Here is an article "Metaphors in ACT: Understanding how they work, Using them, and Creating your own" discussing the use of metaphors in ACT, from an RFT perspective, as well as from the perspective of the clinician. This article aims to help practitioners understand RFT in basic terms and to see how it applies directly to clinical work through the creation and use of metaphors. Jean-Louis Monestès and Matthieu Villatte authored the article, and interviewed Yvonne Barnes-Holmes (both a clinician and RFT researcher).

You can also read two books:

• Metaphor in Practice: A Professional's Guide to Using the Science of Language in Psychotherapy by Niklas Törneke M.D.
• The Big Book of ACT Metaphors: A Practitioner's Guide to Experiential Exercises and Metaphors in Acceptance and Commitment Therapy by Jill A. Stoddard Ph.D. and Niloofar Afari Ph.D.

The Journal of Contextual Behavioral Science (JCBS) of has articles about metaphors.

• Crego, A; Yela, J.R; Ozores-Pérez, R. (2024). A map of living: Moving through the variations of life with the guidance of metaphors. Journal of Contextual Behavioral Science, 31, 100718.
• Foody, M., Barnes-Holmes, Y., Barnes-Holmes, D., Torneke, N., Luciano, C., Stewart, I., & McEnteggart, C. (2014). RFT for clinical use: The example of metaphor. Journal of Contextual Behavioral Science, 3, 305-313.

If you are interested in learning more about the creation of metaphor from an RFT perspective, check out Ian Stewart's 2001 paper on the subject.

Many years ago, a friend of mine had the unfortunate experience of a leech attaching to her leg. Even though it was not easy and a pretty bad scene overall, she allowed the creepy creature to fill itself up and it eventually detached itself from her leg without further incident.

Our first intuition was to rip the leech off; however this could have caused toxic leech vomit to enter her system.

So, the same goes for any unwanted, nasty, and blood-sucking private experiences. While we want to act intuitively and engage in experiential avoidance (which most likely will contribute to the problem worsening later on) we have to learn that sometimes it is just best to OPEN UP to and ACCEPT the situation. Just like a leech, these experiences can be bothersome and painful to observe, but they won't kill you. Just thinking about this now, my friend must have engaged in a huge amount of defusion from leech-related thoughts during those 25 minutes.

Relatively new to ACT, I thought of this metaphor with clients who have a hard time with anxiety/intrusive thoughts:

Imagine you're at an auction where thoughts/feelings are being auctioned off. You're allowed to inspect the 'products' before the auction begins, observing what they're like, possible functions, even how you might categorize them. When the auction begins, you sit down and "positive" thoughts come up first, then later more difficult thoughts/emotions. Which thoughts/emotions do you want to bid on and how much are you willing to pay for them?

Often, the client will say "I don't want to pay anything for the negative ones", to which I'll reply "well it seems like you're paying a lot for them right now, what might be a reason for you doing that?".

As I said, I'm quite new to ACT so there may be aspects of this that are not precisely ACT-consistent, so any direction on that would be great.

Greetings I'm relatively new - Response submitted by mihail.m.nedkov on January 28, 2017.

Greetings

I'm relatively new to ACT too, but either way I'd like to share my thoughts on the metaphor you've crafted.

In my honest opinion, it's very good at having the person experience in a more evocative way the costs of clutching to certain thoughts. However, I think that this metaphor would suit work on defusion from the conceptualized self better.

Also, I suppose that the part with bidding on positive thoughts might fuel some experiential avoidance - "bid on the positive ones and they'll come more often / will become more believable / will manage to push the negative ones away" and if I were to use this metaphor, I'd drop this part.

Overall, you've created an excellent metaphor which allows for variations - e.g. bidding on eBay / bidding against your valued directions (for example something in the lines of "Do you think the life you'd like to lead / the person you strive to be would be the highest bidder on that thought? Why not?)

I have used this with couples and individuals who are hook around 'being right' or taking a position that does not necessarily align with their personal values.

"How has your mind tricked you into taking on the role as a defense lawyer for your family traditions?"

This seems to help people be less 'fused' with historical content they carry with them into relationships outside their family of orgin.

This is a hybrid of the Russ Harris' boat with monsters metaphor and weather as emotions metaphor to explain commitment to values. 

You have an indestructible ship that only you can steer. You have serveral compasses on your ship (that represent different values). Because there is nothing that can destroy your ship, and you're the only that can steer it, the only thing that moves your compass needle(s) away from the direction you need to go is you. The weather is your emotions- sometimes choppy, sometimes calm, but they can't actually move the boat. The animals and the sea monsters are your thoughts- sometimes scary, sometimes pleasant, sometimes beautiful, sometimes terrifying, but they can't actually move the boat. 

Bumblebees ('the struggle') Metaphor

By: Alexandra Zax & Dana Bakula

Purpose of the metaphor: 

This metaphor was created to help explain the “struggle” we can get caught up in with our mind to individuals across the lifespan (children to adults). This metaphor can help set up talking about how ACT is different from the ways we often think about dealing with stressors. This metaphor was created as an alternate option to metaphors like quicksand and ‘caught in a riptip’ that may be challenging for all children or adults with intellectual disability or cultural differences to relate to. 

Metaphor: 

Let’s think about our current approach to stress. When we experience stressful, scary, sad, or frustrating thoughts or feelings, our instinct is often to try to get those thoughts and feelings to go away. 

For instance, sometimes our instincts tell us to avoid these thoughts and feelings. Our mind wants to focus on something else or maybe try to control everything we can, to keep the scary thoughts from being true. We call this “the struggle.” 

This probably works some of the time, which is why we keep doing it! But there are costs to to the struggle. Also, somehow those thoughts and feeling always seem to come back. 

To understand the struggle better, let's think about an example. For this example, let’s think about what our normal reaction is around bees. Imagine you are walking outside, and you suddenly find yourself surrounded by a bunch of bees. 

Quick! What do your instinct tell you to do? Do you kick? Swat at the bees? Do you run? 

If your answer is to struggle (run, swat, kick, flail) then your instincts are the same as the rest of us! But - what happens if you starting swatting at the bees or start running away? 

Does that help you? 

That’s right – swatting and waving your hands at the bees makes them really angry and scared. That makes them want to sting you. Do you know what actually helps you escape a bunch of bees? 

Staying super still and calm like a statue. When you do this, the bees start to calm down and lose interest in you. You are still surrounded by the bees, that has not gone away – but they are no longer angry and you can slowly walk away to safety.

This is a simple presentation of an ACT exercise commonly used in therapy that illustrates the difficulty with getting caught up in one's thoughts, as well as a way to change one's relationship to them.

As part of my workshop in Parma on metaphors, I compiled many of the ACT metaphors with example "scripts" of how they are presented in session. Here it is.

People get into Heroin or Morphine for all kinds of reasons. You can compare it to getting into boating. At first you are given free rides and you like it. Then you get your own boat and you enjoy your trips. But soon you find yourself adrift at sea attacked by pirates. You have to seek shelter in a shark infested archipelago, full of reefs, sandbanks, rocks and dangerous currents and things get really unpleasant and very scary.

The sensible thing to do now is to throw in your anchor (which is a good metaphor for the Methadone substitution program). You are still in the same territory but for now you steadied the boat and you are safe from running aground, drowning and beeing eaten by sharks.

Remember, at that point there is nothing wrong with that sea anchor (Methadone). Lifting it (reducing/stopping) will not by itself be of benefit to you. You are not making any progress by setting yourself adrift again in those dangerous waters. In this situation the anchor is not your problem, it is your salvation.

But over time you will want to move on. So you think about where to go from here, looking for a safe direction and a worthwhile goal.

Once you have made up your mind where you want to go, you plot a course out of the treacherous waters. Now your anchor has turned into a hindrance and lifting it (i.e. getting off the Methadone) will set you free to move towards the goals you have chosen according to your deeply held values.

Makes sense?

I have adapted this metaphor for clients with OSFED, BED & BN - Comment submitted by Maria Aleksandr... on December 8, 2018.

Hi,

I have adapted this metaphor for clients with eating disorders (OSFED, BED, and BN in particular) who doubt whether they have to start working with a dietitian. Here how it goes:

Dropping Anchor (Starting a Meal Plan)

People get into addiction to food and binge eating for all kinds of reasons. You can compare it to getting into boating. At first you are given free rides and you like it. Then you get your own boat and you enjoy your trips. But soon you find yourself adrift at sea attacked by pirates. You have to seek shelter in a shark infested archipelago, full of reefs, sandbanks, rocks and dangerous currents and things get really unpleasant and very scary.

The sensible thing to do now is to throw in your anchor (which is a good metaphor for the Meal Plan. You are still in the same territory but for now you steadied the boat and you are safe from running aground, drowning and being eaten by sharks.

Remember, at that point there is nothing wrong with that sea anchor (Meal Plan). Lifting it (not following/stopping) will not by itself be of benefit to you. You are not making any progress by setting yourself adrift again in those dangerous waters. In this situation the anchor is not your problem, it is your salvation.

But over time you will want to move on. So, you think about where to go from here, looking for a safe direction and a worthwhile goal.

Once you have made up your mind where you want to go, you plot a course out of the treacherous waters. Now your anchor has turned into a hindrance and lifting it (i.e. getting off the Meal Plan) will set you free to move towards the goals you have chosen according to your deeply held values.

Makes sense?

Today I had an interesting experience working with a 50+ woman with PTSD/GAD secondary to horrid childhood and marital abuse.

I was using Russ Harris' emotions are like the weather metaphor, including a mindful walk to experience today's weather. While debriefing the exercise we talked about how weather shows up and how futile it is to stand and curse the weather. Actually for her it is not futile - cursing the (real) weather is a form of emotional regulation and mostly soothes her, as long as she then connects with her values and engages with life. Sometimes this engagement means "staying inside" - forsaking some important activities while pursuing other "indoor activities" until the storm passes. But sometimes it means putting on wet weather gear and braving the cold, getting soaked to the bone while doing something more important (for her - feeding the animals).

We then compared this with how she handles the emotional weather. Two of her "storms" were memories and thoughts regarding mother - whom we labelled "Cyclone V...." and her stepfather "Tornado T..." The process of labelling them as such brought instant defusion. Running with the tornado theme, I asked her if she liked the movie Twister and she broke into a big grin and before I could say it she said "We've got cows".

As we explored it a bit further, she realised her experience of anxiety and trauma memories was very much like the scene from Twister - dodging cows, trucks and trees, getting scared out of your wits while pursuing your values.

When I told her I thought she'd invented a new therapeutic technique that might help others as well as herself, she literally glowed.

So she's going away to practice noticing the weather, labelling Cyclone V and Tornado T when they turn up and defusing via "we've got cows".

Ironic that the speaker of the lines was a therapist :-)

What other ways do you fol use the weather metaphor and popular culture?

This is written with kids in mind to help with Acceptance:

Yellowstone National Park is world-famous for its spectacular geysers, like “Old Faithful”. Geysers are interesting natural wonders. They are hot springs of water which when they get hot enough to boil they send all the water into a tall plume or jet of water into the air. But, they only work like geysers if they have all of the following: heat, water and a plumbing system that clogs up. If they don’t clog up they are just a hot spring of water in the ground. One hot spring in Yellowstone is the Heart Spring, which is a beautiful deep green pool of water shaped like a heart. If they do clog up, pressure builds up and it “blows its top”.

Yellowstone has so many different geysers. Old Faithful erupts every 35 to 120 minutes all day every day for 1 ½ to 5 minutes at a time and the water reaches a height of between 90 and 184 feet in the air. Even though you can count on it erupting, even it is not on a set schedule.

The Giantess Geyser can erupt violently with bursts up to 100 to 200 feet high and the area surrounding may shake from the underground steam explosions. Its eruptions can occur two times an hour for between 4 and 48 hours but only two to six times a year.

Sawmill Geyser erupts and spins water around its crater so it looks like a circular blade of a lumber mill. However its eruptions can last all kinds of different times. It can be between 9 minutes and 4 hours.

They all have something in common: they erupt! Human beings erupt, too… but not exactly like a geyser. We erupt with words or actions “blowing out tops”, too. If we remember what is necessary for geysers to be geysers, it is they “clog up” and build up a lot of pressure. If we try to push a feeling down and try not to think about upsetting things we “clog up” too. If we only think about upsetting things, we can be like the Giantess Geyser with the ground shaking and huge bursts of hot boiling water. We can get out of control.

So, what’s a person to do? Well, noticing our feelings and letting them bubble up like a hot spring doesn’t usually hurt anyone. However, they may be very hot and we have to respect the feelings, just like you can’t do a cannonball dive into a hot springs. You may need to find out a little about the feeling and ease into it and learn all about it.

By the way, Yellowstone National Park has a live webcam of Old Faithful geyser: Old Faithful Geyser Live. Check it out!
 

Another one I've been using regarding the mind and language is the asking a fish if they're wet metaphor. We're the fish, and language is the water. How would a fish know if they were wet if they'd never been out of the water? Jumping out of the water helps you to notice the water, but we all still must swim in it.

Any refinements or thoughts would be helpful.

Thanks,

Joanne Steinwachs

The variant from This Is Water - Comment submitted by josh.mervis on November 8, 2017.

David Foster Wallace has a variant of it that I think is nice for certain clients:

There are these two young fish swimming along, and they happen to meet
an older fish swimming the other way, who nods at them and says,
“Morning, boys, how's the water?” And the two young fish swim on for a
bit, and then eventually one of them looks over at the other and goes,
“What the hell is water?”

If at this moment, you're worried that I plan to present myself here as the
wise old fish explaining what water is to you younger fish, please don't be. I
am not the wise old fish. The immediate point of the fish story is that the
most obvious, ubiquitous, important realities are often the ones that are
the hardest to see and talk about.

This metaphor is used to create defusion. I have client's flip through a magazine and ask them which ads they buy into or they would purchase. I ask what ads to they find helpful or unhelpful. We then make the analogy to how their mind works. Their thoughts are like each ad in the magazine and it is as if their mind is flipping through each page, but they decide which thoughts they want to buy or hold onto.

I have just been on a four day workshop here in New Zealand with Robyn Wasler – and it has stimulated a number of metaphors.

Here is one that can be used around the idea of ‘buying’ our thoughts/feeling/reactions and treating them as if they are real. It also covers that it is part of the human condition to ‘get hooked’ – but that we do not need to stay hooked if it is our own mind that has hooked us.

Flyfishing Metaphor

“Have you heard about fly fishing. A good fly fisher knows exactly what the trout are feeding on and tie up flies that imitate those insects. They are so good at this that the trout can not tell the difference. They cast the fly into the stream right in front of the trout – the trout sees it floating by – buys that the fly is real, bites and gets hooked.

Our minds can be like really skilled flyfishers. Our thoughts and feeling are like really specific flies our mind designs and are just the ones we will bite on. Our mind casts them out on the stream in front of us – they seem so real to us and so we ‘buy’ them, bite and get hook.

Once we are hooked, the more we struggle the more we are behaving in ways that pulls the hook in further and keeps us on the line.

Funny thing is our mind can only tie flies on barbless hooks. It feels like we can’t get off, but if we pause from the struggle and spit the hook out – we are off the hook. Our mind will tell us there is a barb on the hook and we can’t get off – but if we stop struggling so hard, we get off the hook.

As we swim in the stream of life there are flies floating by on the surface all the time. As we get better at spotting ‘ that is just another fly floating by – I don’t have to bite’ we get hooked less often. But it is part of being human to get hooked on a regular basis. Remembering these flies are always on barbless hooks allows us to spend less time struggling, to get unhook and to then have the flexibility to swim in the direction our values let us know we want to."

Purpose: This metaphor is used to illustrate the “unworkability” of trying to “fix” (e.g. reduce, remove, suppress or change the form of) difficult “automatic” thoughts and emotions, by “adding” new thoughts when they appear in our “experiential window”. (as when clients try to "solve" these internal experiences with self-debating, or when clients are fused with their thoughts).

This is a heavy tested metaphor, rated as “successful”. Change the words, or explanation procedure, as needed, when using this metaphor on your own.

(Download metaphor as attachment).

Lessons from the Skies: A Hot Air Balloon Metaphor (shared by Brianna Z. Kauer, M.S., BCBA)

Growing up with a dad who was a hot air balloon pilot meant I had many experiences in the sky. It wasn’t until I was an adult that I realized how out of the ordinary this actually was. For me, it was a normal thing we did every calm summer evening; Soft Skies Balloon Rides was our family business. We spent many evenings preparing for the flight while explaining the mechanics to awed and excited customers who were about to experience it for the first time.

The process became second nature. We began with checking the wind, and then watching the direction of the helium balloons we would send up beforehand, rolling out the balloon in the field next to our house, connecting the basket, listening to the the sound of the fan blowing air into the balloon, checking instruments, velcroing seams together at the top, pulling material, holding ropes and then finally lighting the fire. The burners would ignite, drowning out all other sounds while the balloon went from laying on its side to floating over our heads. Passengers would climb into the basket, the ropes would be released and we would slowly rise off the ground. As the youngest in the family, I didn’t add much weight to the basket which meant I got to go along for many rides.

Floating in the sky above Wisconsin farmland was a big part of my childhood. It was a familiar space and one of the most peaceful places I’ve ever been. Not only did I have many adventures, but it also has given me some insight into perspective taking and letting go.

Many of the people we took for a balloon ride would be surprised to learn that you cannot steer a hot air balloon. The balloon follows the path of the wind and you must go along for the ride. All that you can control is going up or down; adding more heat by lighting up the burners (up) or releasing hot air through the top valve (down).

The balloon ride can be a great metaphor for life. There is so much we cannot control. We cannot control the direction of the wind and if we struggle against it we will only waste our energy. When we allow ourself to surrender to the wind we may notice the things around us in a different way. When we go up or down in the balloon our perspective will change.

The distance from which we look at something impacts our experience.

When we are flying low to the ground, everything seems large and appears to be moving quickly. When you are flying high in the air, everything seems small and appears to be moving slowly. We can’t control which direction the wind blows us, but we can choose to rise above the struggles of the day to see them from a distance. When we create distance from our negative thoughts or feelings they don’t seem so big; mountains become foothills, houses become toys, people become ants.

This distance gives us a bigger picture and often we can see things we couldn’t see before. We might notice other details or possibilities.

What I’m describing is a process called cognitive defusion which is a component of acceptance and commitment therapy and has shown to have a huge benefit on mental health and wellness. The goal is not to escape or avoid those difficult thoughts or feelings, it’s just to see them from a different angle. To create some distance, so that we are looking at them rather than from them.

Many of us learn complex information and concepts best through the use of story and metaphor. Metaphors are especially useful when understanding concepts of cognitive defusion. Finding an exercise or metaphor that works for you can be a useful tool for the difficult moments.

The hot air balloon metaphor is one of many ways to practice this technique of defusion. Other common exercises include observing your thoughts as a train on a track, or leaves on a stream, or playing with the words themselves (de-literalizing language).

When you find yourself overwhelmed by a thought or feeling, you can jump into your hot air balloon basket and float above it. Notice how your perspective changes as you float above those difficult thoughts and feelings. You can go up and down to change your distance from them while you surrender to the path of the wind and see where life takes you.

If you'd like to see pictures of my families ballooning adventures you can see the original post here: https://createbehaviorsolutions.com/lessons-from-the-skies-a-hot-air-balloon-metaphor/

Guided Defusion Exercise (also found here):https://docs.google.com/document/d/e/2PACX-1vQ-UW8WJLjluTLrNI8-emWvu6MlGJ2zlHHb8NeQCaquKvgvNt8eiM9XBJcXreGni7IL-a6jRYFkBilu/pub

Hot Air Balloon Metaphor: Defusion Exercise

You are welcome to close your eyes for this exercise if that helps. If at any time you need to pause, just open your eyes and do what you need to do.

Begin by noticing your body in space. Take a few deep breaths and arrive wherever you are.

We are going to practice putting some distance between you and your thoughts and feelings.

We will start by imagining yourself climbing into a hot air balloon basket. You look up and see the fully inflated balloon over your head filled with warm air.

Outside of the basket on the ground are all the things that have been troubling you. It is hard to see anything else because they are taking up so much space around you and are very big. Picture your troubling thoughts and feelings as actual objects on the ground. They could take shape as houses, vehicles, people, books, animals, to do lists, cell phones, or maybe just abstract shapes or different colors.

When you are ready to take flight you reach up and pull the burner which blows fire and heats the air of the balloon. That air begins warming up and soon the balloon gently rises off the ground and into the air.

You feel weightless and free.

You continue to rise.

You can feel the breath moving in and out of your lungs naturally with ease.

If you notice yourself getting closer to the ground you can simply add more heat to the balloon to rise higher into the air.

