACT and CBT focus on cognitive distortions—the latter is geared predominantly toward restructuring them, however, while ACT is about creating space for these through acceptance. Without an awareness of cognitive distortions in the first instance, however, we’re hard-pressed to do either.
This Increasing Awareness of Cognitive Distortions intervention works well in conjunction with mindfulness interventions as part of ACT therapy (Burns, 1980). It begins by introducing the cognitive distortion concept and outlines 11 examples that your client may be able to relate to. Examples include All-or-Nothing Thinking, Personalization, Should Statements, and Jumping to Conclusions.
While this comes as a helpful PDF, therapists will likely find this a very useful step to work through with your client. Being able to answer any questions will be helpful as your client moves to the next stage; filling out a worksheet with cognitive distortions that they can identify.
Three columns, as shown below, provide some structure for a guided awareness intervention that will ideally take place for at least 5 minutes daily over a week.
|Try to identify and/or label the emotion that’s present in the moment. Is it fear? Unhappiness? Embarrassment?|
This works for bodily sensations, too. Is it tension? Heaviness? Lethargy?
|What thoughts are passing through your head as these feelings are occurring?|
Ideally, this is a good start to understanding how the two relate to one another.
|Use the table if necessary to identify which cognitive distortion might be at work. Are you perhaps discounting the positive in this situation? Or overgeneralizing?|
If you feel this intervention might be handier to have as a download, you’ll find it here in our PP Toolkit.
2. Acting Independently of Language
Adapted from an experiential exercise by Monestès & Villatte (2013), this intervention encourages your client to act independently of their thoughts. It’s a form of exposure in a sense, fostering their ability to behave as per their values rather than reacting instantaneously to their mental processes. So, it’s about developing psychological flexibility.
- Starting in a face-to-face standing position with your client, start a sequence of actions—jump on the spot or wave your arms, anything that they can then verbalize to you as they carry out something completely different. They should preface this verbalization with “I must…”.
- To illustrate, you might touch your nose; your client might then cover their ears while saying out loud: “I must touch my nose”.
- Repeat this exercise up to 10 times to help your client appreciate the feeling of disobeying literal instructions.
It’s always good to debrief afterward with some discussion about how it felt, and the salience of independent action which isn’t driven by language. Try not to let your client’s actions become the direct opposite of what you’re doing, however, as this still leaves some link to language rather than encouraging psychological flexibility.
A full version of this appears in Stoddard and Afari’s (2013) Complete Book of ACT Metaphors.
3. Attending Your Own Funeral
Walking the client mentally through their own funeral is a guided intervention that aims to help them clarify their values. To open the discussion as a therapist, ask your client to imagine that they’ve suddenly passed away. As the universe would have it, they’re able to attend their own funeral, albeit as a ghost of their former self.
The discussion can be used to explore what they’d like their friend’s eulogies to include, as well as their family member’s speeches. They can think about what they’d like on their tombstone, prompting an exploration of questions like:
- What they would like to have accomplished?
- What kind of a person would they like to be remembered as?
- What qualities would be mentioned?
- How would they have contributed to or shaped others’ lives?
There are numerous variations of this Values intervention, but the original is from Hayes’ (2004) vignette in A Practical Guide to Acceptance and Commitment Therapy.
A little earlier, I introduced the idea of metaphors. Let’s look at a few examples and how these can be used within your ACT intervention.
3 Acceptance & Commitment Therapy Metaphors
Relational Frame Therapy (RFT) premises that our uniquely human ability to evaluate, mentally connect, and verbally communicate phenomena can be as damaging as it is useful. Closely related to RFT, ACT is based on the idea that overidentifying with language contributes to psychological inflexibility (Hayes et al., 1999; Stoddard & Afari, 2014).
Thus, ACT and RFT both use metaphors as a means of helping clients understand the impact of their thoughts and emotions on their behaviors while enabling them to reconceptualize those psychological processes in more adaptive ways (Foody et al., 2014).
Use these 3 metaphors as they are or adapt them based on your clients’ situation.
1. Ball in a Pool – An Expansion and Acceptance Metaphor
Trying to control our emotions and thoughts is as fruitless as trying to control an inflatable ball in a swimming pool.
