This worksheet provides an Acceptance based alternative to ERP, graded exposure and behavioural experiments. You can download any of our ACT, CFT or CBT resources by visiting http://www.thinkcbt.com and following the free downloads tab. We also welcome new ACT or RFT resources from other therapists. Our ACT, CFT and CBT resources are free to download and share with clinicians and members of the public.

Attached is an ACT take on the traditional CBT thought record.  I have used this with clients and also in training workshops to illustrate one of the differences between ACT and CBT; acceptance, present moment awareness, and values vs. the 'struggle' of evidence for and against, and changing thinking.

Disclaimer: This is a worksheet which is designed to be used by a therapist for therapy purposes only. The therapist using the worksheet takes full responsbility for its use and any impact of it on the client/therapy process.

Purpose of the worksheet: The aim is that the therapist works through the four steps with the client sequentially, you can break these up and divide it over a few sessions. It is most useful for people who are struggling with everyday activities, or activities of daily living (ADLs). This may be because of mood issues or physical discomfort. 

I wrote this exercise based on the "Thoughts as Butterflies" metaphor found in various ACT materials such as the "Learning ACT" book.  I have used it in my ACT group and have recieved positive feedback.  Feel free to comment and critique!

Spanish version submitted by Paulina Salles.

The attached worksheet, developed by Brandon Scott, has been used as a daily exercise to trigger and harness creative hopelessness for individuals with chronic pain. It has been used to help clients grow into living their life even if the pain exists.

I use this a lot with clients who tend to keep derailing the session. It’s incredibly powerful, and it trains defusion, acceptance, contact with the present moment, and committed action all in one simple intervention. (I wanted to put it into ACT Made Simple, but there was no space –so here it is in print for the first time).

To use this strategy, first, you need to agree that you and the client are a team - working together for a specific goal. (Obviously if the client’s goal is to get rid of their anxiety, you can’t agree to that – you just declare your helplessness; admit you don’t know how to do it in any manner that enriches life; and offer them the alternative: to ‘learn how to handle anxiety more effectively so it has less influence and impact over you’.)
So in this case you and the client might agree the goal is to have ‘more successful social interactions’, or to ‘learn how to handle anxiety more effectively so it has less influence and impact over you’, or to ‘increase social life’ etc.
Okay, that’s step one: agree on a goal, and agree you’re a team.

Step two: you say, ‘Now here’s my prediction. I could be wrong, but i predict that throughout this session, every time we start to really knuckle on down to achieving this goal, your mind is going to try and derail us; to pull us off track. And what I’d like for us to do, if you’re willing, is to identify all the different tactics your mind uses to do this; so we can spot them when they show up, and make sure we don’t get derailed by them. Is that okay?’

Step three: Therapist pulls out a large sheet of paper and a pen.
T: ‘So I’m going to write down here every tactic your mind uses. I’ll start off writing for the first few tactics, and then I’ll pass the paper over to you, and you can take over, okay?’
C: Okay
T: So what’s your mind saying now about this?
C: It won’t work.
T: Okay. Let me jot that down. ‘It won’t work’. (As the therapist says it aloud, he also writes down: ‘It won’t work’). What else?
C: This is bullshit.
T: Okay. ‘This is bullshit.’ (As the therapist says it aloud, he also writes down: ‘This is bullshit.’) What else?
C: I don’t see how this will help me.
T: Okay. ‘I don’t see how this will help me.’ (As the therapist says it aloud, he also writes down: ‘I don’t see how this will help me.’) What else?

After writing down five or six ‘derailing tactics’ - such as, ‘this is weird’, ‘but nothing has ever worked in the past’, ‘I won’t be able to do it’, - the therapist hands the paper and pen to the client.

T: So what I’d like you to do, if you’re willing, is each time your mind comes up with one of these tactics to pull us off track, just put a tick by it, so we can see how many times it shows up. Okay? And if your mind comes up with a new tactic I’ll get you to write it down, add it to the list, okay?
C: Well I can do that, but I don’t see how it’s going to help.
T: Okay, now you’ve already got that one on the list, right there: ‘I don’t see how this will help me’ – so can you place a tick by it?
(Client ticks the statement on the list)
T: See how quickly that one showed up? I bet it’s gonna come back at least another 3 or 4 times this session. Any others showing up?
C: Yeah, this is bullshit.
T: And that’s there too, isn’t it? So put a tick next to that one.
(Client ticks the statement on the list)
T: Any others showing up?
C: Yes. (smiling a little – ticks two of the other statements on the list)

As the session continues, every time the client tries to move away from the goal, the therapist calls it out as a derailing tactic and asks the client to write it down. Most clients have a repertoire of about five to fifteen tactics, and the others they come up with are just variants on these basics. At some point, the therapist is likely to need to have the following conversation:

T: Okay, so now let’s get back to that goal we agreed on.
C: There’s no point. It won’t work.
T: Is that one on the list?
C: Yes. (ticks it) But it’s true! It really won’t work!
T: Well, here’s the thing – I can’t guarantee you that it will work. In fact if you ever visit any professional who guarantees you that their treatment will work, I suggest you don’t go back to them, because they’re either bullshitting you or they’re deluded. Go to the world’s greatest surgeon for an operation and she will not guarantee you a successful outcome; she will ask you to sign a consent form in which you acknowledge all the things that could possibly go wrong. So I could show you lots and lots and lots of research on ACT to prove how effective it is with depression, anxiety, addiction, schizophrenia, you name it ... but that wouldn’t guarantee it will work for you. So here’s what I DO guarantee: I guarantee I will do my very best to help you, using the skills and knowledge that I have. I also guarantee, that if we stop the session because your mind says it won’t work, then I will be of no help to you whatsoever. So here we are – your mind is saying this won’t work – shall we let it say that and carry on, or shall we stop the session?
C: Carry on.
T: Great. So can you write down the words ‘But it really is true’ just there on your sheet, in front of ‘This won’t work’ – and put another tick by that thought, and let’s get back to the goal.


The beautiful thing about the ‘off-track, on-track’ strategy is that you are training defusion, acceptance, contact with the present moment, and committed action without even mentioning that this is what you are doing, and with minimal psycho-education – you’re just right into it. Plus, it helps the therapist defuse and stay on track.

The life line exercise is an experiential metaphor to help the therapeutic dyad discuss and establish the basic ACT principles.  It comes from The Art & Science of Valuing in Psychotherapy: Helping Clients Discover, Explore, and Committed to Valued Action Using Acceptance and Commitment Therapy (Dahl, Plumb, Steward, & Lundgren, 2009).  This brief summary was put together as a way of teaching ACT for workshops in Sierra Leone.

I put this together to help clients with defusion and self-as-context exercises; using small sticky notes or writing directly on it, clients can label their observations/emotions/predictions/evaluations. By writing these and putting them on the paper, it can serve as a direct example of letting go of our mental content.

Let me know what you think and if any additions/revisions might be helpful. I work with clients who experience psychosis, mood fluctuations, and anxiety so that was what I had in mind when I put this together.

It is a basic insight in ACT that irrespective what body sensations, feelings or thoughts which occupy us, we can accept that and focus on our values and chose our ACTions and behaviour accordingly.

The problem with insomnia is that sleep is not a behaviour, nothing we can “behave” but a state of consciousness. Of course we can use exercises as muscular relaxation, mindfulness focusing on the body, as body scan or breathing which can relax us an increase the tendency to fall asleep. But  it is clearly stated e.g. that in body scan  we shall not fall asleep but  be awake.  Focus on body and breath will not led all the way to sleep,  because in sleep we don’t experience, at least not normally, neither the body nor the breathing.

But I think there is a mindfulness exercise, which can bring us even closer to sleep.

When we close our eyes we see, so to speak, behind our eyelids lighted and shaded areas.

If we focus on these phenomena exactly as we do in the raisin exercise, that is focus on the seeing of lighted and shaded areas in all minute details and not evaluating or thinking about what we see, it is my experience that sometimes this can lead to more picture like phenomena. And sometimes more dreamlike sequences which can lead into dream sleep and so in to the cycles of sleep.

I have tested this exercise with a few clients, one with pain often preventing sleep, and it worked sometimes.

It is my hope that others in the ACT community will find this simple exercise worth testing and even develop it further.

 

Jan Pilotti

M.D. Child and Adolescent psychiatrist

B.Sc. Mathematics, Theoretical physics

Örebro Sweden

 

dr.pilotti@telia.com

 

PS See also the clear and valuable article  Lundh, L.G. (2005). The role of acceptance and mindfulness in the treatment of insomnia. Journal of Cognitive Psychotherapy, 19, 29-39.      http://contextualscience.org/Lundh_2005

I think the excercise above can be used in the broader setting which the article clearly present.

This is a reworked version of the old acronym that I put to gether for working with Clients. Feel free to use, hope it helps your work and your Client.

Cheers,

Nik

Attached is the Tin-Can Monster exercise, which I recorded using the script from Get Out of Your Mind and Into Your Life. This is a really powerful willingness/acceptance exercise.

I recorded separate tracks for each experiential domain (bodily sensations, emotions, behavioral predispositions, thoughts, memories). This enables clients to repeat tracks to cycle through as many experiences in a domain as they'd like before going on to the next domain.

To go through the whole exercise just once takes a fairly long time (45 min) but people can do this acceptance work in smaller chunks over time. To download the tracks, you must first LOGIN to the site (and be a current paid member) & then when you click on the link & the dialog box appears, click "SAVE" not "play."

This is an exercise adapted from Russ Harris's ACT Made Simple (Chapter 9, Drop The Struggle) as an exploration of the areas that we cannot control and developing the ability to control what we can. I ask the client to carefully circle only those phrases  that describe what we can potentially control. Once they circle at least nine different phrases we discuss and process their choices. This becomes a teaching tool for exploring the concept of dropping the struggle. I usually will discuss the wisdom of the Serenity Prayer and how our work together will involve identifying and relinquishing control of what we cannot control so that we can develope (psychological flexibility) skills for what we potentially can. Whether or not the client circles incorrect responses, it tends to open the door for exploration and discussion.