As you float upwards, you look down to see the ground and all the thoughts and feelings it holds. Notice how the size of those things looks much different from up here. They are still down there but they are taking up much less space in your line of sight. Now you can see them along with the whole city/town and horizon. You know they are there but from up here you can notice them from a distance.

From up here they are not the only thing you are experiencing.

From up here you can notice your body and the gentle rise and fall of your breath.

From up here you can notice your feet touching the basket.

From up here you can notice the sounds of the birds and the warmth of the air on your face.

From up here you can let go of your agenda and surrender to the direction of the wind.

This space is available to you whenever you choose to come.

For now we will let this image dissolve and bring your attention back to your body in space.

Taking a few more deep breaths before opening your eyes and returning here and now.  

Attached is a ppt & handout I did as an assignment during my final year undergraduate psych study. There's also a video role play of the chessboard metaphor which I've posted on YouTube (search by title "chessboard metaphor"). These materials were designed to briefly introduce other students (with no knowledge of ACT or RFT) to the use of metaphor in ACT as a psychotherapeutic technique. I've used material from this website extensively and hope I've acknowledged those sources adequately. I am sooooo grateful for the wealth of material that is available here!

In a way, life is like a cycling race. We are all pedaling and we wear shirts with words written on them. In French we have a way of speaking («Vous roulez pour qui ?) that translates litterally into "for whom do you travel ?" The idea is the same as the one Bob Dylan expresses in the song "You've got to serve somebody". We sometimes believe it's possible to have blank shirts without anything written on them or we can "not know" for what we pedal but in this case it happens that we nevertheless have something written on our shirt, namely "NOTHING" or "I DON'T KNOW". And how does that feel to travel for that master?

Now imagine there is a shop with piles of shirts wearing all kinds of words written on them. Like ELEGANCE, GENEROSITY, LOYALTY, HEALTH, LOVE, CARING, HONESTY, and so on. And you can choose, for free, any one of them. Which one would you choose?

And look what happens (at least to me). There comes this voice (you've probably heard it before) that says : "Waah, ELEGANCE, are you kidding? Have you looked at yourself in a mirror? That one for sure is not for you." Or something like "How come you want to take CARING? With that crappy introverted personality of yours? Or like "XYZ, are you crazy? You really don't have the temperament to do that!"

Can you have all these thoughts AND take the shirt you find «way cool», the one showing the quality you choose to «make important» in your life (thanks to Hank Robb for those wordings)? Then, find a goal, preferably a small one, an action that would lead your life a tiny little bit in the direction of that value, and DO it! Of course the voice will come with you, all along the way. See if you can welcome it without trying to have it shut up but without obeying it.

A boat docked in a tiny Mexican village. An American tourist complimented the Mexican fisherman on the quality of his fish and asked how long it took him to catch them.

"Not very long," answered the Mexican.

"But then, why didn't you stay out longer and catch more?" asked the American.

The Mexican explained that his small catch was sufficient to meet his needs and those of his family.

The American asked, "But what do you do with the rest of your time?"

"I sleep late, fish a little, play with my children, and take a siesta with my wife. In the evenings, I go into the village to see my friends, have a few drinks, play the guitar, and sing a few songs. . I have a full life."

The American interrupted, "I have an MBA from Harvard and I can help you!. You should start by fishing longer every day. You can then sell the extra fish you catch. With the extra revenue, you can buy a bigger boat. With the extra money the larger boat will bring, you can buy a second one and a third one and so on until you have an entire fleet of trawlers. Instead of selling your fish to a middle man, you can negotiate directly with the processing plants and maybe even open your own plant. You can then leave this little village and move to Mexico City, Los Angeles, or even New York City! From there you can direct your huge enterprise."

"How long would that take?" asked the Mexican.

"Twenty, perhaps twenty-five years," replied the American.

"And after that?"

"Afterwards? That's when it gets really interesting," answered the American, laughing. "When your business gets really big, you can start selling stocks and make millions!"

"Millions? Really? And after that?"

"After that you'll be able to retire, live in a tiny village near the coast, sleep late, play with your children, catch a few fish, take a siesta with your wife and spend your evenings drinking and enjoying your friends."

I've mainly used the "caught in a rip" metaphor as a graphic way of capturing the essence of giving up the struggle. As I've written it down I think it actually has value for many aspects of ACT. So please feel free to email me with ideas for extensions or ammnedments.

Life’s a beach

Sometimes life is like swimming at the beach. We launch headlong into life expecting to have a fun, relaxing and refreshing time. People ply us with good advice. Don’t forget the sunscreen. Swim between the flags. Stay out of the water for 30 minutes after eating. Watch out for sharks. So we jump in, splash around and have a good time. Depending on our personality and experience we may be carefree, or we might be anxiously watching for sharks, or continually monitoring the flags to make sure we’re in the right place. Or maybe we are the sort of person who loves to flout the rules and swims anywhere.

Suddenly our pleasure is interrupted by an unpleasant sensation. We are knocked off our feet, we can no longer touch the sandy bottom and we notice we are headed out to sea. We panic and immediately set the goal, “I must get back to shore” so we take action to achieve that goal. We do it without thinking. It’s instinctive. We start paddling furiously against the rip. Sometimes we seem to be making a little progress, but we start to tire and notice we are losing the battle. We swim harder, we roll over on our back and kick with our legs, but we are getting nowhere and getting exhausted. We forget why we came to the beach in the first place. We begin to tell ourselves, “If only we had stayed between the flags” or “I wish I’d done some more swimming training before I risked it all by coming to the beach”, but none of this wondering how you got here is any help. You are still paddling furiously and getting nowhere. Maybe you call for help, and here I am – a lifesaver come to the rescue. So notice – here I am with a board to rescue you, and I suggest you grab hold of the board. Before you can grab hold of the board you need to stop paddling furiously. Even though every fibre in your body screams in protest, you must stop paddling and try something different – grab the board.

Now I am a very contrary lifesaver, for my job is not to rescue you, but to teach you to rescue yourself. For the thing about life is you can get sucked into a rip at any time. That rip may be depression, or grief, or anxiety or urges to eat, gamble, spend or use drugs.

So I want you to learn how to get out of trouble when you get stuck in a rip. So I invite you to swim slowly across the rip. I’ll even swim alongside you. As you do this you will feel the tug of the rip. You will get carried out to sea further than you’d like to be and your mind will flash all sorts of scary scenarios before your eyes. That is what minds do. Mine does it too. I’m not asking you not to be scared, or anxious, or depressed. I’m asking you to swim across the rip while experiencing those thoughts and sensations and eventually you will come to calm water and be able to get on with enjoying your day at the beach. So what I’m inviting you to do is to give up paddling furiously and accept the uncomfortable sensations and scary thoughts of being carried out to sea. I’m inviting you to reconnect with what really matters – having fun at the beach for whatever reasons that is enjoyable for you. I’m inviting you to take effective action and what that is depends on the situation. If you’re safe it means enjoying the sun and the surf for your own reasons. If you’re stuck in a rip of (insert presenting problem) it means stopping the struggle and taking small strokes in the direction of where you want to be, whatever experiences come up.

Additional Extensions

(For OCD/Anxiety)

Notice that in this scenario there are precautions you can take to improve your safety. You can learn skills like how to do survival stroke, or simply train to be a better swimmer. You can put on sunblock to stop getting burnt. You can stay out of the surf on really rough days. You can avoid beaches where there are stingers. You can swim between the flags. These can serve to improve your enjoyment of being at the beach. But what happens to your fun if you become obsessed with safety. Instead of floating around or catching waves, you keep your eyes glued on the flags? Or as soon as your toes hit the water you run back to your bag to put on some more sunblock? Or if you give up on going to the beach because it’s too dangerous? (Let client answer – and discuss reasonable safety and how to practice it as well as willingness to have worry thoughts while pursuing valued activity)

Notice also that despite your best efforts, you can still get stuck in a rip. Winds, current and tide may change and the area that was once safe turns into a rip, or maybe a huge wave comes and knocks you off your feet. It doesn’t matter whose fault it was or how it happened, once you’re in a rip you have an important choice to make. Keep struggling and eventually succumb to exhaustion and drown, or stop struggling and start taking effective action by swimming across the rip towards your values.

(Values)

Notice that there are lots of people at the beach on a hot day. Now I imagine they’re not all there for the same reason. What are some of the reasons for going to the beach? (Let client answer and prompt for as wide a range of options.) Use this as a jumping off point for discussing goals and values including pursuing the same goal for different reasons, and also being able to pursue values even if a specific goal is blocked. For example if you go to the beach (goal) to cool down (value) – if the road to the beach is closed, there are other ways to cool down – e.g. – sit in an air conditioned room, have a cold shower, have an iced coffee etc.

(Advice/Pliance/Programming)

Do you remember all the good advice people have given you about how to be safe when going to the beach? Notice that some of it is good advice (don’t get out of your depth if you can’t swim), some is mostly right but sometimes wrong (it’s safe to swim between the flags) and some is just urban myth (rubbing butter on your skin protects you from sunburn). I’ll bet you didn’t ask for any of that advice, it just randomly came your way. People with good (and maybe bad) intentions filled your head with a mixture of good, bad and indifferent advice. So how do you tell whether that bit of advice that pops into your head when you make plans to go to the beach is worth following? (explore workability)

I use this with clients who are experiencing troubling thoughts. I find it helpful as a rapid analogy about value driven behavior and acceptance. In addition, the metaphor itself is easily  anchored , as most of us actually check a mailbox each day.  I enjoy sharing on this site, feel free to play with this , and offer  your feedback.

1) When you go home today, what do you expect to find in your mailbox?
Client answers: Bills, advertisements, junk mail, maybe a letter.

2) How do you sort through to decide which mail needs follow up and which is considered junk?
Client answers: I have to look at it, and decide what is important.

3) How do you know what is important?
Client: Well if I don’t pay my bills my electricity would get disconnected, and if I don't renew my license plates, I can't drive.

4) I see, so you sort things out according to what matters to you, your priorities are easy to identify because you value the stability of a comfortable home and the freedom of driving your own vehicle.       What do you do with the junk mail?
Client: I throw it away

5) When you throw it away, is that the end of it?
Client: no there's always more junk mail the next time I open the box.

6) Why don't you follow up on it? You could call and check on those offers or you could get mad and call the advertisers and demand that they stop delivering the junk?
Client: Yes, but that would just be a waste of time…I've learned those offers are things that I don't need, or they are scams. I once tried to stop the mail but other companies send more. There's always more junk mail the next day, it's not worth getting upset..

Summation: So your experience helps you sort out what is important, according to the things that matter to you. And you learn to live with the junk mail that shows up everyday. It's in the box, you notice it long enough to recognize it for what it is, and then you move onto what matters in your life. …… Maybe these thoughts are like the mail that shows up in your mailbox; you take action on the important things while you have to accept the fact that there will be some junk , and you simply allow it to show up.

I have created a free little iOS iPhone app that visualises the mind as an obtrusive chat application.

The user can play with it and try different strategies on how to respond to the chat request, like just pushing it away, be harsh or getting hooked. And there are other ways to try, like notice and name, drop anchor, jot down the thoughts to come back later in some worry time. The app uses ChatGPT to mimic interactions with the worry monster.

Download and read more
https://apps.apple.com/ch/app/sorgenmonster/id6727016600

This is a file with several mindfulness body based ACT metaphors that consist in guided mindfulness of the body exercises that target specific processes specially shifting mode of mind from doing mode to being mode. They all enphatize learning from direct experience and connecting with here and now. You can explore more you can go to the ppt presentation at WC IX  for more resources. Hope you all enjoy them! and if you use them please let me know how was your experience.

This is a metaphor I'm working on to help explain the utility of acceptance.  I'd really love to get feedback if folks have any thoughts.  --Melissa Wright

Therapist: Sometimes it seems almost impossible to sit with our feelings. I’d like you to imagine something that might help you understand what I mean about “making room” for your experiences, or accepting them. Would that be alright?

Now imagine you are walking home your usual way, just walking through your neighborhood. Suddenly, you hear something, and it sounds like it’s right behind you. It sounds big, it sounds scary, it actually sounds like a giant flying beast… you think you can hear its massive wings flapping and its jaws crunching and grinding. Terrifying sounds. My guess is you might take off running, does that sound about right?

Client: Well yeah.
Therapist: Me too. Are you a runner?
Client: Oh, sometimes. I’ve been a runner in the past.

Therapist: So, tell me… what happens once you’ve been running for a mile or so?

Client: Well I should be fine after a mile.
Therapist: Okay, so what about after five miles?
Client: I’d definitely be getting tired by then.
Therapist: I certainly would too. And what do you normally do while you’re running?
Client: What do I do?
Therapist: Yeah, I mean, do you make business calls, or catch up with the people you love?
Client: While I’m running?
Therapist: Yeah, while you’re running.
Client: Well, no, running is pretty much the only thing I do while I’m running. I mean I get all sweaty and out of breath. 

Therapist: I’d certainly be sweaty and tired. But the thing is, the beast is still following you, so you keep running. You run and run and run and run and you are sweaty and you are tired, but the beast is still there, you can hear it, so you keep running.

Finally, at some point, you trip over a rock. And when you look up, you see it. And this beast that’s been following you? … Now, bear with me, this is a funny image, but this beast - well… It’s a gang of mosquitos. There’s about 8 of them, and they are flying around with these little megaphones that make them sound MUCH bigger than they really are. And those big wings that you thought you could hear flapping? They are actually tiny mosquito wings… and those jaws that were grinding? That’s actually the noise of the tiny little mosquito mouths…
But you’ve stopped running, so now they do bite you. And you sure do get itchy. And that’s actually pretty unpleasant… but do you think that at this point, as you’re looking up at the mosquitos, you would choose to get up and start running again?

Client: I guess not, if they are just mosquitos…but what do you mean?
Therapist: Well, sometimes running does make sense, right? If its really a monster you need to avoid, then running makes sense.   But the thing is, feelings are a lot more like a pack of mosquitos chasing you around than an actual monster. No one has ever been injured or killed by anxiety and sadness. Feelings ARE itchy: they often aren’t fun, they can be downright awful to experience. But if we run from them, we end up using all our energy getting sweaty and out of breath, while we could have been making business calls, catching up with old friends…

Client: Hmmm

Therapist: The important thing to remember is that even when feelings and thoughts look and sound like a huge crazy monster, the truth is, they can’t actually hurt you.
And what I’m hoping is that, above all, we can help you notice when you are running. That way you can make a decision -- you can ask yourself, “is running actually helping me get what I want? Or, am I all sweaty and tired and unavailable to my friends and family because I’m so busy running away from something that isn’t actually dangerous to me?” 

Running takes a lot of energy, and you might find that you’d rather get a few mosquito bites, feel the itchy feelings, and be able to stay in one place and do the things that you want to do. But it takes practice to know that you’re running, practice to learn how to keep walking instead, and I’m hoping we can practice some of that here together. 

Internal Struggles (The Chessboard Metaphor) - Contributed and posted with permission by Dr. Russ Harris

Here's a brand new animation of the chessboard metaphor. It is posted on YouTube so you can freely share with clients if you wish.

https://www.youtube.com/watch?v=phbzSNsY8vc

Passengers on a Bus - An ACT Metaphor: https://www.youtube.com/watch?v=Z29ptSuoWRc

Les Passagers du Bus (Français): A French animated Choose Your Own Adventure video series featuring The Passengers On The Bus metaphor. Viewers are able to make decisions that shape the story, with each video demonstrating the impact of their chosen strategy: https://www.youtube.com/watch?v=TYjIYp-46zc

Picture your life as a room. One day you notice that a pipe near the ceiling in a corner is dripping. The sound of the falling drops makes you nervous and you'd like to get rid of it. So you repair the leak with a length of adhesive isolation tape and your peace of mind is back. Until the water finds his way through the glue and the dripping sound is back. Plop.... plop... plop... So you put one more length of tape around the first repair and you are quiet again. Of course your quietness doesn't last very long and you have to fix the leak again and again. That's not a great problem since adhesive tape is pretty cheap and you manage to always have a spare roll handy. It can take months, even years until you notice that that big clumsy repair slowly fills the whole room, that there's less and less space for you to live in and that the dripping comes nearer and nearer to you...

This metaphor adresses basically the same problem than the «feeding the tiger» metaphor. The hopelessness it conveys seems to me to be more «creative» since it doesn't lead to the thought «it's too late now, the tiger has grown so huge I really can't do nothing else than feeding him» clients will often buy when the «feeding the tiger» metaphor is presented.

Sandstorm metaphor

Sandstorms are violent wind storms that occur in the desert when high winds lift particles of sand into the air thus unleashing a turbulent and suffocating cloud of sand. They can occur unexpectedly and last for as little as a few minutes or as long as a few months. Regardless of how long they last, the effects can be abrasive and blinding to exposed skin. To survive a sandstorm one therefore has to experience the sandstorm from a different position of having exposed skin covered, and ‘riding’ the storm. A sandstorm can move whole sand dunes, thus changing the landscape. It can therefore be difficult to rely on the landscape to show you which direction to go in. The stars which are constant and remain unchanging can be used instead as a compass for guidance. There is therefore a real danger of getting lost in a whirling wall of sand, as well as the abrasive effects on exposed skin and eyes. To survive a sandstorm, one has to cover exposed skin, and then sit and wait for it to pass whilst experiencing the sights, sounds, smell, taste of the storm, but doing so from a position that allows you to experience it, but not be caught up and exposed in it. Major sandstorms are a natural occurrence – they are part of life in the desert and cannot be avoided.

Difficult life situations/worries/anxieties/fears/problems can be like sandstorms. They are a natural occurrence of life and living. We can sometimes feel as though we are caught in the middle of a sandstorm, lost (moving sand dunes and changing landscapes), and unsure of which direction to move in.
 

The enclosed attachment illustrates two ways of responding when caught in a sandstorm - psychological flexibility and psychological inflexibility, and the different ACT processes within each.

I recently used this metaphor with a lady with needle phobia that regularly needed to be cannulated to receive cancer treatment.  She hated the experience and had the urge to rip the needle out of her arm. Having the treatment was in line with her values as she wanted to live.
 

‘Have you ever stood on the edge of a cliff or the balcony of a high rise building when you’ve suddenly had the thought ‘what if I jump’? (most people have had that experience and she said ‘yes’). How did you feel? Did you ever think that you would actually jump? Did you know that you were in control over whether you jumped or not? Must people experience a surge of anxiety but know that they would never jump.
 

What if it’s the same when the needle is put in your arm and you are attached to the drip?
You can’t control the thought (what if I jumped/pulled the cannula out of my arm?), but you have a choice to jump or to stand back and admire the view?
This lady felt much calmer in the subsequent cancer treatment sessions and said that she was able to sit back and observe her thoughts rather than buying them.

Although I used this with a lady with needle phobia it could easily be used with any situation where the client fuse with a thought and believe that they might act on it.
 

Plain language version of ACT Submitted by Steven Hayes

This is ACT in a few sentences: You've been trying to win the war with your mind, with your anxiety, with your urges [add whatever is relevant]. True? (They always say "yes."). Well, ACT is about letting the war roll on while you leave the battlefield.

This is a joke I've been using with clients recently that seems to have been pretty successful so far in orienting them to the concept of "workability." 

There's this little boy that won't stop shredding paper. No matter what his parents do, every piece of paper they put in front of him, he tears up. They take him to three different doctors to see what they can do to fix it. The first doctor says that his problem is psychological, and so he prescribes him six sessions with a therapist. At the end of the sessions, they put a piece of paper in front of the boy...and he shreds it immediately. The second doctor says his problem must be neurological, so he does a bunch of tests and prescribes a bunch of different medications in an attempt to curb the behavior, all to no avail. So they take the boy, who by this point is incredibly frustrated by this entire process, to see a third doctor. This doctor, rather than writing a prescription or doing some kind of complex diagnostic, simply walks up to the boy, bends down and whispers something in his ear. The boy looks at him, says "Okay!" and from that moment on, the behavior completely stops. A few weeks go by, and it looks like whatever doctor number three did fixed it. So, curious, the boy's parents ask him what incredible piece of wisdom and insight the doctor gave him. The boy replies:

"He told me if I stopped shredding paper then you guys would stop taking me to see these all these doctors."

This metaphor is useful for car enthusiasts, or anyone really, as long as they understand the concept of a clutch in a manual transmission vehicle.