Think about your memories, emotions, and thoughts as a beachball in a pool. You know they aren’t doing you any favors, and you want to get rid of them. But when you try to submerge them away from your conscious mind, they keep bouncing back up again to the water’s surface.
Only pushing the ball back down repeatedly or by forcing it down will keep it submerged, which takes energy and effort—and it means you need to keep the ball close by at all times.
Letting go of it will mean it’s floating around in the water’s surface, but in time it will drift elsewhere in the pool. While it might be uncomfortably close by at first, you wouldn’t have to keep struggling with it and you could use your energy to enjoy your time in the water instead.
2. The Prince and the Beggar – A Self as Context Metaphor
While our circumstances and psychological experiences might change, an element of ourselves remains stable throughout.
Picture a beggar and a prince—in terms of physical characteristics, they look almost identical. The beggar wears rags and lives on the street, however, while the prince lives in a palace and is richly dressed.
On crossing paths, they decide to swap roles for twenty-four hours; the beggar puts on the prince’s robes and is waited on by his servants. The prince changes into the beggar’s rags and gets shooed away on the street.
The richly dressed, luxuriously treated beggar is intensely grateful for the delicious food he’s served and shares his feast with other vagrants. The prince still sees himself as deserving of good food, so he steals from others. He won’t mingle with the other vagrants and turns his nose up at them.
While the two are in different clothes for a day and others around them treat them as they see them, each is still the same person inside.
3. The Anthropologist – The Observing Self Metaphor
Anthropologists are social scientists who study different cultures across the world; while they study diverse ways of living and being, they often remain detached from the phenomena at hand. Becoming an observer of your self is like being an anthropologist, but instead, you’re studying your own psychological and physical experiences.
Being effective as an anthropologist means using your powers of observation. Without disrupting or interrupting the phenomena that you’re studying, you need to elicit information about these thoughts, emotions, memories, and sensations.
As a detached scientific observer, you need to be impartial. You’re separate from these experiences and avoid merging into them to maintain your perspective. You are a separate observer.
The Ball Under Water can be found here in our Positive Psychology Toolkit. These last two were adapted from Scarlet (2013), and Stoddard (2013) respectively. You can find the original versions in The Big Book of ACT Metaphors: A Practitioner’s Guide (Amazon) by Dr. Jill Stoddard and Dr. Niloofar Afari.
3 Exercises and Activities
1. Acceptance of Thoughts and Feelings
This exercise is about the mindful acknowledgment of our psychological experiences as well as cognitive defusion. While it’s best to allow at least five to ten seconds for transitioning between steps, this exercise is mostly intuitive and your pace will reveal itself as you move along with it. It’s easily tweaked into a script of its own.
- Start by sitting yourself or your client comfortably upright in a chair, in a relaxed position with no crossed arms or legs.
- Close your eyes slowly and gently, then quietly feel your breath as it moves in and out your body. Note any physical sensations across your body with relaxed detachment.
- Take several minutes to notice how it feels in your chest, in your lungs, as it moves through your nose, throat, and stomach. Don’t worry about the pace or depth of your breathing, and as you take some time to be in the moment, other thoughts will drift along—just recognize their existence and try creating some space inside for them.
- As you breathe in, visualize yourself making more room in your body for these thoughts. Recognize that they are simply thoughts. Memories are just memories, and emotions are just emotions that come and go. If it helps, label them for what they are and gently bring your attention back to your breathing.
- Worries or fears might also come along, and you can label those too before once again returning your mind to the present. You might catch yourself thinking self-critical thoughts, but there is space in your body for these before you let them go again. See if you can observe them while not taking them as truth. If they persist, remind yourself that you’re only observing your own experience.
- When you’re ready to wrap up, try to end with the feeling of detached acceptance. Throughout your day, you could try evoking the mindset of an observer, rather than a reactor.
This is adapted from The Mindfulness and Acceptance Workbook for Anxiety (Forsyth & Eifert, 2016)
2. Not This, Not That Exercise
Here’s a short but sweet activity designed to encourage a Self-in-Context perspective. It’s actually a succinct thought experiment that emphasizes the transient yet continual nature of our feelings and thoughts.