It's as if you're driving a car on your journey through life.  However, you begin to notice over time that the engine in this car is very finicky, almost like it has a mind of its own.  It occasionally revs up very high, or bogs down low.  As it does this, the car speeds up or slows to a crawl, regardless of the speed limit, upcoming turns, or what the traffic is like around you.  Naturally, this can make it difficult for you to effectively drive in the direction you want to go.  Your initial response is to try to control the pace of the engine by hitting the brakes when it speeds up or hitting the gas when it slows down.  You push down hard on the brake, and you slam the gas pedal in response to the engine acting up.  However, you notice over time that this does not work very well or for very long, and the engine revs even higher or bogs down even lower when you try to fight it.  What's more is while you have been putting all of your energy into those pedals, your attention is no longer on the road or the direction you are headed.  What if there were an alternative to the gas and brake pedals.  What if you looked down to find that there was a clutch, hidden over in a dark area of the floorboard?  Instead of trying to control this finicky, unpredictable engine, you could simply take the car out of gear.  This would eliminate the need to control or change the pace of the engine, and instead as it begins to race or bog down, you could simply push in the clutch.  When the pace of the engine is appropriate or effective for the road that you are on, you could let the clutch back out.  The engine no longer controls the speed of the car.  You do.  And you are now free to concentrate on the road ahead of you.   We can think of our minds as being like the engine in this example, and willingness, acceptance, and mindful awareness are all like the clutch.  When our mind begins racing, telling us to run away or escape, showing us images of possible dangerous scenarios, reminding us of painful past events, or bogging us down with evaluations, judgments, and negative predictions, we can choose to engage the clutch and willingly observe these things without allowing our behavior (the car itself) to automatically speed up or slow down.  When we find that our mind is being helpful, we can release the clutch and allow it to do its work.  We can't ever successfully gain control of the engine, but we can gain control of the speed and direction of the car.

The Cold Shower metaphor

Taking a cold shower – dealing with discomfort in the service of a valued life. Noticing Willingness and Unwillingness and how to make Willingness easier.

Two scenarios:

You are thinking of taking a shower but you discover there is no hot water:

1. If you had the choice to have a cold shower…or not to, you might choose not to. Because it’s cold, it’d be uncomfortable, you could do without the shower, I will be cold afterwards, I’m not that smelly I’ll do till the morning etc. You might not be bothered because there’s no point in putting up with that much discomfort for no good reason.

2. If a close relative or friend was getting married that day, you wanted to be clean and fresh but again you find there is no hot water. If you stopped for a few minutes and you thought about the person getting married and how much you care about them, and the great time you were going to have sharing in that special day, wouldn’t you put up with a few minutes of discomfort of the cold shower? Because it was Important to You. Mightn’t you be able to put aside your feelings of discomfort, because you wanted to be fresh and clean for the great day ahead? In this instance, we are prepared to make room for the uncomfortableness. We chose discomfort in the value of feeling better after the shower.

In both scenarios, the water is the same unpleasant temperature.
Which of the 2 scenarios would ‘feel’ better? And why?
When we increase Willingness to make room for uncomfortableness it can increase our bandwidth to be able to take on experiences we might previously have avoided.

In the second scenario, I made room for the uncomfortableness and I let it be there, and I still went ahead and had the shower because it was important to me. In the first scenario, I only focused on the uncomfortable feelings and I preferred to avoid the shower altogether.

Finding out what’s important to us in life can really help manage uncomfortable feelings and make room for them by focusing on What’s Important in our lives.

So if someone was socially anxious, yet they wanted to go to a gathering. They could choose to make room for some uncomfortable feelings (to have the cold shower as it were) because What’s Important is that I move forward towards things I enjoy, What’s Important to me, like socialising with others.
 

This is a metaphor and defusion technique devised by one of my clients and shared with her permission.

It provides a very simple and powerful image for the acceptance of thoughts which are disturbing and unwanted.

The Jigsaw Piece

When an unwanted or distressing thought arises, I try seeing it on a jigsaw piece.

My jigsaw has many pieces, each representing the many different aspects of myself and my experience.

I see the jigsaw piece with my thought (or feeling) on it as it finds its alloted place in my jigsaw.

There is a space for this piece.  It is a perfect fit.  It belongs here, for whatever reason, even if I don't understand or want it.

It is a part of my experience.  Just that.  Even if this piece looks ugly or painful or disturbing, it is one piece of a large and beautiful picture. 

As I'm typing this, I'm also thinking of those photo montages where, for example, the picture looks like a face and when you zoom in it is constructed from thousands and thousands of unrelated smaller images.

There is some scope to elabourate this image a little or use it in conjunction with other exercises - for example I sometimes use an exercise called "Big I, little i's" (constructing a big I on the wall using lots of post-it notes, the client being invited to write about different aspects of themselves on each one)...the point being that I am more than any one aspect of myself e.g. I'm more than my appearance;  more than my history;  more than my intrusive thoughts...

I hope this is helpful.

Regards

Andrew Chester

Sheffield, UK.

$86,400 -- Something To Think About!

Imagine that you had won the following prize in a contest: Each morning your bank would deposit $86,400.00 in your private account for your use.

However, this prize has rules, just as any game has certain rules.

The first set of rules: Everything that you didn't spend during each day would be taken away from you.

You may not simply transfer money into some other account.

You may only spend it.

Each morning upon awakening, the bank opens your account with another $86,400.00 for that day.

The second set of rules: The bank can end the game without warning; at any time it can say, Its over, the game is over!

It can close the account and you will not receive a new one.

What would you personally do?

You would buy anything and everything you wanted, right?

Not only for yourself, but for all people you love, right?

Even for people you don't know, because you couldn't possibly spend it all on yourself, right?

You would try to spend every cent, and use it all, right?

ACTUALLY, this GAME is REALITY!

Each of us is in possession of such a magical bank.

We just can't seem to see it.

The MAGICAL BANK is TIME!

Each morning we awaken to receive 86,400 seconds as a gift of life, and when we go to sleep at night, any remaining time is NOT credited to us.

What we haven't lived up that day is forever lost.

Yesterday is forever gone.

Each morning the account is refilled, but the bank can dissolve your account at any time....WITHOUT WARNING.

SO, what will YOU do with your 86,400 seconds?

Aren't they worth so much more than the same amount in dollars?

Think about that, and always think of this: Enjoy every second of your life, because time races by so much quicker than you think.

I'm not too satisfied whith the two scales metaphor. The two scales are unrelated and therefor difficult to understand.

I propose the pendulum metaphor as an alternative. You have two dimensions of a pendulum: one is the amplitude the other is the string between its sinker and attachment. They are clearly related and the metaphor is easy to understand since almost everyone have some experience of a pendulum. 

The pendulum metaphor below. It's a remake of the two scales metaphore.

Comments welcome. Feel free to use.

Detta verk är licensierat under en Creative Commons Erkännande 3.0 Unported Licens.

A Pendulum

Imagine a feeling, any feeling or emotion. How long will it last?

Imagine a pendulum. The higher you lift it in one direction, the more power to swing up on the other side will you give it. You will perhaps notice the power in it’s weight and resistance, more when you let it go.

It is with feelings as with the pendulum – they swing! Inexorable! You may like one side more than the other. If you try to fight the pendulum and try to get it high up on the side you prefer, you will give it power to get high on the opposite side (the one you dislike). You may for a short moment stop it or lift it higher then it’s natural cycle (provide). It will though consume and lock your own power. And sooner or later it will anyway go to the side you dislike – and with the extra power you’ve been giving it! Fact is that in the moment you notice a resistence in your strive to get the pendulum in your disired direction, it’s power is in the opposit direction.

If you on the other hand are willing to let the pendulum swing, you don’t lock your energy in the pendulum and you do not give the side you dislike any extra energy. For some persons it may swing more than for others. Some might like it, others are getting seasick. Willingness is not equal to like it when it swing. Willingness is to change focus. Instead of sitting in the sinker, it is to climb up the string to the attachment! It means you have acceptance for all feelings.

At the attachment of the pendulm can you let it swing without getting seasick. The whole of you are not swayed by the swing, but the swing is still there.

Let’s take anxiety as an example:

It is when you are really unwilling to have anxiety that anxiety is something to be really worried about. It is as when anxiety is high and willingness low the anxiety clings hard. And how hard you press the pendulum the harder the anxiety clings. You give it more power. So what is favourable to do is to shift focus from the power of the anxiety in the pendulum to acceptance and willingness. Climb from the sinker to the attachment of the pendulum. You have, in vain, tried for so long to control your anxiety. You can not change the swing (at least not from the position in the sinker) but you are free to climb to the attachment. 

That is not a reaction, not a feeling, emotion or thought – is is a choice.

You have probably been at the sinker – you might have been in high swing. That might be the reason you are here. What needs to be done now is to climb up to the willingness in the attachment point of the pendulum.

In doing so, sitting at the attachment wherer willingness is high, I can guarantee you what will happen to your anxiety. I’ll tell you exaclty what will happen, and you can hold an me as a solemn promise. If you stop trying to control anxiety it will be low – or high.

I swear. And when it is low it is low until it is not low any longer. When it is high is will be high untill it becomes low again. I’m not teasing you. There just aren’t enough words for what it is like to sit at the attachment of the pendulum compared to sitting at the sinker.

These strange words are as close as I can get. I can say one thing for sure, and I guess your experience says the same thing – if you want to know for certain where you have the anxiety, there is something you can do. You only need to glide down to the sinker (were willingness is low) and follow it. And sooner or later, when it swings up the anxiety side you don’t want to be there any longer. Then you go in clinch with the pendulum and give anxiety power. It’s very predictable.

If you on the other hand again climb to the attachment where you willingly can let the pendulum swing – you can let it swing both ways! Sometimes there is anxiety, sometimes not. And in both cases you will keep out of a useless and traumatic struggle that can lead only in one direction. Sitting at the attachment of the pendulum and willingly letting it swing without an urge to control the swing (you are not getting seasick and you don’t favour one side) the unnatural unease dissapear and only the natural unease remain.

You can’t say how long it will linger, but one thing is certain - I don’t say the unease will disappear, what I say is that if you give in your attempts to manipulate your unease the degree of unease will be set by your temporary, personal history. No more, no less.

Control works in some areas of life. But not in getting rid of heavy feelings or thoughts. Acceptance and willingness on the other hand work, it’s in your hand. There is a little trap here. There is a paradox. Imagine the rule we mentioned earlier is true: " If you are not willing to have it, you have it."

What can you do with that knowledge? If you are willing to have it – for to not have it – then you really don’t want it.

Are you then willing?! You can not fool yourself.

Am a life coach and new to ACT.  (new to life coaching too actually) so I hope others can improve on this metaphor I used with a client and it blew her mind.  This is aimed at defusion of nasty thoughts about self.  Creating some distance by putting the nasty thought in the mouth of a character you know the clients will hold with some aversion.

So the thought that was expressed by the client was "that's the last thing I am is a genius".  I asked her, so if I just thought of something that might sound a little strange at first but might give you an interesting perspective would you want me to share it with you?  "Sure"  (somewhat guardedly).  

So lets pretend you are in a bar.  Is there a bar you go to frequently?  O.K., picture that one.  And you are waiting for a friend.  She texts you and tells you that she is stuck in traffic but still coming.  While you are waiting, a guy starts to notice you. You ignore but are aware that you are being noticed.  After a while he comes up to you and says "Hello my name is Clod".  You say nothing and just look at him.  Clod says, "I have been noticing you and just wanted to say, the last thing in the world you are is a genius."

What would you do?  "Tell him to get lost". Right.  That makes sense.  What a 'Clod'.  But just for fun, what options would you have in that situation?  "Well I'm certainly not going to talk to him."  Agreed, that makes total sense.  But let's just list out the options....Discussion leads to,  1)  You could talk to him.  2)  You could ask the manager to kick him out of the bar. 3) Ignore him and hope he goes away. 4) Throw a drink on him.   I then raised, well tell me if I'm wrong but it sounds to me like you didn't do any of those things.  It sounds like you went and sat down with him asked him if you could wear his school ring around your neck.  "Huh?"  Yes I mean here we were talking about something I thought was ingenius and you told me the last thing you were was a genius, sounds like you are buying into Clod pretty intensely.

In my session it did not result in a committed action step but it could be pursued, e.g.  How do you want to respond to Clod next time he comes at you with that line.  

BTW, would use the exact same scenario for a heterosexual male also.  If he is fused with the idea that he is NOT a Clod, but also fused with the idea that he is NOT a genius, then it might work just as well, have not had the chance to try.  I would just say 'What is the likelihood you would use a line like that on someone?  "Zero", right so what part of the bar room is a good analogy to your use of the term on yourself?  "It wasn't a pickup line!"  True enough, so what was it?  and where did it come from?  And what other stuff comes from that place?  For gay clients, minor tweaks.

Am interested from those more experienced where this approach might have potential downsides or how it could be improved.

Cliff Jekel

P.S. Hat tip to Russ Harris who in ACT in Context podcast episode mentioned the idea of treating these thoughts as if they came from annoying teenagers.  That's where I got the idea.

This is a metaphor I devised, because so many of my clients are too young to know much about quick sand and don’t have their licenses yet so also don’t really understand skidding on the road. It works very well when you ask the client what they know about rip currents and then draw out the analogy from the information given by them. Young surfers love this metaphor and most clients can relate to how exhausted they are by their current control efforts.  

When caught in a rip current, swimmers often intuitively swim towards the shore, unwittingly swimming directly against the rip. This is the main reason rips are so dangerous, because the strong current keeps pulling the swimmer back into the ocean, so even the strongest swimmer makes little progress, risking exhaustion and drowning. Experts advise us that a rip is ‘like a treadmill which the swimmer needs to step off’. This is done by swimming parallel to the shore until one is outside of the rip current, encouraged to aim for places where waves are breaking, which can assist one in being transported towards the shore. If the rip is too strong to allow the swimmer to swim away from it, advice is to relax and calmly float or tread water to conserve energy and wait till the rip loses its strength. Then swim leisurely in a diagonal direction away from the rip, but back to the shore.
Being caught up in a turmoil of emotions and thoughts can be very similar to a rip current. You might be able to clearly see the shore, i.e. the direction you want to take your life. Yet all your efforts just leave you exhausted, as you desperately try to fight your thoughts and feelings in order to reach your goals, almost like swimming into the rip current towards the shore. Our intuition and often the coping mechanisms we have learnt, urge us to try to get rid of thoughts and feelings as the only way to reach our goals. Yet, contrary to what you might believe, this is a very ineffective strategy. Some of the processes used in ACT therapy are counter-intuitive, asking you to go against what may feel like the right thing to do. At first some of these techniques might feel as if you are going deeper into the ocean rather than moving towards your goals. Sometimes it will be necessary to just calmly tread water and allow yourself to feel overwhelmed by your thoughts and feelings until the turmoil loses its strength. And at times you might have to make a slight course correction, swimming diagonally towards your goal rather than in a straight line. As you learn to notice what is happening in the here and now, you might be able to find the “places where waves are breaking”, the things that will aid you in getting to your goal more efficiently.
 

I'm sure you will have fun in drawing out more explicit analogies to Values, committed action and Self as context.  I just thougth I would get the idea started.

Warm regards

Esthe Davis

Here's a fun one. It's a little gross, perhaps. A client and I were talking about what minds do and I pulled the idea of using the comparison to organs. I think this is from Out of Your Mind.

Anyway, so the client says: "I get it, intestines make shit. Minds make thoughts."

We laugh and then start fooling around with the metaphor, like this: What happens if your intestines stop making shit? Not a good thing.

What happens when your intestines do make shit?

We agree that most people tend to check it out to see if things are working all right, and then they flush it.

Do your intestines make shit sometimes when you don't want them to?

Yes and sometimes won't make shit when I DO want them to.

Would it make sense to scoop your shit up, put it in your pocket, carry it around with you, and check on it all day?

Ewww, no!

So I'm thinking this is one of my more memorable Cfunc experiences.

That was a fun one. I've been laughing about it for a while.

Hope you all get a giggle too.

Joanne Steinwachs

I kept hearing ACT therapists talk about "buying" thoughts, so I took this idea to its extreme and wrote out the following, which I sometimes bring into sessions with clients:

The Store Metaphor
By Shane Knox

Let's imagine that your mind is a giant store. Since this store is your mind, you're the only customer. Oh, and you also have virtually unlimited money! All the merchandise in the store symbolize your thoughts, emotions, memories, urges, etc.—everything that goes on in your mind. Some of the merchandise you like, some you don't. Some of it seems really important to you, and other items are trivial. Some products are useful, or fun, or trendy, or unhealthy. Just like a real store, you probably have positive or negative judgments about lots of the items in the store, and others you just feel neutral about.

As a customer of this store, you don't really have direct control over what merchandise the store has for sale. But what do you have control over? Well, you decide what to buy! Your purchases will probably influence the store's future inventory. For example, if you buy lots and lots of staplers, the store will likely order more. And if they continue to sell out of staplers, the store will probably make a bigger stapler section to accommodate the apparent demand. So as customer, you do have some control over what the store sells, but it's a slow power, and there are no guarantees—it's really ultimately up to the store what's on the shelves.

So you can't control what's on the shelves, but you do get to choose what to buy. You choose what to take home with you. You likely don't like certain products, so why do you buy them? Are there any thoughts or feelings that you've “bought” that have actually made your life less rich?

What might it mean to “buy” a thought or feeling? It means you've “taken it home with you”. To “buy” a thought or feeling is to think you own it, to strongly identify with it as part of who you are. It might also mean you feel you must act on it. Or to put it another way, you believe this thought or feeling as if it's real and not just a thought or feeling. It's to mistake it as a solid object rather than just a passing experience. (Spend some time thinking about what it means to “buy” a thought or feeling, using personal examples if you can.)

It's not easy to scale back our spending and make conscientious purchases—we're often tempted by products that deliver short-term benefits at the expense of long-term well-being. We sometimes think we need something we actually don't, or get addicted to buying things in general. Even if we try to avoid the store altogether, there are bound to be reminders about what to buy in the form of advertisements and societal messages.

Ultimately, though, the “merchandise” you buy is your decision.

Thanks for sharing this Metaphor! - Comment submitted by scottpalasik on February 19, 2013.

Dear Shane,

You have really developed a well thought out and descriptive metaphor here. I can picture the store rows of items (thoughts) on a shelves as far as the eye can see (kind of like a giant Sam's Club). I particularly enjoyed the practice of "Spending some time thinking about what it means to "buy" a thought or feeling". This gets at the crux of choices and how we can change our behaviors by examining our thoughts.

This "buy in" is so important in life. I know you said we have "unlimited money", what if we didn't. How might having a limited supply of currency change the metaphor if we can only spend a certain amount on the thoughts that service us best. What thoughts would we want to own? At the same time, what thoughts do we let sit on shelves collecting dust? We can't throw them away, however we don't have to buy them either.

Thanks again,
Scott

Scott Palasik PhD, CCC - SLP
University of Akron
School of Speech-Language Pathology and Audiology

A little Acceptance thrown in too..... Comment submitted by docberf on December 4, 2014.

I've used a very similar scenario with my ACT groups that I call "The Supermarket of the Mind". Very same shopping metaphor (I usually ask who has ever shopped for groceries at a supermarket...a pretty universal experience). I then proceed to ask:

1. When you shop for groceries, do you go through and put everything that's on the shelves into your cart each week? (Resounding "No" from everyone). Why not? Usually the responses come along the lines: "Because I can't use/don't need everything." "Just buy what I need that week", etc. We usually concur that the best strategy is to buy what we can use and leave the rest on the shelves.

2. I then take it a step further and ask, "And I bet before you leave the store you stop by the manager's office to complain about all the products that were on the shelves that you can't use and demand that he not carry them any more, since that would surely make your marketing much simpler to know that the store only carried what you needed, right?" Generally, no one agrees with that and as we explore why not, we hear "Because I might need some of that stuff on other weeks" or "Just because I can't use it right now, doesn't mean I won't need it sometime" or similar ideas (which is a very nice way of introducing context and present moment awareness into the metaphor too).

3. Finally, I ask: "And in this whole scenario, guess what your mind's job is?" This will usually be a bit of a go round as we consider different "jobs" in the supermarket (manager? shopper? etc.) and try to compare it to their experience of their mind. At some point (if it hasn't been suggested by one of the group), I'll offer: Doesn't your mind work kind of like the stockperson? He/she isn't concerned with what you need or what you can use, what's good for you or bad for you this week, or even what you like or don't like. Their only job is to KEEP THE SHELVES STOCKED WITH EVERYTHING AND ANYTHING (also helping with Acceptance and Willingness to encounter products week to week that we dont like, can't use, etc. but no big deal since no one forces us to buy them).

Helping to draw the distinction between stocking the shelves and shopping from the shelves helps with a number of core processes from defusion to self-as-context (shopper vs. stocker vs. contents of my cart).

It's one of my favorite metaphors to use because everyone can relate and really have fun exploring it.

Keith Berfield
 

Here's a metaphor I've been using to describe the difference between ACT and other therapies.

What if you're on the Titanic?

Some approaches might suggest moving the deck chairs around. (laughs all around)

What would be a better approach?

Client usually comes up with the idea of steering better.

My offering to them is perhaps it would be a good idea to get off the boat completely.

My Best, Joanne

Sometimes I find it useful to see the voice in my head that constantly provides me with an analysis of the surroundings and tells me what I have to do to proceed safely (and to be right !) as one of those GPS systems you can have built into your car. A sampled voice will then give you constant advice about what to do at the next crossroads. These systems are very convenient and useful. But it's still important to keep one's eyes wide open. Some drivers ended in a river because a bridge had been suppressed and the system hadn't been updated. In the north of Europe, a truck driver got stuck in a narrow lane. For sure he was on the right way, but the road couldn't accommodate such a wide vehicle. And some accidents happen because a driver is too busy fiddling with the controls of the system and neglects to watch the road.

Of course that thought is perfectly logic and your mind tells you that it's not only a thought but the plain truth. But will doing what that thought tells you to do lead you in a direction dear to your heart ? Fiddling with the controls won't give you the answer...

I often use this metaphor with clients to convey the counterproductivity of cognitive and emotional avoidance. It is similar to the Pink Elephants metaphor but also suggests the alternatives of acceptance and willingness.

Imagine what you're doing with these (thoughts/distressing memories/feelings) is like fighting with a ball in a pool. You don't like them, you don't want them and you want them out of your life. So you try and push this ball under water and out of your consciousness. However, the ball keeps floating back to the surface, so you have to keep pushing it down or holding it under the water. This struggling with the ball keeps it close to you and is tiring and futile. If you were to let go the ball, it would pop up, float on the surface near you and you probably wouldn't like it. But if you let it float there for a while, with your hands off, it would enventually drift away and out of your life. And even if it didn't, at least you'd be better able to enjoy your swim rather than spending your time fighting!

I hope you find this is helpful.

This metaphor can be used as a vehicle for meditation/mindfulness practice or in therapeutic conversation with a client. 

Thoughts and feelings come into our awareness. They create ripples - other thoughts and feelings. We don't like "bad" thoughts and feelings, so we bat at them.

We interfere by splashing around. The droplet of (a"negative" thought or feeling) comes in and we can choose to observe it, or meddle with it. What is it like to stop splashing? To let the droplet come, the ripples happen, and let them naturally subside. 

If you have feedback, I'd love to hear your thoughts about this metaphor: anna@moodtreatmentcenter.com. Clients tend to come up with some brilliant ways of making this their own!

This metaphor resulted from my work with the owner of a small business. I found it useful with other clients too.

Picture your thoughts as sales representatives. Some of them aren't really gifted for that job. You just tell them you are not interested or you are busy right now and they will apologize for having disturbed you and never bother you again.

But then there are the tough guys. If you refuse to give them an appointment in your office, they will pop up on the parking lot when you are going back to your car or even around your house wenn you are mowing the lawn and put their open briefcase under your nose with those fantastic products they want to sell you. Your life is becoming a hassle, you need to spend more and more time trying to escape them. Instead of doing productive work, you spend most of your time at the office door trying to get rid of them. Maybe it's easier to let them in, listen to what they want to tell you, thank them for coming and let them go... After all, you are the boss : It's up to you to decide which product you'll buy.

I sometimes add: And maybe one or the other of all these products they advertise could be a good business opportunity?

I've always liked this - Comment submitted by joshua.zurba on December 14, 2017.

I've always liked this metaphor. It makes sense, the mind is trying to hook you and suck you in the same way a salesperson can. To build a bit of self-compassion, I might also say the salesperson might have good intentions (e.g. the mind telling you you should drink to get rid of your anxiety is trying to release you from feeling pain) but that maybe they're not selling the most helpful products. In later sessions you can bring this metaphor back: "There's your salesperson mind trying to sell you a thought again. If you buy this thought, how much will it cost you?" Obviously cost in this sense isn't monetary, so I love the play on words.

YouTube Video - Comment submitted by LauraAnn on October 12, 2020.

Thoughts as Sales Representatives - an Acceptance & Commitment Therapy (ACT) Metaphor

https://www.youtube.com/watch?v=SyzwCZ1fAS0&feature=youtu.be&fbclid=IwAR3my7JO4eSEIio4uvfZ90vaP3muDNHo1vh7YbaixkGnQH7yTHwwUZbMpMc

Quoted from Twohig, M. (2004). ACT for OCD: Abbreviated Treatment Manual "It’s like you’re in the process of climbing up a big mountain that has lots of dangerous places on it. My job is to watch out for you and shout out directions if I can see places you might slip or hurt yourself. But I’m not able to do this because I’m standing at the top of your mountain, looking down at you. If I’m able to help you climb your mountain, it’s because I’m on my own mountain, just across a valley. I don’t have to know anything about exactly what it feels like to climb your mountain to see where you are about to step, and what might be a better path for you to take."

These are images that may prove useful in the delivery of ACT. They are in PDF format to allow for clear and accurate printing. Individuals are free to use these in their research and practice, but please note that the images are copyright © Steven C. Hayes and are not to be used in commercial publications without written permission. The images come from multiple sources. We will upload this info a little later

This is a metaphor that grew out of working with various clients over the last couple of years and from my own reading. I was thinking of the idea in ACT that clients can get stuck in a place of "things must get better, then I'll get moving". In this sense our clients (and dare I say, often ourselves as well)get stuck on our 'buts'. Sort of like "I know where I want to go but....I have this thing....it must go away or get better before I can do X,Y,Z". So we wait for our problems to leave or change before we can go on our merry way. So much so that chances to actually move in our valued direction may be missed, life passes us by while we wait for things to improve or while we avoid our discomfort.

So before I go on anymore, here is the metaphor I came up with.

"Imagine you are going on a journey. Somewhere really special, where you really want to go, somewhere you've wanted to go your whole life. When you get to the train station you see two trains, one is a bit odd looking and strange, some of the seats look a bit hard and overall it looks a bit dirty and uncomfortable. On the next platform, there is a different train; it's a super train. It looks familiar, safe, reliable, the sort of train an accountant or an insurance sales man might prefer. The sign says it has air conditioning, a cinema, and a fancy all you can eat French restaurant that is free. You think, wow! I just have to take this train, I couldn’t possibly make my journey on that other one, no way! So you wait for this 'great' train to get ready to board and the odd looking train goes on its way. And you wait for the safe train some more and another odd train leaves the station, and another. All the while you are waiting for a chance to board this great reliable train so you can take your journey, as yet another odd looking one leaves. But here is the thing. What if the safe train can't ever board, what if it won't ever leave the station. What if you are waiting for the wrong train?"

Like most process in ACT there is no definitive right time to use this metaphor. It could be discussed like the man in the hole exercise, or I suppose it could be done more experientially, especially if your client has a clear idea of their values and can visualise stuff very clearly. However, I think what I am trying to get at is

1. You know where you want to go in life, what are you prepared to have/experience to get there?

2. If we can't ever have discomfort, where does that leave us?

3. How does waiting for the good ol' predicable train work in terms of actually moving towards our values and goals.

the metaphor was tweaked slightly after sharing it with the listserve for feedback. It was also realised by one person who gave me feedback, that the metaphor may lend it self to further tweaking. Essentially we have 2 trains, one that will help clients move forward that might be difficult and another one that they would rather wait for. It should be possible to alter the descriptions of the 2 opposing trains to better fit our clients difficulties.

So if the metaphor makes sense, if it seems to connect with some of the difficulties your clients are struggling with, then give it a go. If you do though, please feedback on how it went, what they made of it etc.

I work with children mostly between 8 and 13 years of age, many who have autism and struggle to navigate the social world - with dificulties like how to interpret and respond to others, how to frame theirs or others' communication - often they lack context from which to confidently respond and/or react to people.

I do a lot of teaching of flexibility vs. rigid thinking in social and peer situations. In my work I have shared the idea of the willow tree being strong becasue it is flexible and bends in the wind and storms, thus it's indestructable, yet the mighty oak, tall and rigid, can be brought down by a strong wind and a well-placed bolt of lightening, really not very strong ....

Lately I've added a new slant to this wisdom with a Windmill Metaphor.

Think of a windmill, tall, sleek, majestic, especially the modern ones. Not only does a windmill survive a fierce storm, but it most likely LOVES a good strong wind. In fact, the stronger the wind, the more power it generates - and this power is a completely "good power." It makes electricity that we all use, yet in a way that is gentle and does not hurt; it is soft, fluid, quiet (doesn't yell, scream, or cry) it doesn't damage the enviornment or pollute (doesn't punch, kick, or hit ) --- all the windmill needs is the most natural of all elements, the limitless wind (no resistance, only acceptance).

I use the windmill metaphor when working with kids who are being picked on or when they don't know how to respond to someone being mean or nasty. Of course, we all know violence isn't the answer, in fact in the ACT playbook, that which you resist only becomes stronger (think: inner monster/demon or our internal or external tug of war, right?)

In order to beat the monster, one must lay down the rope and stop pulling.

• I feel the windmill image goes a step further: Put down the rope, stop fighting/resisting, and be like a windmill.

The windmill metaphor asks: "How can you use that graceful and limitless energy to give yourself the might and power you need?" In fact, I have come up with an acronym for this:

"WWAWD"? 

Kids like this imagery and they have no problem with the concept. It's simple, we all love windmills, they thrive off of the mightiest winds (bullies, mean people), yet just like a willow tree, they offer up no resistance. In fact, a windmill drawing session could also be easy to produce, drawing with the client a series of windmills while envisioning the quiet and confident power they hold for us.

- They just turn, and turn, and turn -

- Graceful, with no extra effort -

- Soft and yeilding, yet tall and strong -

I've found this metaphor useful in values work and as a defusion exercise. Janet Wingrove's feedback (thank you Janet!) helped me to improve the wording.

Picture your life as a movie. The first episodes are already shot. (Here I usually summarize what I know of the – usually difficult – salient moments of the clients life). Now the movie is going on. Imagine you are the director and you can direct an actor that plays your part. But you're a special kind of director with a limited power. You can't go to the screenplay writer and ask him to change the life events happening to you or direct the other characters to act like you'd want them to do. The only actor you can have an influence on is the one playing your part. You can have him/her play exactly like the person you dream to be. Figure out how you would want him/her to act, in that precise situation you are experiencing now. How would you instruct the actor to act if you want the continuation of the movie to resemble what you would like your life to be, or to show the father / spouse / colleague / etc. you would like to be?

This metaphor has multiple sources.

(1) Doing values work with clients, I tried the tombstone exercise and the funeral exercise and had the feeling they didn't really ring a bell. It seemed to me that people understood them as one more appeal to pliance, to being a «good boy» or «good girl».

(2) I found an idea of Dan Millman interesting : «When I refer to practicing "everyday enlightenment," I'm speaking about actually consciously asking, "How would an enlightened being act in this moment?"—and then acting that way.»

(3) Alexandre Jollien is affected by a severe form of cerebral palsy due to birth damage and had to face the trauma of being separated from his parents at the age of 3 and raised in a faciltiy for disabled children. He finally made it to a degree in philosophy and published two books the title of which can be translated as «In praise of weakness» and «The trade of becoming a human being». He's now married and father of a young child. He explains in his crippled voice how the ancient greek philosophers have taught him that one could sculpt one's life in order to do a work of art out of it.

(4) This connected with Viktor Frankl's suggestion to think of ourselves as those who were being questioned by life - daily and hourly. And with the bus driver metaphor, each question of life being a new crossroad, a new opportunitiy to drive the bus in a valued direction. The reels of the past episodes come with us. I remember Frankl said that, in a novel or in a movie, it is sometimes what happens at the very end that gives a new meaning to the whole story.

The recalling of this metaphor in some difficult situations sometimes helped me to defuse of some tricky contents and to steer the course dear to me. I had the feeling it was less felt as pliance inducing by clients as the funeral and tombstone exercises. They sometimes answered to it with statements like «I would want him (her) to stay cool, to think positively etc.» which set the occasion for one more round of creative hopelessness work.

What I'm mainly afraid of is that the metaphor could be fueling self-accusations in all the cases where the passengers succeed in having the bus driven in the direction they want life to proceed.

I'm still interested in and grateful for any feedback

ACT for the Public - Free Videos: Learning About and Applying ACT

• Chessboard
• Demons on the Boat (Joe Oliver)
• Passengers on the Bus (Oliver, Christodoulou, & Whitfield)
• Tug of war with a Monster (Louise Gardner - Your ACT Auntie Series)
• The Unwanted Party Guest (Joe Oliver)
• New animation of the Chessboard metaphor (Russ Harris)

More Videos

• Les Passagers du Bus | Choisissez l'aventure qui est la vôtre: https://www.youtube.com/watch?v=TYjIYp-46zc

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ACT for ALL is an ongoing effort to develop and share online resources for professionals from diverse nations to learn about ACT and to learn about adapting its application for various cultural contexts. With the support of the ACBS Developing Nations Committee and the Training Committee, ACT for ALL resources are developed through collaborations between volunteer peer reviewed ACT trainers (PRTs) and valued professionals from low and middle income countries (LAMIC). 

There is more information about the development of this effort through the document attached below.
 

Values conversation with Fady Safwat and Jenna LeJeune (Recorded May 2023)

Fady Safwat and Jenna LeJeune just completed a collaboration video about values for the ACT for All (Peer-Reviewed Trainer and LAMIC Practitioner) Project. This is a recorded conversation between Fady and Jenna about how they view values and work with values in their various contexts, in the U.S. and in Egypt. We hope listening to this conversation will give ACBS members some ideas about working with values in different cultural contexts.

Welcome to the LAMIC Resource page for ACT. This page is aimed at practitioners from Low-and-Middle-Income-Countries (LAMIC) who are new to Acceptance and Commitment Therapy (ACT) and would like to learn more. It is our hope that this page supports your own committed action to learn and makes the content more accessible for you.

ACT is pronounced as one word (not as an acronym) and has a very ACTive community. This means that new evidence, content, and resources are constantly being created. If you are looking for something that is not available on this page or have an idea of something that can be added please let us know.

We have tried our best to indicate whether each resource below applies to beginners or more intermediate practitioners. However, we recommend that you remain flexible and use the resources that are useful and meaningful for you and your context.

You will need to login as a member to see many of the linked resources, but some are available freely to the public (free resources are designated by 3 asterisks***). If you are interested in ACBS Membership you will find more information, including our values-based dues here.  ACBS offers a number of membership scholarships - you can apply for a scholarship here.

Community
If you are seeking community to support your growth and learning, then please click this link https://contextualscience.org/chapters/sigs/affiliates
and explore the global ACT chapters and affiliates. If you would like to start with some self-directed learning, then please check out the resources below.

Books
Books for the beginner. These books are a useful ‘first look’ into ACT and how it can be applied. These are also readings that can be given to clients/patients/the general public who are seeking to know more and understand how to apply ACT to their lives.

• The Happiness Trap (Dr Russ Harris). Is a book that covers the basics and gives experiential exercises and is written for those with no training in mental health.***
• A Liberated Mind (Dr Steve Hayes), How to Pivot towards what matters. A self-directed learning book with a greater emphasis on explaining the more technical terms of ACT.***

Books for the beginner: technical stuff
The books below are useful for the practitioner who would like to start actively using ACT in their own professional space. They provide an insight into the theoretical foundations of the model and how it is applied in a real-world context:

• ACT Made Simple: An Easy-to-Read Primer on Acceptance and Commitment Therapy (Russ Harris). This book is aimed at newcomers but useful to experienced practitioners too. It offers a clear introduction to the 6 core processes and guidance on how to apply these with clients.***
• Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists (Jason B. Luoma, Robyn D. Walser, and Steven C. Hayes). This book has a skills-training focus. The authors recommend reading once you are familiar with some of the basic metaphors and processes of ACT.***

Once you have some ideas about specific things to try using ACT, feel free to use them yourself daily… this is by far the best way to really get the hang of the six processes and associated tools and techniques.

Articles
There are more that you might find interesting (and in other languages) so check out the full Publications list.

• Hayes, S. C. (2004). Behavior Therapy, 35, 639-665.
• Hayes, S. C. (2004). Acceptance and Commitment Therapy and the new behavior therapies: Mindfulness, acceptance and relationship. In S. C. Hayes, V. M. Follette, & M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 1-29). New York: Guilford.
• Hayes, S. C. (2000). Acceptance and Commitment Therapy in the treatment of experiential avoidance disorders.
• Hayes, S. C., Luoma, J., Bond, F., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

You will find a list of studies in low and middle income countries here.

Videos
There are many video presentations, examples & trainings available to the beginner practitioner. The list below aims to serve as a starting point, if your passion for ACT is ignited, we hope you continue to explore as more videos are created and shared throughout the ACBS community.

• Louise Gardner - Your ACT Auntie Series (ACT and Mindful Moments Videos)***
• Janina Scarlet, Yonatan Sobin - Superhero Therapy: Using Pop Culture to Strengthen Acceptance and Commitment Therapy
• Dr. Russ Harris - About ACT in simple terms***
• Tom Lavin - New Skills for Living - Experts on using ACT in daily life***
• Hank Robb - Being Where You Are and Doing What's Important***
• Louise Hayes - How we can use CBS to help humanity
• Robert Whelan - Thinking Big (Data) For Contextual Behavioral Science
• Rachel Collis - Why 21st Century Leaders Often Feel In Over Their Heads and How Psychological Flexibility Can Help
• Pam Katz - Creative Metaphors in ACT
• Luoma, Walser and Hayes - Learning ACT - Skills and Comptencies for Clinicians***
• Daniel J. Moran, Patricia Bach, Sonja V. Batten - Committed Action in Practice: Blending Evidence-Based Interventions into the ACT Model
• Interview with Steve Hayes - ACT, RFT and their clinical applications (subtitles in Portuguese - Rolê Contextual Entrevista - Steven Hayes - ACT, RFT e suas aplicações clínicas)
   

If you are familiar with ACT already and are looking for some more intermediate videos to explore then try these:

• Stefan G. Hofmann - An Individual Complex Network Approach to Intervention Science
• Paul Atkins, Gareth Holman, Benjamin Schoendorff - Meaning and Resilience In Our Organizational and Community Work
• Dr. Peitao Zhu - Cultural Humility in Counseling and Clinical Supervision
• Maggie McCulloch, RSW - ACT for Psychosis: Supporting individuals and their families
• Jane Morton, MA - Wise Choices: ACT for people with symptoms of Borderline Personality Disorder

Online courses
You can search for online courses in the ACBS Community Events Calendar. There are many online courses out there…. Please reach out to the DNC (Developing Nations Committee) who may be able to provide some low cost / no cost options to you.  

Podcasts
If you are looking for content you can listen to, there are a number of podcasts available. Browse the podcast links below to listen to insights from the leaders in our field.

John Dehlin & Jennifer Plumb - An introduction to ACT Part 1***

John Dehlin & Jennifer Plumb - An introduction to ACT Part 2***

Steven Hayes - The History and Development of ACT with Steven Hayes***

Sonja Batton - An Introduction to Acceptance with Sonja Batten***

Russ Harris - An Introduction to Defusion with Russ Harris***

Matthieu Villatte - An Introduction to Self-As-Context with Matthieu Villatte***

Kelly Wilson - An Introduction to Contacting the Present Moment with Kelly Wilson***

Joanne Dahl - An Introduction to Values with Joanne Dahl***

DJ Moran - An Introduction to Committed ACTion with Daniel J. Moran***

Robyn Walser - ACT for Coping with Trauma and PTSD with Robyn Walser***

Louise Hayes - ACT with Adolescents with Dr. Louise Hayes***

Worksheets & in-practice resources
For the practitioner who is already applying ACT or would like to start using it in a real-world setting. Below are some resources you can use to support these processes. Worksheets and handouts are a great way to facilitate Committed Action.

ACT Handouts***

Joseph Ciarrochi - Choice Point Model

Russ Harris - Handouts from Introductory and Advanced ACT Workshops

Protocols
Protocols are usually developed for research purposes and are useful in that context. They are not an essential part of ACT therapy; this is because ACT is designed to be flexibly applied and is not a rigid set of techniques. However, for the beginner practitioner protocols can be a useful starting point. They give an “inside-look” into the structure of a session and an unfolding of the process. Protocols can also be useful to explore how ACT can be tailored to a specific problem or client presentation. If you think protocols may be a useful resource for you and your work then please use the link below to explore.

https://contextualscience.org/treatment_protocols

Welcome to the LAMIC Resource page for Focused Acceptance Commitment Therapy (FACT). FACT is a brief therapy that uses principles of ACT in a highly condensed version.

The strategies employed in FACT are delivered in fewer sessions when compared to traditional psychotherapies without compromising on the outcome. FACT is very useful in settings where time and resource-limitations are a limiting factor, it has been used in many different medical settings around the world.