- Tell yourself or your client to observe something—anything tangible and nearby might be a good start, or you could use the flow of breath as part of an exercise.
- Bring your awareness to the fact that you are distinct from this phenomenon: “There is that breath, and you are observing it.”
- To reinforce this sense of Self as an Observer: “If you’re able to observe your breath, you can’t be your breath…”
- And emphasize the dynamic nature of the observed, while the self remains unchanged: “Your breath is continually changing, in and out, and in its very nature. But the you that observes your breath does not alter.”
The original exercise was presented by Russ Harris at the 2009 ACT World Conference and can be found here.
3. Milk, Milk, Milk Exercise
In 2009, Dr. Akihiko Masuda and colleagues released a paper that analyzed the cognitive defusion exercise Milk, Milk, Milk. This uses wordplay to cognitively defuse a painful or persistent thought that we might be taking too literally, and which may be contributing to upset or anxiety.
As a therapist, invite your client to conjure up all the characteristics they can think of which are related to the thought—Masuda et al. (2009), of course, used “milk”. So, white, cold, creamy, and so forth.
Then have your client verbalize the word repeatedly for around 45 seconds. Masuda and colleagues’ study found this an effective way of helping their participants remove the associations. “Milk, milk, milk,” thus became a series of arbitrary sounds with little emotional impact.
You might try something with more perceived emotional valence, such as “failure”, or “ugly”. Going through the exercise once more should help reduce your client’s discomfort with the term, and after a longer period, it may help reduce its perceived credibility.
You can find more on this exercise in the researcher’s original paper: A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts.
Other Ways to Apply ACT
By no means is ACT limited to one-on-one counseling. As an analytical and applied framework for behavior change, its potential uses cover a wide working envelope:
- In educational contexts, ACT can be seen as a means of supporting students and teaching professionals with the general pressures of academic life (Gillard et al., 2018). At a broader level—not unlike Emotional Intelligence and Social-Emotional Learning—it has less targeted potential applications when embedded in well-being curricula.
- Acceptance and Commitment Therapy is also playing a growing role in sports contexts, where its impact on performance has shown more promising outcomes than hypnosis therapy (Fernández Garcia et al., 2004).
- In social work, of course, ACT’s key premises resonate well with core guiding principles such as the importance of relationships and individual dignity (National Association of Social Workers, 2008). Here, it plays an important role in helping those facing bias and stigma at the societal level.
- Clinically, ACT is used in treating addiction and trauma, the latter of which brings us almost full cycle back to individual therapy (De Groot et al., 2014).
A good way to think about potential ACT applications is to consider its fundamental aim—the promotion of psychological flexibility as a means of enhancing well-being. With this and the six core principles or processes in mind, we’ll likely be seeing a lot more ACT applications as positive psychology moves forward.
A Take Home Message
Compared to some other Positive Psychology fields, ACT is still a relatively young discipline. It’s not the youngest, by a long shot, but there are still promising directions emerging for its application.
Hopefully, there is something useful for either yourself or your client among this article’s many resources, but if you’ve spotted a super exercise is missing, let us know. Our Positive Psychology Toolkit is also full of worksheets, exercises, meditations, interventions, and informal practices that you can access alongside more information on the theory behind each.
Have you tried any of these? How would you describe your own personal variants on any of the activities above? Let us know in the comments, or ask us any questions you might have. Happy practice!
- Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70(5), 1129.
- 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.
- Burns, D. D. (1980). Feeling good: The new mood therapy. New York: New American Library.
- Ciarrochi, J., & Robb, H. (2005). Letting a little nonverbal air into the room: Insights from acceptance and commitment therapy Part 2: Applications. Journal of rational-emotive and cognitive-behavior therapy, 23(2), 107-130.
- De Groot, F., Morrens, M., & Dom, G. (2014). Acceptance and commitment therapy (ACT) and addiction: a literature review. Tijdschrift voor psychiatrie, 56(9), 577-585.
- Fernández García, R., Secades Villa, R., Terrados Cepeda, N., García Cueto, E., & García Montes, J. M. (2004). Efecto de la hipnosis y la terapia de aceptación y compromiso (ACT) en la mejora de la fuerza física en piragüistas. International Journal of Clinical and Health Psychology, 4(3).