This page is aimed at practitioners from Low-and-Middle-Income-Countries (LAMIC) who are new to FACT and would like to learn more and use it in their community. It is our hope that this page supports your own committed action to learn and makes the content more accessible for you.

You will need to login as a member to see many of the linked resources, but some are available freely to the public (free resources are designated by 3 asterisks***). If you are interested in ACBS Membership you will find more information, including our values-based dues here. ACBS offers a number of membership scholarships - you can apply for a scholarship here.

The following resources will aid you in learning more about FACT:

Books

• Strosahl, K., Robinson, P., & Gustavsson, T. (2012). Brief interventions for radical change: Principles and practice of focused acceptance and commitment therapy. New Harbinger Publications.***

Online courses
Several private providers run online courses and discounts are available for colleagues from LAMIC.

• Focused ACT for Brief Interventions by Kirk Strosahl and Patti Robinson. 6 weeks online course with evergreen access after enrolment. Some discount available for LAMIC, you would need to contact Patti Robinson for this.
• ACT as a brief intervention by Russ Harris. 6 weeks online course. Free courses are available for LAMIC participants, contact the chair of DNC for access.

Videos
There are only a couple of video presentations of FACT for the beginner practitioner. We are in the process of creating more, so please check this site regularly.

• ACT as a Brief Intervention: Clinical Training Workshop with Kirk Strosahl (Workshop Recording); 2011.
• FACT by Bruce Arroll (Video playlist); last uploaded 2017.***
• FACT by David Bauman (Video playlist); ongoing videos.***

Articles
As FACT is relatively new, the research base is still growing. Here are a couple of quality articles as a starting point.

• Monia Barreto, et al. (2019). A Single-Session of Acceptance and Commitment Therapy for Health-Related behavior change: An Open Trial with a nonconcurrent matched comparison group. Journal of Contextual Behavioral Science, https://doi.org/10.1016/j.jcbs.2019.06.003
• Heidi Maria Kyllönen, et al. (2018). A brief Acceptance and Commitment Therapy intervention for depression: a randomized controlled trial with 3-year follow-up for the intervention group. Journal of Contextual Behavioral Science, https://doi.org/10.1016/j.jcbs.2018.08.009

Welcome to the LAMIC Resource page for RFT. This page is aimed at practitioners from Low-and-Middle-Income-Countries (LAMIC) who are new to Relational Frame Theory (RFT) and would like to learn more. It is our hope that this page supports your learning journey and makes the content more accessible for you. 

For more information about Self-Help Plus (SH+) and "Doing What Matters in Times of Stress" click here.

SELF-HELP PLUS (SH+) (2021)
A group-based stress management course for adults (World Health Organization)
https://www.who.int/publications/i/item/9789240035119

Overview
Self-Help Plus (SH+) is WHO’s 5-session stress management course for large groups of up to 30 people. It is delivered by supervised, non-specialist facilitators who complete a short training course and use pre-recorded audio and an illustrated guide (Doing What Matters in Times of Stress) to teach stress management skills. The course is suitable for adults who experiences stress, wherever they live and whatever their circumstances. It has been shown to reduce psychological distress and prevent the onset of mental disorders. The format of SH+ makes it well-suited for use alongside other mental health interventions, as a first step in a step.

Available in English, Arabic, Juba Arabic, French, Portuguese, Spanish, Turkish, Ukrainian.

Doing What Matters in Times of Stress (2020)
An Illustrated Guide
https://www.who.int/publications/i/item/9789240003927
https://iris.who.int/handle/10665/331901

Overview
Doing What Matters in Times of Stress: An Illustrated Guide is a stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques. The guide can be used alone or with the accompanying audio exercises.
Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.

Available in Arabic, Armenian, Chinese, Czech, Dari, English, Estonian, Farsi/Persian, Finnish, French, German, Georgian, Greek, Hungarian, Indonesian, Italian, Japanese, Juba Arabic, Korean, Lithuanian, Malay, Polish, Portuguese, Romanian, Russian, Slovak, Spanish, Swedish, Tigrinya, Tongan, Turkish, Ukrainian, Urdu, Vietnamese.

How to Use WHO Self-help Plus Protocol
Webinar presented by Russ Harris and Claudette Foley
April 13, 2022
https://contextualscience.org/video/how_to_use_who_selfhelp_plus_protocol_webinar

Overview
This is a webinar on WHO's ACT protocol for refugees. We will answer Frequently Asked Questions about the protocol–also known as “Self-help Plus”-and explore how to implement it.

from 

Wilson, K. G. (2006). The Heart of Acceptance and Commitment Therapy. 

Wilson, K. G. (May, 2007) The hexaflex diagnostic: A fully dimensional approach to assessment, treatment, and case conceptualization. Presidential address presented at the annual convention of the Association for Contextual Behavioral Science, Houston, TX. 

Empirical clinical psychology has largely been focused on measurement of the frequency and severity of various signs and symptoms and the treatment of psychological syndromes defined by clusters of signs and symptoms (DSM disorders for the most part). These syndromes have increasingly organized clinical psychology in spite of much criticism. It is imperative for us to understand that this is not as trivial as would be yet another theory of psychopathology. In such an instance, the presence of the theory might organize the activities of a relatively small group of individuals who share the area of research interest. Supposedly atheoretical syndromal classification, as seen in the DSM, has had a much more far reaching impact. Our central federal funding agency, the National Institutes of Mental Health, is organized around these categories, as are our abnormal psychology textbooks, journals, assessment instruments, and reimbursement for professional services. Such hegemony is wholly unwarranted based upon available evidence. Concerns about syndromal classification of psychological problems has been around for a good long time. However, only recently has dawn begun to break within the DSM effort. 

The failure of syndromal classification carries with it a call for alternatives. At the University of Mississippi Center for Contextual Psychology and Acceptance and Commitment Therapy Treatment Development Group, we are exploring an alternative approach. Based on the idea that multiple systems of classification ought to compete with the gold standard being the treatment utility of the system of problem classification, we are currently pursuing the development and testing of the hexaflex model as the kernel of a fully dimensional diagnostic system within which there exists close linkage between diagnosis, assessment, and intervention. 

Posted below are 1) slides from the plenary session in which the Hexaflex Diagnostic was presented at the ACT Summer Institute and 2) draft versions of clinician worksheets designed to facilitate use of the hexaflex model in this way. Please feel free to offer any feedback you might have as to the utility of the model and tools presented here. Send feedback to Kelly Wilson at kwilson@olemiss.edu These documents are extracted from a book in progress "The Heart of ACT," please copy and use at will for clinical practice and research. Distribute only with express consent of the author. 

peace all, 

Kelly

Attached is a simple, user-friendly 9-box case conceptualization grid from a functional contextual perspective.  The top row emphasizes the situational/historical context of the presenting problem(s); the middle row allows for a basic functional analysis of unworkable behaviors (taking into account the contextual variables identified in the top row); and the bottom row emphasizes values/process-directed treatment planning.

I. Context for case formulation

The goal of ACT is to help clients consistently choose to act effectively (concrete behaviors in alignment with their values) in the presence of difficult or interfering private events.

II. Assessment and Treatment Decision Tree

Beginning with the target problem, as specified by the client or significant others, refine these complaints and concerns into functional response classes that are sensitive to an ACT formulation and to the client's contextual circumstances, and link treatment components to that analysis

A. Consider general behavioral themes and patterns, client history, current life context, and in session behavior that might bear on the functional interpretation of specific targets in ACT terms. These may include:

1. General level of experiential avoidance (core unacceptable emotions, thoughts, memories, etc.; what are the consequences of having such experiences that the client is unwilling to risk)
2. Level of overt behavioral avoidance displayed (what parts of life has the client dropped out of)
3. Level of internally based emotional control strategies (i.e., negative distraction, negative self instruction, excessive self monitoring, dissociation, etc)
4. Level of external emotional control strategies (drinking, drug taking, smoking, self-mutilation, etc.)
5. Loss of life direction (general lack of values; areas of life the patient "checked out" of such as marriage, family, self care, spiritual)
6. Fusion with evaluating thoughts and conceptual categories (domination of "right and wrong" even when that is harmful; high levels of reason-giving; unusual importance of "understanding," etc.)

B. Consider the possible functions of these targets and their treatment implications.

1. Is this target linked to specific application of the tendencies listed under "A" above
2. If so, what are the specific content domains and dimensions of avoided private events, feared consequences of experiencing avoided private events, fused thoughts, reasons and explanations, and feared consequences of defusing from literally held thoughts or rules
3. If so, in what other behavioral domains are these same functions seen?
4. Are there other, more direct, functions that are also involved (e.g., social support, financial consequences)
5. Given the functions that are identified, what are the relative potential contributions of:

a. generating creative hopelessness (client still resistant to unworkable nature of change agenda)
b. understanding that excessive attempts at control are the problem (client does not understand experientially the paradoxical effects of control)
c. experiential contact with the non-toxic nature of private events through acceptance and exposure (client is unable to separate self from reactions, memories, unpleasant thoughts)
d. developing willingness (client is afraid to change behavior because of beliefs about the consequences of facing feared events)
e. engaging in committed action based in values (client has no substantial life plan and needs help to rediscover a value based way of living)

C. Consider the factors that may be perpetuating the use of unworkable change strategies and their treatment implications

1. Client's history of rule following and being right
(if this is an issue, consider confronting reason giving through defusion strategies; pit being right versus cost to vitality; consider need for self-as-context and mindfulness work to reduce attachment to a conceptualized self)
2. Level of conviction in the ultimate workability of such strategies
(if this is an issue, consider the need to undermine the improperly targeted change agenda, i.e., creative hopelessness)
3. Belief that change is not possible
(if this is an issue, consider defusion strategies; revisit cost of not trying; arrange behavioral experiments)
4. Fear of the consequence of change
(if this is an issue, consider acceptance, exposure, defusion)
5. Short term effect of ultimately unworkable change strategies is positive
(if this is an issue, consider values work)

D. Consider general client strengths and weaknesses, and current client context

1. Social, financial, and vocational resources available to mobilize in treatment
2. Life skills (if this is an issue, consider those that may need to be addressed through first order change efforts such as relaxation, social skills, time management, personal problem solving)

E. Consider motivation to change and factors that might negatively impact it

1. The "cost" of target behaviors in terms of daily functioning (if this is low or not properly contacted, consider paradox, exposure, evocative exercises before work that assume significant personal motivation)
2. Experience in the unworkability of improperly focused change efforts (if this is low, move directly to diary assessment of the workability of struggle, to experiments designed to test that, or if this does not work, to referral)
3. Clarity and importance of valued ends that are not being achieved due to functional target behavior, and their place in the client's larger set of values (if this is low, as it often is, consider values clarification. If it is necessary to the process of treatment itself, consider putting values clarification earlier in the treatment).
4. Strength and importance of therapeutic relationship (if not positive, attempt to develop, e.g., through use of self disclosure; if positive, consider integrating ACT change steps with direct support and feedback in session)

F. Consider positive behavior change factors

1. Level of insight and recognition (if insight is facilitative, move through or over early stages to more experiential stages; if it is not facilitative, consider confronting reason giving through defusion strategies; pit being right versus cost to vitality; consider need for self-as-context and mindfulness work to reduce attachment to a conceptualized self)
2. Past experience in solving similar problems (if they are positive and safe from an ACT perspective, consider moving directly to change efforts that are overtly modeled after previous successes)
3. Previous exposure to mindfulness/spirituality concepts (if they are positive and safe from an ACT perspective, consider linking these experiences to change efforts; if they are weak or unsafe - such as confusing spirituality with dogma - consider building self-as-context and mindfulness skills)

III. Building interventions into life change and transformation strategy

A. Set specific goals in accord with general values

B. Take actions and contact barriers

C. Dissolve barriers through acceptance and defusion

D. Repeat and generalize in various domains

An external website also has an outline of a case formulation framework (based on the chapter in the Practical Guide to ACT) along with a form for therapists to use to complete the process (http://www.drluoma.com/actresources.html).

ACT ADVISOR 

ACT ADVISOR is a hexaflex-based self-report measure of psychological flexibility, its name being an acronym for the hexaflex processes (Acceptance; Commitment & Taking action; Attention to present; Defusion; Values Identification; Self as Observer; and Resulting psychological flexibility). It may be used both in case formulation and in tracking progress during therapy.

On being presented with this “double hexaflex” diagram, users are asked to choose where they would place themselves on the six different scales representing these core ACT processes, each with “opposite” statements at either end. Scoring is simply a matter of recording the user’s numerical responses and totalling them to give their Resulting psychological flexibility score. If ACT ADVISOR is administered repeatedly, scores can be tracked using the charts provided.

The idea for using the hexaflex as a diagnostic/ case formulation tool was, I believe, originally Kelly Wilson's and his materials (see The Hexaflex Dimensional Approach to Diagnostics) influenced the development of this instrument. Steve Hayes made helpful suggestions about the anchor statements for each process in earlier drafts, and I am also grateful for the ACT listserv community’s interest and input.

ACT ADVISOR statement rating form offers an alternative format. In this version users are asked to rate 12 statements independently of each other and without the possible steer of the double hexaflex diagram. Instructions for scoring this version are provided separately, with the Resulting psychological flexibility score here being converted to a percentage. 

ACBS members login their account and then click here to download the ACT ADVISOR and related documents.

Submitted by David Chantry

Psyflex Planning Tool from Hayes, Strosahl, & Wilson

The ACT daily diary and weekly report (see attachments below) can be clinically useful in monitoring progress.

This brief questionnaire was designed to quickly assess skills related to psychological flexibility: awareness (of here-and-now experience), openness (to private events), engagement (in valued actions), and perspective-taking (of self/other). It can be freely used as a clinical assessment tool and for treatment planning purposes.

All feedback is welcomed!

Please log in as a ACBS member, and click the attachment link below in order to download the Behavioral Health Progress Note Template.

This tool will allow you to see if you have made a significant difference in your clients life. It looks at two outcome scores (e.g. pre vrs post). It will tell you:

1) If there was significant change from Time 1 to Time 2

2) if the symptoms have reduced to a point that you would consider the client symptoms to be no worse than what you would find in a normal population

The tool allows you to look at a wide variety of outcome measures, such as the beck depression inventory, trait anxiety scale of the STAI, and many others You can also print out a report for your client file. Simply complete name and date and then print the first page of the spreadsheet.

I hope you find this useful best Joseph

This brief clinical instrument was designed for use in follow-up sessions to assess skills related to the three pillars of psychological flexibility (openness, awareness, engagement), as well as key features of the therapeutic alliance (consistent with ACT and evidence-based), while evoking consideration of a goal for the current session, and a space for progress notes.  Please use freely, and feedback is always welcomed.

The following worksheet, titled "Getting to Know Your Mind," is an attempt to create an ACT-consistent "thought record" that can assist the client in practicing defusion after they leave the therapy session. ACT clinicians typically engage their clients in defusion work by encouraging them to relate to their thoughts in a variety of ways while emphasizing the automatic nature of thoughts, the harmful effects of avoiding or struggling with thoughts, the subtle experiential differences between fusion and defusion, and using workability/usefulness to measure whether or not a thought should be "used" or bought into. This is a lot for clients to remember and by its very nature can be difficult to grasp after just an hour-long therapy session. The hope is that this form can function as a boiled down, concrete version of defusion work seen in the therapy room and assist the client in making defusion a well-practiced part of their repertoire.

I made some adaptations to the Bull's Eye exercise for my own clinical use - this seemed to suit my purposes well.

This article introduces the Process Based Progress Note (PBPN), a newly developed tool aimed at enhancing documentation in therapy by focusing on a process-oriented approach. The PBPN was created to address the limitations of traditional note formats, such as SOAP and DAP, which often became repetitive, time-consuming, and insufficient for capturing trends at a glance, particularly with the integration of Acceptance and Commitment Therapy (ACT).

The development of the PBPN was influenced by various therapeutic approaches, including Solution Focused Brief Therapy, ACT Immersion course, and Focused Acceptance and Commitment Therapy (fACT). The tool incorporates key measurements of psychological flexibility—openness, awareness, and engagement—culminating in the total Hexaflex Assessment score. This score provides a comprehensive overview of an individual's progress, with scores greater than 24 indicating potential readiness for discharge.

The PBPN also integrates elements from traditional behavioral notes and the Extended Evolutionary Meta Model, making it a comprehensive Process-Based Therapeutic (PBT) tool. It serves as a valuable resource for therapists, providing clear documentation of session content and progress, while also acting as a learning tool for clinicians and interns.

The article outlines the historical development of the PBPN, emphasizing its practicality and effectiveness in improving therapeutic implementation of ACT. The PBPN has been adopted as a standard template and has received positive feedback from interns, supervisees, and colleagues.

The main goal of this paper is to introduce and an overview of the PBPN and its benefits while inviting feedback and suggestions for further improvement. For more information or to request the outline, contact todd@toddschmenk.com.

(The webpage was last updated on June 19, 2024)

Attached, please find a copy of self-monitoring forms I use with a wide range of patients. I direct patients to monitor those self-care behaviors relevant to their treatment (hygiene, eating, going to sleep at reasonable hour, exercise, meditation/centering, alcohol use). There is ample room for adding other behaviors or to permit some journaling/notes. *I recently replaced the GIF formatted forms with forms converted to PDF format (using free PDF writer at www.gohtm.com).

Experimental tests to date:

None Published

For further information contact: Amy Murrell or Kelly Wilson.

Author's note: We are posting this protocol in the hope that they will provide useful information in helping clients and spark further interest and research in ACT with children and adolescents. Please, recognize that we consider the treatment technology to be evolving in nature. These protocols, therefore, should be viewed as works in progress. The underlying principles should be adhered to, but the protocols can (and indeed should) be used with flexibility.

The protocol is attached to this page.  Log into your ACBS member account to view/download the file.

An ACT protocol designed for use with agoraphobia. Experimental tests to date: Hayes, S. C., Wilson, K. G., Afari, N., & McCurry, S. (November 1990). The use of Acceptance and Commitment therapy in the treatment of agoraphobia. Paper presented at meeting of the Association for the Advancement of Behavior Therapy, San Francisco. This is a very early anxiety protocol, written about 18 years ago. There has been a lot of work since on ACT for anxiety and though it is still recognizably the same kind of protocol, it has gotten better as we've gone along. For an excellent and detailed ACT anxiety protocol see the book by Eifert and Forsyth, 2005. Acceptance and Commitment Therapy for anxiety disorders. Oakland: New Harbinger. For further information contact: Steve Hayes (hayes@unr.edu), Department of Psychology, University of Nevada, Reno, NV 89557-0062.

ACT For Life Intervention

The intervention consists of four, two-hour weekly group sessions. The intervention is based principally around the “Passenger on the Bus” metaphor (Hayes, Strosahl, & Wilson, 1999), which is used to provide a consistent narrative thread throughout the groups. We use the metaphor to explore issues of workability, fusion, mindfulness, values and committed action in each of the sessions. We emphasise choice around participation, saying from the outset that, we would like people to participate as much as possible but it is an equally valid option to sit out of exercises. However, we generally find participants enjoy the interactive aspects of the group and often comment afterwards that the role playing is often one of the more memorable aspects of the group.

From the first group, we ask participants to be setting values goals that they can work towards throughout the week. However, we are careful to emphasise process goals here rather than outcome goals. As such, we frame this as an opportunity for participants to notice “passengers” or obstacles that arise as they approach the activity, and if the activity is completed, this is simply an added bonus.

We use PowerPoint presentations to make the groups more interactive and provide further structure to the groups. We have found this particularly useful in working with younger clients. The video vignette of the story of Tom can be downloaded from here: https://dl.dropbox.com/u/20036241/Tom_vignette_ACT_for_Life_groups.avi

The groups are designed to for approximately 8-10 participants. In each group we would have two to three therapists working with the group.

Each session follows a similar structure, which includes:
1. Warm-up exercise
2. Noticing (mindfulness exercise)
3. Discussion of the out of session activity from the previous week
4. Group discussion/ activity
5. Planning out of session activity

Thank you to everyone who has expressed interest in the toolkit. In order to effectively distribute the most up-to-date version of the toolkit, we have created a website for you and your clients to access:

https://www.helpwithact.com/ 

The toolkit compiles information from around the web for psychoeducational and therapeutic use with clients. It also includes several exercises and worksheets designed by the creators. The website hosts the client version, and a Clinician Guide can be found here: http://www.helpwithact.com/toolkit

A training video of the creators reviewing the toolkit and how to use it can be accessed here: https://www.youtube.com/watch?v=Hu3f6UpUZJw

Please contact the creators with any questions or feedback.

This toolkit compiles information from around the web for psychoeducational and therapeutic use with clients. It also includes several exercises and worksheets designed by the creators. Please contact the creators with any questions or feedback.

The file can be accessed in its current form here:

https://docs.google.com/document/d/1hr3jsIE4RiiMPzY0EUIBxGyw-BwKI8r_pEcmmrALd7E/edit?usp=sharing

This ACT for Kids manual was developed by Steven Gordon, Michael Asher, and Michael Selbst.

Please note: due to copyright laws, ACBS removed images from the document. Therefore, some of the formatting might be slightly off. 

This protocol was developed by Lindsay Fletcher at the University of Nevada, Reno. This protocol was developed by Lindsay Fletcher at the University of Nevada, Reno. Contact Lindsay for more information.

I work in the Birches Program at the Brattleboro Retreat in Southern Vermont, a Partial Hospitalization/Intensive Outpatient Program (PHP/IOP). Participants usually stay in our program four to six weeks. I have developed a set of a dozen ACT-based groups that are inter-related and mutally supportive. Themes of: mindfulness; compassion; matrix; defusion; acceptance; anger; assertiveness; self-care; healthy relationships; finding motivation; values and action. Partcipants also have daily check-in groups that are more freely structured. I facilitate these themes on a rotating basis. I don't recommend them as stand-alone processes.  I got most of the practices and metaphors from ACT trainings and books; if there is anything original, it's how I've sequenced things (and how I interact with the participants, with humor and on equal footing). I hope you will find these write-ups helpful.

Charlie Laurel, MS, LCMHC

Attached is a more developed version of the Togus one-week protocol. Kevin Polk presented the sketch of this at ACT SI III. Dr. Hambright has developed it further. Email Kevin if you have questions. polkkev@gmail.com.

Click here for the newest version of the protocol

Additional materials are routinely updated on Kevin Polk's blog

This is a 6-session group programme designed for use in in a secure hospital setting, although the content could be used and adapted for other settings.  It was written in response to the fact that many service users who are mandated to stay in hospital rapidly put on weight as a consequence of various factors including leading a sedentary lifestyle, prescribed medication, lack of control over hospital food choices, and comfort eating.  Whilst there is often very good advice available about healthy eating and exercise, many service users seemingly choose not to follow this advice.  We hypotheseised that this may be due to remoteness from values, and/or patterns of cognitive fusion and experiential avoidance.  The resulting programme represents an attempt to draw attention to these processes in the service of making choices that were more mindful and more value-driven.

I would like to acknowledge the 'Obesity Stigma and Weight Management Acceptance and Commitment Therapy Treatment Manual', which is a one-day workshop protocol developed by Jason Lillis, Steven Hayes, and Kara Bunting.  This is also available on the ACBS website and was a big part of the inspiration for our work.

Please contact Richard Bennett via info@thinkpsychology.co for more information.
 

The World Health Organization (WHO) decided around 2015 to test ACT as a fully scalable psychological intervention. Dr. Mark van Ommeren, head of Mental Health, was looking for a radically transdiagnostic approach that could help with the wide variety of mental and behavioral consequences of war. The breadth of outcomes across different problems areas world wide for ACT attracted his attention. The war in the South Sudan was a particular issue at the time and Van Ommeren was aware that ACT had been deployed in Sierra Leone by the "Commit and ACT" clinic in Bo. ACT was proving helpful in the ebola outbreak there. Dr. Ommeren consulted with leaders of the ACT community (including Steve Hayes), asking for ideas of how best to simplify ACT and was referred to the work of Russ Harris. Van Ommeren was especially impressed with the simplicity of Russ Harris Illustrated Happiness Trap and Russ agreed to work with the WHO team to produce what became Doing What Matters in Times of Stress ("DWM"; 2020) -- an illustrated guide to ACT ideas stated in very non-technical language with graphical images.

WHO does not distribute health care advice until it is rigorously tested in a series of high quality randomized trials, beginning with very careful pilot work. These evaluation studies are deliberately conducted with developers held at arms length. If the methods are helpful they are then distributed for free. At the time, WHO had no fully scalable psychological interventions in its portfolio that could be distributed without the involvment of highly trained professionals. Over a period of 4-5 years ACT self-help was tested both in the simplest way (distributing the book, wih some minimal addition supports) and with the lessons in the book being described in audiotapes and discussed in a small group format by non-specialists in a program called "Self-Help +" ("SH+"; Brown et al., 2018; Tol et al., 2018).

ACT self-help successfully passed through these tests of efficacy across a range of settings, cultures, language communities, and problem areas. SH+ reduced anxiety and depression with war refugees at a level that was similar to self-help in economically privileged societies (Tol et al., 2020; Turrini et al., 2022), and reduced future development of mental health disorders by nearly by half over a year's time (Purgato et al., 2022). Importantly, increases in psychological flexibility were shown to mediate these changes (Lakin et al., 2023). Said simply, the evaluation studies suggested that ACT works and works via its putative processes of change.

Doing What Matters in Times of Stress is now distributed by WHO on a website that describes it in unusually broad terms: "Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances." As an example of that view, when the COVID pandemic hit and WHO did not have an evidence-based approach for that problem, people were referred to that page  https://www.who.int/publications/i/item/9789240003927 and studies were quickly conducted on DWM and SH+. The data showed that stressed health care workers were indeed helped (Riello et al., 2021; Mediavilla et al., 2023). Similarly WHO is now actively disseminating ACT self-help in the Ukraine to help with war survivors. Data are being collected there but it is not yet published.

ACT self-help is increasingly being built into the fabric of global health at WHO. In 2023 in an invited plenary talk at the World Congress of Cognitive and Behavioral Therapies in Seoul, Korea, WHO Mental Health head van Ommeren said that Doing What Matters in Times of Stress was now the most downloaded physical or mental health document of any kind at the World Health Organization.

SELF-HELP PLUS (SH+) (2021)
A group-based stress management course for adults (World Health Organization)
https://www.who.int/publications/i/item/9789240035119

Overview
Self-Help Plus (SH+) is WHO’s 5-session stress management course for large groups of up to 30 people. It is delivered by supervised, non-specialist facilitators who complete a short training course and use pre-recorded audio and an illustrated guide (Doing What Matters in Times of Stress) to teach stress management skills. The course is suitable for adults who experiences stress, wherever they live and whatever their circumstances. It has been shown to reduce psychological distress and prevent the onset of mental disorders. The format of SH+ makes it well-suited for use alongside other mental health interventions, as a first step in a step.

Available in English, Arabic, Juba Arabic, French, Portuguese, Spanish, Turkish, Ukrainian.

Doing What Matters in Times of Stress (2020)
An Illustrated Guide
https://www.who.int/publications/i/item/9789240003927
https://iris.who.int/handle/10665/331901

Overview
Doing What Matters in Times of Stress: An Illustrated Guide is a stress management guide for coping with adversity. The guide aims to equip people with practical skills to help cope with stress. A few minutes each day are enough to practice the self-help techniques. The guide can be used alone or with the accompanying audio exercises.
Informed by evidence and extensive field testing, the guide is for anyone who experiences stress, wherever they live and whatever their circumstances.

Available in Arabic, Armenian, Chinese, Czech, Dari, English, Estonian, Farsi/Persian, Finnish, French, German, Georgian, Greek, Hungarian, Indonesian, Italian, Japanese, Juba Arabic, Korean, Lithuanian, Malay, Polish, Portuguese, Romanian, Russian, Slovak, Spanish, Swedish, Tigrinya, Tongan, Turkish, Ukrainian, Urdu, Vietnamese.

How to Use WHO Self-help Plus Protocol
Webinar presented by Russ Harris and Claudette Foley
April 13, 2022
https://contextualscience.org/video/how_to_use_who_selfhelp_plus_protocol_webinar

Overview
This is a webinar on WHO's ACT protocol for refugees. We will answer Frequently Asked Questions about the protocol–also known as “Self-help Plus”-and explore how to implement it.

References:

Lakin, D. P., Cooper, S. E., Andersen, L., Brown, F. L., Augustinavicius, J. L. S., Carswell, K., Leku, M., Adaku, A., Au, T., Bryant, R., Garcia-Moreno, C., White, R. G., & Tol, W. A. (2023). Psychological flexibility in South Sudanese female refugees in Uganda as a mechanism for change within a guided self-help intervention. Journal of Consulting and Clinical Psychology, 91(1), 6–13. DOI: 10.1037/ccp0000774

Mediavilla, R., Felez-Nobrega, M., McGreevy, K. R., Monistrol-Mula, A., Bravo-Ortiz, M. F., Bayón, C., ... & Ayuso-Mateos, J. L. (2023). Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: A multicentre randomised controlled trial. BMJ Mental Health, 26(1), 1-8. DOI: 10.1136/bmjment-2023-300697

Acarturk, C., Uygun, E., Ilkkursun, Z., et al. (2022). Effectiveness of a WHO self-help psychological intervention for preventing mental disorders among Syrian refugees in Turkey: A randomized controlled trial. World Psychiatry, 21, 88–95. DOI: 10.1002/wps.20939

Acarturk, C., Kurt, G., Ilkkursun, Z., Uygun, E., & Karaoglan-Kahilogullari, A. (2022). “Doing What Matters in Times of Stress” to decrease psychological distress during COVID-19: A randomised controlled pilot trial. Intervention, 20(2), 170-178. DOI: 10.4103/intv.intv_29_21

Turrini, G., Purgato, M., Tedeschi, F., Acartürk, C., Anttila, M., Au, T., et al. (2022). Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial. Epidemiology and Psychiatric Sciences, 31, E39. DOI: 10.1017/S2045796022000269

Purgato, M., Carswell, K., Tedeschi, F., Acarturk, C., Anttila, M., Au, T., Bajbouj, M., Baumgartner, J., Biondi, M., Churchill, R., Cuijpers, P., Koesters, M., Gastaldon, C., Ilkkursun, Z., Lantta, T., Nosè, M., Ostuzzi, G., Papola, D., Popa, M., Roselli, V., Sijbrandij, M., Tarsitani, L., Turrini, G., Välimäki, M., Walker, L., Wancata, J., Zanini, E., White, R., van Ommeren, M., & Barbui, C. (2021). Effectiveness of Self-Help Plus in preventing mental disorders in refugees and asylum seekers in Western Europe: A multinational randomized controlled trial. Psychotherapy and Psychosomatics, 90, 403–414. DOI: 10.1159/000517504

Riello, M., Purgato, M., Bove, C., Tedeschi, F., MacTaggart, D., Barbui. C., & Rusconi, E. (2021). Effectiveness of self-help plus (SH+) in reducing anxiety and post-traumatic symptomatology among care home workers during the COVID-19 pandemic: A randomized controlled trial. Royal Society of Open Science, 8, 210219. DOI: 10.1098/rsos.210219

Tol, W.A., Leku, M.R., Lakin, D.P., Carswell, K., Augustinavicius, J., Adaku, A., Au, T.M., Brown, F.L., Bryant, R.A., Garcia-Moreno, C., Musci, R.J., Ventevogel, P., White, R.G., van Ommeren, M. (2020) Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial. Lancet Global Health, 8(2), e254–63.  DOI: 10.1016/S2214-109X(19)30504-2

Tol, W. A., Augustinavicius, J., Carswell, K. Adaku, A. M., Leku, R., Brown, F. L., Garcia-Moreno, C., Ventevogel, P., White, R. G., Kogan, C.S., Bryant, R. and van Ommeren, M. (2018). Feasibility of a guided self-help intervention to reduce psychological distress in South Sudanese refugee women in Uganda. World Psychiatry, 17(2), 234-235. DOI: 10.1002/wps.20537

Tol, W. A., Augustinavicius, J., Carswell, K., Brown, F. L., Adaku, A. M., Leku, R., Garcia-Moreno, C., Ventevogel, P., White, R. G. and van Ommeren, M. (2018). Translation, adaptation, and pilot of a guided self-help intervention to reduce psychological distress in South Sudanese refugees in Uganda. Global Mental Health. DOI: 10.1017/gmh.2018.14

Brown, F. L., Carswell, K., Augustinavicius, J., Adaku, A., Leku, M. R., White, R. G., Ventevogel, P., Kogan, C. S., García-Moreno, C., Bryant, R. A., Musci, R. J., van Ommeren, M., & Tol, W. A. (2018). Self Help Plus: study protocol for a cluster-randomised controlled trial of guided self-help with South Sudanese refugee women in Uganda. Global mental health, 5, e27. DOI: 10.1017/gmh.2018.17

Epping-Jordan, J., Harris, R., Brown,F.L., Carswell, K., Foley, C., García-Moreno, C., Kogan, C., & van Ommeren, M. (2016). Self-Help Plus (SH+): a new WHO stress management package. World Psychiatry, 15, 295-296. DOI: 10.1002/wps.20355

This page includes treatment outlines that were used in the Forman and colleagues (2007) effectiveness study comparing ACT and CT for anxiety and depression.

Please note (From Sue Orsillo): The research manual referenced in the Anxiety Outline attached below is no longer distributed since the publication of the book Mindfulness and Acceptance-based Behavioral Therapies in Practice. The book is intended to serve as a "clinical manual". The research protocol was an in-house protocol that states which questionnaires should be handed out in each session for the study, etc.  That manual assumes the reader was trained by, and is supervised by, us. It is not written in a way that is easily useable by others.

Experimental tests to date: 
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.

We created this 8-week group as part of our postdoctoral residency program development project at Kaiser Permanente in Vallejo, CA. 

Megan Foret, Psy.D. and Patricia Eaton, Psy.D.

dr.meganforet@gmail.com

Note: Much of the content ideas can be credited to other authors who are acknowledged on page two. 

'The Flexible Mind - Session Guides' are intended for use by practitioners working with athletes who wish to use Acceptance and Commitment Training to support the performance and mental health of the athletes. The sessions are organized as follows:

1. Introducing Athletes to The Flexible Mind approach (Session 1)
2. Mind full vs. Mindful (Session 2)
3. Orientating to Our Inner Compass (Session 3)
4. Being Open, Living Big (Session 4)
5. Getting Present with the Discomfort (Session 5)
6. Flexibility… of the Psychological Kind (Session 6)
7. Developing the Game Plan (Session 7)

For further details please see: www.FlexibleMind.co.uk and the book: http://cutt.ly/CbM2bV4  Twitter: @Mind_Flexer

We hope that the materials are helpful. If you have any queries or feedback please contact Ross White (admin@strive2thrive.co.uk). 

Introduction - These materials accompany the ACT for Depression and Anxiety Group...
These materials accompany the ACT for Depression and Anxiety Group developed by Matt Boone at Cornell University's Counseling and Psychological Services. It is a 10 session college counseling center group which combines didactic elements, mindfulness exercises, experiential exercises, group discussion/process, and homework (called LIFE Exercises). The protocol described here is very close (about 90%) to what was used in Matt Boone's pilot study of a transdiagnostic ACT group in college counseling. A few homework worksheets have been removed to give participants less to do between sessions, and the order of a some elements have been changed slightly.

The group is meant to fit within a single semester. The first half of the semester covers the six processes of psychological flexibility. The second half focuses on mobilizing psychological flexibility in the service of values-driven committed action – both inside the group, as members interact with one another, and outside the group in the students' lives. The second half looks a little bit more like traditional group therapy – group leaders are encouraged to incorporate the interpersonal group process into conversations about acceptance, mindfulness, and values.

The materials were collated and revised by Matt Boone and Cory Myler during the 2011-2012 academic year. Feel free to contact either Matt or Cory about any aspect of the group. Matt can be reached at matthewsboone@gmail.com. Cory can be reached at cory.myler@gmail.com.

Group Format
Each group meeting is organized roughly as follows:
● opening mindfulness exercise
● review of LIFE Exercises from the previous week
● didactic portion with group discussion
● experiential exercise with group discussion
● further group discussion
● assigning LIFE exercises for next time
The didactic portion ends in the fifth session and is reinforced by the readings.

The progression of the group throughout the semester is roughly organized around the six processes of psychological flexibility. These are defusion, acceptance/willingness, contact with the present moment, self as context (called the "observing self" in the group), values, and committed action.

The order is as follows:
● session 1: "control is the problem" and contact with the present moment
● session 2: defusion
● session 3: acceptance/willingness
● session 4: values
● session 5: observing self
● session 6: committed action
● session 7-10: all processes, with a focus on building greater patterns of committed action in the service of values

Background
It is helpful if you have been to at least one ACT training and you are familiar with some core ACT texts. At minimum you should read ACT Made Simple, because many of the group's didactic elements are drawn from it, and The Happiness Trap, because readings from it are used as homework. Other good texts are The Mindfulness and Acceptance Workbook for Depression, Learning ACT, Mindfulness for Two, Get Out of Your Mind and Into Your Life, Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, and The Mindfulness and Acceptance Workbook for Anxiety. All of these influenced the creation of the group. Full citations of these texts are included at the end of this document..

Session Outlines
Outlines for each group session are included. For the first five sessions, the outlines give instructions which accompany the PowerPoint slides. The outlines are far more detailed in the first few sessions, mostly because the majority of the psychoeducation happens then, but partly because limitations on time and resources have prevented writing everything out extensively. You should use your best judgment and your experience with leading groups, but feel free to contact Cory or Matt with questions.

Power Points
As noted above, PowerPoint is used to introduce didactic elements in the first five sessions. Beware of relying on them too much. Remember: ACT draws on metaphors and experiential exercises just as much as it relies on education. Most of the text in the PowerPoints comes directly from ACT texts. Citations are included where appropriate, but some may have been forgotten. The pictures are all from Google images, and their copyright is uncertain.

Readings
The readings are not included. Group members should be encouraged to buy The Happiness Trap, and the short excerpt from the Mindfulness and Acceptance Workbook for Depression assigned in session 3 can be photocopied and passed out. Optional additional readings are also excerpted from The Acceptance and Mindfulness Workbook for Depression. If you assign the optional readings, consider encouraging students to buy the book. These readings expand on the concept of defusion. The Acceptance and Mindfulness Workbook for Depression extensively explores defusion, the function of thinking, and potential pitfalls in getting wrapped up in the mind.

Worksheets and Handouts
Most worksheets and handouts are adapted from ACT Made Simple and The Happiness Trap. Every attempt has been made to cite original sources where appropriate. The excerpt from The Acceptance and Mindfulness Workbook for Depression includes a worksheet which is completed for homework between sessions 3 and 4.

Mindfulness MP3s
Four mindfulness exercises that are used for homework are included in MP3 form. Some of them are also used as exercises to mark the beginning of group sessions. (However, group leaders are encouraged to lead the exercises themselves rather than playing the MP3s in group.) Because the recordings were created in an amateur home studio, they sound fine through speakers, but there is some background noise when you listen to them on headphones. They are designed to be short because busy students often will not do lengthy mindfulness exercises for homework. Keeping them short hopefully makes it more likely that they will do them.

Scripts for all of them except "Brief Mindfulness" can be found in the ACT literature. The script for "Brief Mindfulness" was improvised by Matt Boone, but it's very close to other short mindfulness exercises in the literature. It is meant as a brief instruction on mindfulness, as well as a mindfulness exercise in itself. The scripts for "Leaves on a Stream" and "Acceptance of Thoughts and Feelings" are taken from the Mindfulness and Acceptance Workbook for Anxiety. Both can also be found in Acceptance and Commitment Therapy for Anxiety Disorders and "Leaves on a Stream" can be found in many other ACT texts. "Willingness Exercise" is an extensive acceptance exercise taken from ACT Made Simple. (It is similar to "physicalizing" in the ACT literature. It is assigned for homework a number of times throughout the group to facilitate exposure to feared internal stimuli like thoughts and feelings. Scripts for some of the other group's mindfulness exercises are included with these materials. They are similar to mindfulness exercises found in the ACT literature.

Experiential Exercises
Detailed instructions for many experiential exercises are included, but some are not. For example, nothing is written about "Eyes On," but there is information about it in many ACT texts. The same goes for "Take Your Mind for a Walk."

Notes to Group Leaders
● Be flexible. Feel free to jettison the psychoeducation or any experiential exercise if it does not feel appropriate for a particular group session. The most important thing is that participants get to encounter and understand, both experientially and intellectually, what psychological flexibility is like. Too much structure can get in the way of the group process.
● Working in the "here and now." Despite the psychoeducation elements, some really powerful "here and now" work can be done in this group if there is space left open for it. The ACT vocabulary gives students a way to talk about what they're experiencing in the moment and helps group members understand their reactions as part of their histories, not what others are "doing" to them. Doing this work is not really covered in these materials – draw on your training in group therapy. If you need further reading, see the chapter below, and especially consult Yalom's seminal work, The Theory and Practice of Group Psychotherapy.
● The book chapter "Acceptance and Commitment Therapy (ACT) in Groups" is included as optional reading for group facilitators. It presumes the reader has already had an introduction to the six processes of psychological flexibility.
● Please feel free to e-mail Matt or Cory with any questions.

Cheers!