- Foody, M., Barnes-Holmes, Y., Barnes-Holmes, D., Törneke, N., Luciano, C., Stewart, I., & McEnteggart, C. (2014). RFT for clinical use: The example of metaphor. Journal of Contextual Behavioral Science, 3(4), 305-313.
- Forsyth, J. P., & Eifert, G. H. (2016). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy. New Harbinger Publications.
- Gámez, W., Chmielewski, M., Kotov, R., Ruggero, C., Suzuki, N., & Watson, D. (2014). The brief experiential avoidance questionnaire: development and initial validation. Psychological Assessment, 26(1), 35.
- Gillard, D., Flaxman, P., & Hooper, N. (2018). Acceptance and Commitment Therapy: Applications for Educational Psychologists within Schools. Educational Psychology in Practice, 34(3), 272-281.
- Harris, R. (2006). Embracing your demons: An overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.
- Harris, R. (2014). The Complete Set of Client Handouts and Worksheets from ACT books. Retrieved from https://thehappinesstrap.com/upimages/Complete_Worksheets_2014.pdf
- Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976-1002.
- 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. D. (Eds.). (2004). A practical guide to acceptance and commitment therapy. Springer Science & Business Media.
- Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and Commitment Therapy. New York: Guilford Press.
- 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, 1152–1168.
- Hayes-Skelton, S., & Graham, J. (2013). Decentering as a common link among mindfulness, cognitive reappraisal, and social anxiety. Behavioural and cognitive psychotherapy, 41(3), 317-328.
- Koltko-Rivera, M. E. (2006). Rediscovering the later version of Maslow’s hierarchy of needs: Self-transcendence and opportunities for theory, research, and unification. Review of general psychology, 10(4), 302-317.
- Levin, M. E., Hayes, S. C., & Vilardaga, R. (2012). Acceptance and Commitment Therapy: Applying an iterative translational research strategy in behavior analysis. APA Handbook of Behavior Analysis, 2, 455-479.
- Locke, E. A. (1968). Toward a theory of task motivation and incentives. Organizational behavior and human performance, 3(2), 157-189.
- Locke, L. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation. American Psychologist, 57(9), 705-717.
- Masuda, A., Hayes, S. C., Twohig, M. P., Drossel, C., Lillis, J., & Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification, 33(2), 250-262.
- Monestès, J. L., & M. Villatte. (2011). La thérapie d’acceptation et d’engagement, ACT. Paris, France: Elsevier Masson.
- Moulds, M. L., Kandris, E., Starr, S., & Wong, A. C. (2007). The relationship between rumination, avoidance, and depression in a non-clinical sample. Behaviour research and therapy, 45(2), 251-261.
- National Association of Social Workers (NASW). (2008). Code of Ethics. Retrieved from https://www.socialworkers.org/pubs/code/code.asp
- Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2, 85-102.
- Neff, K., & Tirch, D. (2013). Self-compassion and ACT. Mindfulness, acceptance, and positive psychology: The seven foundations of well-being, 78-106.
- Simon, E., Driessen, S., Lambert, A., & Muris, P. (2019). Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children’s fear of the dark. International Journal of Psychology.
- Stoddard, J. A., & Afari, N. (2014). The Big Book of ACT Metaphors: a practitioner’s guide to experiential exercises and metaphors in Acceptance and Commitment Therapy. New Harbinger Publications.
- Tyndall, I., Waldeck, D., Pancani, L., Whelan, R., Roche, B., & Dawson, D. L. (2018). The Acceptance and Action Questionnaire-II (AAQ-II) as a measure of experiential avoidance: Concerns over discriminant validity. Journal of Contextual Behavioral Science.
- Wilson, K. G., & Murrell, A. R. (2004). Values work in acceptance and commitment therapy. Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. New York: Guilford, 120-151.
- Wolgast, M., & Lundh, L. G. (2017). Is distraction an adaptive or maladaptive strategy for emotion regulation? A person-oriented approach. Journal of psychopathology and behavioral assessment, 39(1), 117-127.