Resources
Boone, M. S., & Manning, J. (2012). A pilot study of an Acceptance and Commitment Therapy group for anxiety and depression in a college counseling center. Manuscript in preparation.

Boone, M. S. , & Canicci, J. (In press). Acceptance and commitment therapy (act) in group. In Pistorello, J. (Ed.). Mindfulness and Acceptance on the College Campus. Oakland, CA: New Harbinger.

Luoma, J., Hayes, S. C., & Walser, R. (2007). Learning ACT. Oakland, CA: New Harbinger.

Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: a practitioner's treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. Oakland, CA: New Harbinger.

Forsyth, J. P., &, Eifert, G. H. (2007). The mindfulness and acceptance workbook for anxiety. Oakland, CA: New Harbinger.

Harris, R. (2010). ACT made simple. Oakland, CA: New Harbinger.
Harris, R. (2008). The happiness trap. Boston, Massachusetts: Shambhala.
Hayes, S. C., & Smith, S. (2005). Get out of your mind and your life: The new acceptance and commitment therapy. Oakland, CA: New Harbinger.

Hayes, S. C., Strosahl, K., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd edition). New York: Guilford Press.

Strosahl, K., & Robinson, P. (2007). The mindfulness and acceptance workbook for depression. Oakland, CA: New Harbinger.

Walser, R. D., & Pistorello, J. (2004). ACT in group format. In S. C. Hayes & K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy (pp. 347-372). New York: Springer.

Yalom, I. (2005). The theory and practice of group psychotherapy (5th ed.). New York: Basic Books.
 

The case study this protocol resulted in is not yet in print, though a description and theoretical elaboration will be presented in:

Skinta, M.D. (n.d.). Acceptance and compassion-based approaches for invisible shame: Working with sexual minorities and chronic illness. In A. Masuda (Ed.), Cultural issues in acceptance and mindfulness-based approaches. Oakland: New Harbinger Publications. In press (anticipated Spring 2014).

As noted in the front matter, this manual was largely drawn from existing protocols and adapted for a focus on HIV.  By drawn from, I mean cut-and-paste was widely used, with revisions made for content, as this originally was intended as only a conversation piece between the co-therapists.  Given the number of requests backchannel in the year since, however, it seems it may be useful to share in this forum.  For this reason, the manual content itself should not be considered original work of Skinta or Wells, but rather an adoption of both the Self-Stigma and Shame in Substance Addictions Manual on this page, as well as Eifert and Forsyth's ACT for Anxiety Disorders and Dahl et al's The Art and Science of Valuing in Psychotherapy. 

Even within our pilot, this was an evolving work, with different techniques explored and shared.  For further information, or excited and lively conversation about working with HIV-affected communities with ACT, please contact Matthew Skinta.

This is a protocol created by Nuno Ferreira and David Gillanders for the use of ACT with Irritable Bowel Syndrome (IBS).

This protocol was used for a single group session that was then followed by work with a self-help workbook.

In the attachments you will find all the steps used during the session. The session maps on the contents of the self-help book and it is best used in conjunction with this book. You will also find the forms we used during the workshops to facilitate some of the exercises.

The effectiveness of this protocol was tested with refractory IBS patients (patients who had had a minimum of 12 months input from a physician without any significant change). Study participants showed improvement in symptoms, quality of life, use of avoidant behaviours and gastrointestinal specific anxiety after the intervention. The effects were medium to large and held up at 6 month follow-up. A paper regarding this study is due to be published soon.

The self-help workbook ("Better living with IBS") is now comercially available through Exisle Publishers or for those in the UK through Sheldon Press.

We'll be happy to respond to questions regarding this protocol.

Best,

Nuno Ferreira

Teaching Fellow in Clinical Psychology

University of Edinburgh

Nuno.Ferreira@ed.ac.uk

The ACT-PAC manual is a 6 session manual for parents of children with anxiety. Five of the sessions are for general use, and the remaining module targets parent behaviors emblematic of families of anxious children. The manual was written so that clinicians new to ACT could deliver it word-for-word if they wish; however, it also integrates options for choosing different but functionally equivalent exercises and activities. It is a principles-based manual, and we offer it to our ACBS community in the spirit of open science, to disseminate, share, research, adapt, and improve by our peers who will continue this work. Please do cite us where appropriate. Other than that, please help yourselves to this resource. May we help to support many families who are struggling. -Lisa & Phoebe

A manual for delivering ACT to parents, targetting parenting stress.  This manual was written specifically for parents of children with developmental disabilities, however, it could be adapted for use with other high-risk parents.  The intervention is written as a four hour intervention with two sessions of two hours each.  This intervention was found to be effective when used in conjunction with Stepping Stones Triple P with families of children with Cerebral Palsy and families of children with Acquired Brain Injury.  In the RCT of Stepping Stones Triple P and Acceptance and Commitment Therapy, Acceptance and Commitment Therapy was found to have a beneficial effect, above and beyond conventional parenting interventions.  

Relevant Publications
Whittingham, K., Sanders, M., McKinlay, L. & Boyd, R.N. (2014). Interventions to Reduce Behavioral Problems in Children with Cerebral Palsy: An RCT. Pediatrics. Accepted 14/02/2014 Epub ahead of print.

Brown, F., Whittingham, K., Boyd R., McKinlay, L. & Sofronoff, K. (in press)

Improving child and parenting outcomes following paediatric acquired brain injury: A randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy. Journal of Child Psychology and Psychiatry. Accepted 27/01/2014.

Whittingham, K., Sanders, M.R., McKinlay, L. & Boyd, R.N. (2013) Stepping Stones Triple P and Acceptance and Commitment Therapy for parents of childrenwith cerebral palsy: Trial protocol. Brain Impairment. 14 (2), 270-280.

Brown, F., Whittingham, K., McKinlay, L., Boyd, R.N. & Sofronoff, K. (2013) Efficacy of Stepping Stones Triple P plus a stress management adjunct for parents of children with acquired brain injury: The protocol of a randomized
controlled trial. Brain Impairment. 14 (2), 253-269.
 

Attached are ACT skills group handouts that we have used on our perinatal psychiatry inpatient unit at UNC Hospital at the University of North Carolina at Chapel Hill. They were adapted from multiple other sources, so the content is in no way original. Also attached is our manuscript describing the rationale and use of these materials.

For additional information, you can contact Crystal Schiller at crystal_schiller@med.unc.edu.

This manual provides guidance for outpatient individual and family sessions for adolescents with co-occurring psychiatric and substance use disorders. The model includes motivational interviewing, acceptance and committment therapy, and contingency managment. Preliminary data has been published in the Journal of Contextual Behavioral Science 107;6:375-379.

Please provide feedback on www.DrThurstone.com.

This is a 15 session ACT group manual for substance use issues that I've run in some UK treatment services.  The manual provides a general structure for introducing ACT exercises and other addiction related treatment components (e.g., skills training), though we've always emphasised flexibility in delivery, and never slavishly following the manual.  

This group was designed as a modular structure: Three modules of five sessions each, with a predominant focus on OPEN, ACTIVE, and AWARE. 

I hope it's of use to people.

all the best

Lee Woodward 

Acceptance and Commitment Training for Substance Abuse Counselors protocol.

Experimental tests to date:

Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (2008). A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to Use evidence-based pharmacotherapy. Journal of Consulting and Clinical Psychology, 76, 449-458.

This treatment consists of eight biweekly 75-minute sessions conducted in group format, intended for use at a residential treeatment facility.

Preliminary empirical support for this manual is published under:

Juarascio, A., Shaw, J., Forman, E. M., Timko, C. A., Herbert, J. D., Butryn, M. L., & Lowe, M. (2013). Acceptance and Commitment Therapy for eating disorders: Clinical applications of a group treatment. Journal of Contextual Behavioral Science, 2, 85-94.

This is an outline of a 7-week group on Dealing with Anger using an ACT framework. The outline includes both facilitator notes, as well as client handouts. We used the materials with a group of adult clients referred from a local community mental health agency, and the clients responded well to the materials and the group process that resulted. Psychology graduate students were the main group facilitators, with a psychologist supervising their work.  Feel free to use/adapt the materials. 

Annette Dufresne, Ph.D., C.Psych.

Ontario, Canada

dradufresne@gmail.com

This is the intervention manual used in the BEACHeS Study. The study was a single case experimental design, testing the feasibility and acceptability of a brief individual delivered, manualised ACT intervention to people who recently transitioned into receiving specialist palliative care services. All patients had a cancer diagnosis, which was considered non-curable.

You can read more about the research in the attached paper.

Hulbert-Williams, N. J., Norwood, S. F., Gillanders, D., Finucane, A. M., Spiller, J., Strachan, J., … Swash, B. (2021). Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliative Care, 20(1), 1–13. https://doi.org/10.1186/s12904-021-00801-7

The manual contains details of expected training to be able to deliver the intervention safely and effectively, and a disclaimer as follows:

DISCLAIMER

This manual has been written and provided in good faith by the BEACHeS Research Team. The manual and intervention has not been the subject of any patient complaint or adverse event in the BEACHeS research study. The BEACHeS study team, Marie Curie, The University of Chester or The University of Edinburgh accept no liability or responsibility for any subsequent use of this intervention in other settings. Individuals and services using this manual take responsibility for doing so, and for ensuring practitioners using this intervention are well trained, supported and supervised, and are competent and legal to deliver services within the country in which they are working.
 

The intervention was also supported by audio files that can be given to participants which can be accessed here

We are very excited to share this protocol with the ACT community! The Better Living with Illness group is an ACT intervention designed for people living with chronic physical illness, to be run over 6 weeks, with 2 follow-up sessions 1 and 3 months post-intervention. Sessions last 2.5 hours, including a half-hour break in the middle. 

This protocol is based on others published here (e.g. chronic pain), but also has some additional elements included that are relevant to this group, such as pacing, assertive communication, goal setting and problem solving skills, delivered in an ACT-consistent way. Its also novel in its transdiagnostic approach: this group was designed to bring people living with different long term physical health conditions together, acknowledging that commonalities that exist across many diagnoses (both physical and mental).

The group has been run in NHS Fife, Scotland for just over 2 years, in a repeated measures controlled trial in conjunction with the University of Edinburgh for a DClinPsy thesis. For the evaluation, we defined chronic physical illness as conditions that had lasted for a minimum of 12 months and required some form of management (e.g. medication). We had 33 participants complete.  The results (n=33 for completers) indicated significant improvements in HADS scores compared to the baseline control period, with similar improvements in measures of valued living (Matthew Smout's VQ measure) and psychological flexibility (AAQ-II). This was in the context of no significant change on perceived health status. These processes were also found to mediate change in HADS scores. We will shortly be submitting a paper for publication on this and will update here with details.

Overall, participants were very positive about the group and their experiences in it, and really valued it.

Please do get in touch if you'd like to know a bit more about this group.

And if you do download and use the protocol, please get in touch with David Gillanders to let him know - david.gillanders@ed.ac.uk

Linsay Brassington linsaybrassington@hotmail.com

Co-authors:

Nuno Ferreira, University of Edinburgh

Shona Yates, NHS Fife

Jackie Fearn, NHS Fife

Pam Lanza, NHS Fife

Kim Kemp, NHS GGC

Hannah Dale, NHS Fife

Mandy Forbes, NHS Tayside

David Gillanders, University of Edinburgh

Publication of the BLI results - Comment submitted by David Gillanders on May 24, 2018 

The journal article that describes the research and evaluation of the Better Living with Illness Protocol in NHS Fife, by the team named above can be found here:

Brassington, L., Ferreira, N. B., Yates, S., Fearn, J., Lanza, P., Kemp, K., & Gillanders, D. (2016). Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness. Journal of Contextual Behavioral Science, 5(4), 208–214. http://doi.org/10.1016/j.jcbs.2016.09.001

https://www.sciencedirect.com/science/article/pii/S2212144716300576?via%3Dihub

From Joseph Ciarrochi:

I wanted to introduce you to a model Ann Bailey, Russ Harris, and I have come up with for facilitating ACT and CBS interventions. The three of us have been using this model continuously, now, for about 6 months, with a wide variety of clients, and we are finding it to be extremely effective. Clients love it.

You can find a PDF of the powerpoint on the Choice Point Model below.

You can also find the powerpoint below, along with an example worksheet.

A choice point is a moment in time when it is possible to choose between values consistent and values inconsistent behaviour.The CP allows you to record key aspects of the situation, the difficult inner experience that shows up, the values ,skills, and strengths used to respond effectively to the situation and the inner experience, and finally the behaviour that can be either value consistent or value inconsistent.

What is the choice point model

The Choice Point is a simple way to help you and your client keep track of where you are in an ACT/ACBS intervention. In the above document,we show how you can use it to summarise willingness, defusion, and self-compassion. It can be used to keep track of all ACT processes, as Russ will illustrate later in videos. We have found that Choice Point gives the client a sense of a safe framework and allows them to be more exploratory, knowing that they can always come back to the ³map², the CP, and know where they are.

There will be questions about how this model relates to other models. The choice point has a clear mapping to tobias and Joanne¹s Bulleseye ,in that the emphasis is on value consistency, rather than appetitive versus aversive-driven behaviour. It is also inspired by the Matrix ability to put things into a simple framework and reach many people .We were struggling to do just that, as we (Ann and I) had to teach ACT principles to dieticians, football players, and other folks who did not necessarily have sophisticated psychological training. After much trial and error with clients, we finally got to the Choice point (and Ann had been using a variant of this for years with Borderline clients).

As far as we can tell, the choice point complements other approaches and does not contradict them.

The Choice Point model illustrates different points of intervention. For example, for the ³situation² part of the choice point (bottom), one can target situation selection and modification (e.g., problem solving, re-engineering the environment). In the values and skills section (bottom right), you can help the client to modify the form or frequency of inner experience (traditional CBT) or you can help the client to respond flexibly to the situation and the inner experience (ACT) or you can help the client identify and use strengths (positive psychology). Of course most therapies probably do all of these activities and differ only in emphasis.

The choice point model and contextual behavioural science: Going beyond ACT

We have attempted to make the CP more generally about Contextual Behavioral Science than ACT. Thus, the choice point worksheet has a place to describe the situation (antecedent events) and the consequences (whether the behaviour is value consistent or inconsistent). The Choice point allows for some avoidance behaviour to be a value-consistent and some appetitive behaviour to be value inconsistent . In a CBS approach, no behaviour is inherently good or bad. It is always assessed in the context of the situation and its consequences to the organism. I have long argued that some appetitive behaviour is value-inconsistent. It doesn¹t have to be "crazy-appetitive" as Kelly puts it. It can be a series of small choices, small appetitive moves, that gradually take you away from the things you
care about. For example, a recent paper shows that induced positive mood can lead to overeating. That sounds like eating under mild appetitive control. Other research shows that as the number of people you eat with increases, so does the amount you eat Šagain, I doubt this effect is mainly about avoidance.

OK, let me be controversial here (you all know how much a love this community and my belief that controversy is necessary). I think that we in ACT (including me) are sometimes making three mistakes.

Mistake 1: Its all about avoidance. I don¹t think we should assume avoidance underpins all unhelpful behaviour. The psychodymanic folks have tried that before us, and I think mostly failed. You can always play the game of "gotcha" and come up with an avoidance explanation for anything, but I think it would be fairly surprising if the appetitive system did not play a key role in some value-inconsistent behaviour. Mostly, behaviour is under both appetitive and aversive control (e.g., I feel guilty if I don¹t exercise and I love exercising)

I'm not saying that avoidance is not central to our suffering; I'm just saying that a complete CBS approach will include potential causes of unworkable behaviour, other than what is explicitly stated in ACT hexeflex.

Mistake 2: Mindfulness is universally good and the "holy grail" of well-being. Being mindful is just another behaviour, which means it's utility needs to be evaluated in context. Recent research suggests that
mindfulness not only disrupts bad habits, it can slow the formation of good habits. Of course, everything depends on how you define the behaviour "mindfulness" and we could play the game of "gotcha," where anything beneficial can be described as involving mindfulness. If everything beneficial is based on mindfulness, then I propose we replace the word "mindful" with "beneficial." I do prefer the ACT phrase, "contact with the present moment", as it seems to have less baggage, and one can easily imagine when contact with the present moment isn't the best move (e.g., when planning and imagining possible futures).

Mistake 3: All attempts at reappraisal and suppression are bad. Again, I return to the CBS mantra Šthe attempt to change inner experience is a type of behaviour, that can only be evaluated in context. I think the coming years will see a push to more clearly specify when interventions like cognitive reappraisal are most and least likely to work (a recent study suggests reappraisal does not work so well when folks can control the situation). Anyway, as you folks know, ACT already does plenty of cognitive restructuring types of stuff, in the form of psych-education and in expanding how people think about feared things.

In closing, I hope what I am putting out there will be of use.

An eight session protocol for chronic pain intended for use in outpatient settings. Includes preface, therapist guide, patient manual, and references.

Experimental tests to date:

Vowles, K. E., Wetherell, J. L., & Sorrell, J. T. (2009). Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognitive and Behavioral Practice, 16, 49-58.

Guidelines for a flexibly structured, six session course for individual clients with persistent musculoskeletal pain, designed to be used by physical and manual therapists with brief ACT training. Resources include an explanatory covering letter, practitioner guide, practitioner and patient workbooks, and a preliminary research evaluation article.

(See also Abbey, H.A. (2017) Developing an integrated osteopathy and acceptance-informed pain management course for patients with persistent pain. (Doctoral Dissertation). University of Bedfordshire, UK.)

Practicing communication skills can promote psychological flexibility and vice-versa. Teaching skill sets like Clean Talk and NVC may compliment ACT work. 

Charlie Laurel, MS, LCMHC

Authors note:

The co-morbidity of psychosis in individuals with developmental disabilities may exacerbate the financial strain, emotional turmoil, and difficulties in adaptive functioning that these individuals experience. Given the salience of distress across domains of functioning, there exists a pressing need for more effective interventions to address this population. I am posting this protocol in the hope that it will assist treatment practitioners working with the developmentally disabled. It is an attempt to create more "physicalized" ACT metaphors for clients who think more concretely. Please understand that ACT work with this population is evolving and that this protocol is a work in progress. An small single case study using this protocol was discussed in Pankey and Hayes, 2003. 

The ACT for diabetes management protocol is available in book form in [[http://www.contextualscience.org/gregg_callaghan_hayes_2007|Gregg, J., Callaghan, G., & Hayes, S. C. (2007).]] The diabetes lifestyle book: Facing your fears and making changes for a long and healthy life. Oakland, CA: New Harbinger. Experimental tests to date: The ACT for diabetes management protocol is available in book form in Gregg, J., Callaghan, G., & Hayes, S. C. (2007). The diabetes lifestyle book: Facing your fears and making changes for a long and healthy life. Oakland, CA: New Harbinger. Experimental tests to date: Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving diabetes self-management through acceptance, mindfulness, and values: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 75(2) , 336–343.

This page contains what are arguably the first two ACT protocols written while Dr. Hayes was at the University of North Carolina - Greensboro in 1981, and the earliest program written after Hayes moved to the University of Nevada, Reno in 1986 ... a protocol in 1987 by Sue Melancon (now Sue Melancon McCurry) for her predoctoral project with agoraphobia, submitted to the clinical psychology program at UNR in November 1988. All were described at the time as "Comprehensive Distancing" protocols but a more detailed review finds references to the major components of nominally "ACT" protocols.

The first protocol is an unpublished five-page manual and is referred in Robert Zettle's 1984 dissertation as "Hayes, 1981". It is called "The Big D" after the lab's slang name for "comprehensive distancing."

The second is a manual for a study on comprehensive distancing for pain tolerance conducted in 1981/1982 and presented in this paper: 

Hayes, S. C., Korn, Z., Zettle, R. D., Rosenfarb, I., & Cooper, L. (November 1982). Rule‑governed behavior and cognitive behavior therapy: The effects of comprehensive cognitive distancing on pain tolerance. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, Los Angeles. 

That study appeared in print in 17 years laer: 

Hayes, S. C., Bissett, R., Korn, Z., Zettle, R. D., Rosenfarb, I., Cooper, L., & Grundt, A. (1999). The impact of acceptance versus control rationales on pain tolerance. The Psychological Record, 49, 33-47. 

The pain tolerance protocol itself was long presumed to be lost but was discovered by Dr. Zettle in a cardboard box in his attic in 2024, misfiled with other papers. It is an onion skin carbon copy of a typewritten document, almost unreadable in physical form due to age, but easily readable as a scanned document with high contrast settings

The third is Dr. McCurry's pre-doctoral project (Melancon, 1988). It was based on a joint therapy client seen by Dr. Hayes and Sue Melancon as a graduate student in 1986-87, the transcripts of which formed the basis for the first protocols called "ACT." It is worth noticing that most of the modern elements of ACT including values are clearly in this Comprehensive Distancing protocol. 

At least two more protocols were written in this era:

Rob Zettle's 1982 depression protocol (see his 1984 dissertation "Cognitive therapy of depression: A conceptual and empirical analysis of component and process issues." Unpublished doctoral dissertation, University of North Carolina – Greensboro.

The final one was probably written about 1983. It was a  protocol focused on weight loss and bodily shame. It was piloted but never presented and apparently has been lost to history (for a partial modern re-emergence see Lillis, Hayes, Bunting, & Masuda, 2009).

Attached is the dissertation by Lundgren (2004) that includes the ACT for epilepsy treatment protocol.

Experimental tests to date:

Lundgren, T. (2004). Psychological treatment of epilepsy. Unpublished dissertation, Uppsala University, Uppsala, Sweden.

Lundgren, T., Dahl, J., Melin, L., & Kies, B. (2006). Evaluation of Acceptance and Commitment Therapy for drug refractory epilepsy: A randomized controlled trial in South Africa. Epilepsia, 47, 2173-2179.

Lundgren, T., Dahl, J., & Hayes, S. C. (2008). Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavior Medicine, 31(3), 225-235.

Louise Hayes and Julie Rowse. (2008). Acceptance and Commitment Therapy: Experiential Adolescent Group Program. Also available from louiseh@unimelb.edu.au

The program is an 8 week group program for adolescents. The aim of the program is to use experiential mediums, for example painting or clay, to facilitate teenagers’ experience of the ACT concepts. Art allows them to explore their own experiences, without getting caught up in language processes.

The group program also makes use of role play and other forms of experience. Initial outcome data is positive and will be available from the first author early 2009. Artwork is shown in this document for training purposes only and should not be reproduced in anyway. All participant artwork has been used with written consent from the participants.

The program is designed for experienced ACT therapists to be modified as needed. It is not a step by step guide to ACT with young people. It is designed to be used flexibly, modifiying the content to fit with the particpants.

Note: The manual attached below follows guidelines for the implementation of ACT derived from Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change (1999) by Hayes, Strosahl, and Wilson.

As such, it is meant to supplement rather than serve as a replacement for this book in the implementation of ACT.

Accordingly, users of this manual should be familiar with the principles of ACT outlined in this book as well as additional techniques and procedures covered within it that are not explicitly contained in this manual.

(Thanks for this manual Rob Zettle!)

Experimental tests to date:

Zettle, R. D., & Hayes, S. C. (1986). Dysfunctional control by client verbal behavior: The context of reason giving. The Analysis of Verbal Behavior, 4, 30-38.

Zettle, R. D., & Hayes, S. C. (1987). A component and process analysis of cognitive therapy. Psychological Reports, 61, 939-953.

Zettle, R. D., & Raines, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 438-445.

For further information contact: Robert Zettle (robert.zettle@wichita.edu), Wichita State University, Department of Psychology, 1845 N. Fairmount, Wichita, KS 67260-0034

Select this link to access the HEAT (Honorably Experiencing Anger and Threat) group treatment protocol developed by Andy Santanello and Sharon Kelly.

 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), 1129-1139.

Lessons using the "hero" to create a life beyond addiction.  This curriculum includes 3 lessons focusing on 1.  Heroes  2.  Values  3.  Your Cause

The following six-module workbook was created by a group of psychologists working in Nova Scotia, Canada.

Although initially created as a workbook to be used in group settings, it was adjusted so that it could also be used as a guided self-help intervention. During the Covid-19 pandemic, this workbook has been provided to clients for self-directed reading and practice (using the guided exercises hyperlinked in the document). Clients were also offered brief telephone coaching appointments during the six week program.

Clinical response and client satisfaction have been tracked and in-house program evaluation has revealed positive outcomes.

Contact: sjbaileyphd@gmail.com

A 3 manual protocol for a 6 week group or individual treatment using ACT and Mindfulness for managing chronic pain and/or chronic illness. Consists of client booklet, facilitator manual and Mindful movement and exercise program. Can be used in health care settings and in private practice.

Questions or queries to Dr C A Phillips christinea54.phillips@gmail.com

Below is the ACT for math anxiety protocol developed by Zettle (2003).

Experimental tests to date:

Zettle, R. D. (2003). Acceptance and commitment therapy (ACT) vs. systematic desensitization in the treatment of mathematics anxiety. The Psychological Record, 53, 197–215.

Mindtrain treatment manual together with ausio recordings for child-friendly mindfulness meditations, can be accessed from the following link:

https://www.dropbox.com/sh/20ffnay3pt2kh5u/AADlHF8Pl2sMuTHORZxH7f0Xa?dl=0

An eight session ACT for OCD protocol.

Twohig, M.P., Hayes, S.C., Plumb, J.C., Pruitt, L.D., Collins, A.B., Hazlett-Stevens, H., & Woidneck, M.R. (2010). A randomized clinical trial of acceptance and commitment therapy vs progressive relaxation training in the treatment of obsessive compulsive disorder. Journal of Consulting and Clinical Psychology, 78, 705-716.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for obsessive compulsive disorder. Behavior Therapy, 37(1), 3-13.

For further information contact: Mike Twohig (michael.twohig@usu.edu), Assistant Professor, Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, Utah 84322-2810, www.twohig.usu.edu.

Laura Walton, Gordon Mitchell, Lindsay-Jo Sevier-Guy, Stephanie Fagan, Emma Butchard, Graeme Babbs and members of Fife Bipolar Group

The Psychological Interventions for Psychosis (PIP) Service, within NHS Fife Clinical Psychology Department, provides psychological approaches for psychiatric conditions including psychosis and bipolar disorder. The service has links with various non-statutory and voluntary agencies supporting people affected by these conditions, and one such link is with the Fife Bipolar Group; a local branch of Bipolar Scotland. Over the last few years, our two organisations have been collaborating in the development of a new resource for people affected by bipolar disorder. The resource has been designed for people with a diagnosis of bipolar disorder; the people in their lives (i.e. family and friends); and professionals who work with people with bipolar disorder (e.g. healthcare workers).

The approached is based upon the principals of ACT and, through consultation with members of Fife Bipolar Group it evolved around the theme of travel, i.e. living with Bipolar being a journey. This is how it came to be called Pole to Pole. The name Pole to Pole simultaneously recognises the bipolar nature of emotional experience and the concept of exploring this experience. The approach consists of a resource pack, containing activities to explore experiences and values, which people are guided through in three group sessions. The sessions are designed to help people to reflect openly on their experiences of bipolar, whether directly or as a carer, and to communicate about the impact the condition has had in their lives. The activities are to create a Map of emotion experiences, a Guide based on values, a Compass to direct value-living and a Travelog to record and reflect upon experience. We also include additional experiential exercises in the sessions to deliver concepts such as acceptance and valued-living.

The purposes of Pole to Pole are to assist people with bipolar disorder and their carers to: learn more about mental, physical and emotional states; identify values and obstacles that get in the way of valued living; develop ways to work around the obstacles; and communicate with others about emotional experiences and values. Pole-to-pole may also be used to communicate with healthcare professionals about experiences of bipolar.

Our manual, pdfs of session Powerpoint presentations and pdfs of the activities are attached here.

An ACT protocol designed for use with postpartum depression. For further information contact: Espen Klausen

The Yale Manual for Psilocybin-Assisted Therapy of Depression provides researchers and therapists with methods, structure, and areas to consider regarding the use of psychedelic- assisted therapy in the treatment of Major Depressive Disorder (MDD). In particular, this manual illustrates a mode of utilizing Acceptance and Commitment Therapy (ACT) as a therapeutic framework for psilocybin-assisted therapy of depression.

For information, write to Dr. Jordan Sloshower: Jordan.Sloshower@yale.edu

Citation: Sloshower, Jordan, Jeffrey Guss, and Robert Krause. 2020. “The Yale Manual for Psilocybin-assisted Therapy of Depression (using Acceptance and Commitment Therapy as a Therapeutic Frame).” PsyArXiv. August 13. psyarxiv.com/u6v9y.

The "ScubaFlex: ACT for Scuba Divers" protocol brings Acceptance and Commitment Therapy (ACT) with scuba diving. Crafted by Laura and a few stranded scuba divers in response to pandemic-era challenges, the guide provides a comprehensive introduction to all ACT processes through the lens of scuba diving, with a focus on achieving psychological flexibility. Each session of the program, enriched by participant feedback and insights, explores a unique aspect of ACT, embodying a playful reinvention of the hexaflex. The protocol delivers a structured yet adaptable approach, encouraging ACT practitioners to infuse their expertise into the program and align it with their participants' needs. From values and mindfulness to defusion and committed action, every topic is addressed in the context of the diving experience.

We are deeply grateful to the ScubaFlex participants for their involvement and to the wider ACT community for their original exercises and practices. This manual is not just a resource, but an invitation to dive deeper into self-understanding and psychological flexibility, above and below the water's surface. Our heartfelt thanks to all who have joined us on this journey.

If you are interested in participating in a group, details are available on fittodive.org.  If you would like to run the group yourself, and have appropriate qualifications and experience, the protocol is freely available.  An outcome measure is included below. This is the VAMS for Ice Hockey, adapted to VAMS for Scuba Diving.  If you would like to carry out research of the protocol's effectiveness, please get in touch!   

Dear ACT community,

We would like to share with you a brief manual which is being developed as part of Doctorate in Clinical Psychology to help those with anxiety and/or depression.

The manual is designed to be accompanied with two therapist telephone calls to guide clients through the manual. It is a brief 58-page document that has been specifically designed to be photocopied in grey scale with ease. We are currently conducting a randomised controlled trial to invesigate the effectiveness of guided self-help, compared to a non-active control condition using this manual. Some pages are specific to a Scottish audience for this reason but please contact us if you feel it could be of some use and we can then adapt it.

The manual contains a chapter on each of the six ACT processes (present moment awareness, cognitive defusion, acceptance, self-as-context, connecting with values and committed action). It is designed so that one chapter is read each week (6 weeks in total) with behavioural tasks at the end of each chapter. It has been deemed 'fairly easy to read', with a Flesh Reading Ease Score of 69.6.

We will seek to post the results of the first study on the ACBS website as soon as they are ready.

Best wishes,

Shane Ford (shanealwynford@hotmail.com)

Co-authors: Dr David Gillanders (david.gillanders@ac.ed.uk)

The treatment manual attached below was originally developed through an iterative process as described in:

Luoma, J.B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A.K., (2008). Reducing the Self Stigma of Substance Abuse through Acceptance and Commitment Therapy: Model, Manual Development, and Pilot Outcomes. Addiction Research and Theory, 16(2), 149-165.

The intervention was then tested in a randomized  clinical trial, the results of which are published here:

Luoma, J. B., Kohlenberg, B. S., Hayes, S. C. & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of Acceptance and Commitment Therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80, 43-51.

Abstract   

Objective: Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of Acceptance and Commitment Therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. Method: Consecutive cohort pairs were assigned in a pair-wise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of six hours of treatment that would have occurred at that same time. The ACT intervention consisted of three, two-hour group sessions scheduled during a single week. Results: Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at four month follow up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow up. Effects of the ACT intervention on treatment utilization at follow up were statistically mediated by post treatment levels of shame, in that those evidencing higher levels of shame at post treatment were more likely to be attending treatment at follow up. Intervention effects on substance use at follow up were mediated by treatment utilization at follow up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. Conclusions: These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use.

You can get both of the articles here.

The fidelity coding system used in the JCCP article is also below. Please contact Jason Luoma for consultation if you choose to use this treatment manual to replicate these findings or need help with the fidelity coding system. We'd also appreciate any input from people who choose to use this protocol in research or in treatment settings. Let us know how it goes or provide feedback to improve it.

As part of a newer study in Russia, our team created a revised version of the manual and then translated it to Russian. The newer manual is more detailed and more structured than the original and probably easier to use for most clinicians. This manual is currently being tested and results will be listed here when we know the results. In the meantime, the English version of the newer manual is also attached below (you need to be logged into see it) and free to use for research and clinical purposes. We also developed an updated fidelity coding system that is available upon request.

If you are interested in helping with the research on self-stigma, consider contacting the Self-Stigma Research Collaborative.

The attachments contain the individual and group ACT protocols (and group handouts) that were designed for use in severe substance abuse problems and were tested in:

An Individual ACT protocol designed for use in severe substance abuse problems. Experimental tests to date: Hayes, S. C., Wilson, K. G., Gifford, E. V., Bissett, R., Piasecki, M., Batten, S. V., Byrd, M., & Gregg, J. (2004). A randomized controlled trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance abusing methadone maintained opiate addicts. Behavior Therapy, 35, 667-688.

Note that the group manual was set up to support the individual manual ... it is not designed for use by itself. Exp

If you have questions email the researchers ... don't just post a comment here (there is not procedure that forwards that to the researchers and there are thousands of pages on this website)

The treatment protocol for the ACT for skin picking study is exactly the same as the one for the OCD study by the same authors. All you need to do is change the word "obsession" to "urge to pick" and it will fit nicely.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). A preliminary investigation of ACT for chronic skin picking. Behaviour Research and Therapy, 44, 1513-1522.

Below is a protocol for a two and a half hour workshop on ACT for stigma toward people with psychological disorders developed by Akihiko Masuda, Kara Bunting and Steven Hayes. The psychoeducation control protocol used in Masuda et al. (2007) is also included.

Experimental tests to date:
Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., Twohig, M. P., & Lillis, J. (2007). The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45(11), 2764-2772.

Kevin Polk is in private practice and at the VA in Togus, Maine, USA has collaborated with Jerold Hambright and Mark Webster to develop "The Matrix" as a way of thinking about and engendering psychological flexibility. It is a simple yet elegant way to understand and experience the complex phenomenon of being human.

[Kevin runs ongoing "The ACT Matrix" webinars and consultations each month. Go to www.theactmatrixacademy.com to sign up.]

The Matrix is a simple to use format developed initially for groups, but then came into wide use with individuals. Based on an original idea by Kevin Polk the format was co-developed with Mark Webster and Jerold Hambright. It is based on learning to discriminate between direct experiencing with the senses and indirect experiencing in the mind (vertical line), and then the idea of sorting behavior into two directions called Towards and Away (horizontal line). The two lines of the matrix intersect in the middle at 90 degree angles. The four quadrants created by the two lines contain the following four categories that are asked in the following order:

Learning to use the Matrix is experiential and much the same as learning to ride a horse, or a bike, or play the piano, or paddle a kayak. It is a simple idea that can be learned very quickly but takes a little time and practice to become proficient. Mainly people practice learning to notice where behaviors are taking them, and to align that with what is important. The simplicity of the model means that it is broadly applicable and can be used outside of the clinical setting, for instance it is already used in education and in the workplace. It's been used in Sierra Leone to help combat the spread of the Ebola virus and in prisons to help inmates improve value consistent behaviors.

Read more about Polk's work on his Psychological Flexibility Blog.

Check out the free ACT Matrix Course here...

Free ACT Matrix Video Course

Mark Webster has also created a 3 part video series introducing the ACT Matrix which can be found here:

Part 1
Part 2
Part 3

To Learn more also see Kevin Polk's training page as well as his Website.

Click here for upcoming workshops and trainings.

Below you will find various handouts and .pdfs about the matrix cultivated from trainings anf conference presentations.

Here's how to use the ACT Matrix for the first time with a client, including scripts of how to phrase things.

It covers creative hopelessness, goal setting, therapeutic alliance and tips and tricks to setting up the ACT Matrix in a clear and comprehensive way.

The ACT Roadmap is a FREE 28 page Ebook for learning about Acceptance and Commitment Therapy (ACT).

With its colourful design, this digestible guide teaches you about ACT practice's head, hands, and heart. You'll learn about Contextual Behavioural Science (CBS), the home of ACT, receive guidance on treatment, supervision and relevant resources to build your knowledge and skills.

Written by Jim Lucas, ACBS Peer-reviewed ACT Trainer.

You can download a FREE copy here.

The ACT Roadmap is available in Portuguese: Roteiro ACT - Guia de Introdução à Terapia de Aceitação e Compromisso

The protocol is available in book form in
Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide. Oxford University Press.

The accompanying client workbook is available in
Woods, D. W., & Twohig, M. P. (2008). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Workbook. Oxford University Press.

Experimental tests to date:
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006). A controlled evaluation of Acceptance and Commitment Therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44(5), 639-656.
 

Hi, 

I have adapted some slides from Dr Janina Fisher- to explain how making contact with our Observing Self can help dampen the effects of our Amygdala on our FIght/flight responses. I hope that you find them useful. I would be most welcome to feedback. 

Kind regards, 

Campbell 

Experimental tests:

Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: A preliminary test of a theoretical model. Annals of Behavioral Medicine, 37, 58-69.

Below is a protocol for a 1-day workshop for weight-related stigma and weight maintenance based on Acceptance and Commitment Therapy developed by Jason Lillis, Steven Hayes, and Kara Bunting.

This is a protocol designed to reduce entanglement with stigmatizing thoughts about clients and through that reduction in burnout and stress at work.

Experimental tests:

Hayes, S. C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B. S., Fisher, G., Masuda, A., Pistorello, J., Rye, A. K., Berry, K. & Niccolls, R. (2004). The impact of acceptance and commitment training and multicultural training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behavior Therapy, 35, 821-835.

The protcol is for a 6 hour group workshop. It is not very detailed -- refering in a single line to exercises that might take 40 minutes. For those familiar with experiential ACT workshops, this should be enough. You will see most of these exercises at major ACT / RFT conventions such as the World Conferences or the Summer Institutes.

This protocol is currently being revised for a large new grant (which will run from 2005 to 2008) that will replicate and extend the study above. It is our sense that we can do better than the protocol that is here, so don't feel bound by it. Use it as a starting point.

The adherence manual include both ACT and Multicultural Training items since that was the comparision in the study (and in this new grant ... which will include an ACT and MT combination group as well as ACT alone and MT alone and a control).

For more information contact Steve Hayes (hayes@unr.edu), Department of Psychology, University of Nevada, Reno, NV 89557-0062

Experimental tests to date:
Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156-163.

The protocol itself can be found in Bond, F., & Hayes, S. C. (2002). ACT at work. In F. Bond & W. Dryden (Eds.), Handbook of Brief Cognitive Behaviour Therapy (pp. 117-140). Chichester, England: Wiley.

For further information contact: Frank Bond (f.bond@gold.ac.uk), Department of Psychology, Goldsmiths College, University of London, New Cross, London SE14 6NW
 

This course was designed for frontline hospital staff who were unable to attend a standard 8-week course in working hours, because of workload/staffing pressures. The course was delivered as 8 half-hour sessions WITHIN the hospital ward, in a quiet room, whilst their colleagues willingly covering their duties. The approach is based on MBCT, ACT and a self compassion exercise (made by combining ACT metaphor with an exercise provided by Choden and Paul Gilbert).

1 page Summary course overview is given in poster format below

Materials for the 8-week course, are supplied, organised by week. (Plus Week 0, which was the taster session). Includes all course materials, scripts, teacher timetables (we needed detailed timings because each session was only half an hour long, and we kept to these timings so that clinical work was not affected); we've also included a few reflections on how sessions went and how we'd do it differently next time, and equipment checklists. Mp3s for raisin and chocolate meditations are provided, and the other audio tracks are available with the course handbook (Peace in a Frantic World, Mark Williams and Danny Penman).

Measures: Another time, we would probably use different pre and post measures (these were selected based on local factors), e.g. GHQ12; the written qualitative questions yielded a lot of useful information; also staff were keen to express their thoughts in a facilitated meeting with the Senior HR manager Antony who championed the pilot.

Please feel free to use and adapt

Margo Campbell (ACBS member), Richard Hawkins, Antony Cobley (not ACBS members)
 

Experimental tests to date: None Published For further information contact: Amy Murrell (amurrell@unt.edu) or Kelly Wilson (kwilson@olemiss.edu), University of Mississippi. Author's note: We are posting this protocol in the hope that they will provide useful information in helping clients and spark further interest and research in ACT with children and adolescents. Please, recognize that we consider the treatment technology to be evolving in nature. These protocols, therefore, should be viewed as works in progress. The underlying principles should be adhered to, but the protocols can (and indeed should) be used with flexibility.

We've gathered therapy resources for COVID-19, also known as Coronavirus.  These resources (as well as the comments) have all been submitted by ACBS members.

For the Public:

Resources for the public, as well as resources in other languages, are included here. 

Resources for Helping Children:

Resources designed for use with children, adolescents, and teenagers are included here. 

For Therapists:

A list of resources for therapists, including Teletherapy resources, are included here.

Looking for a Therapist?: This page lists members of ACBS who have identified themselves as ACT therapists and who are available for online/teletherapy and consultation. You can use the search feature to look for therapists by country, province/state, or city.

Are you an ACBS member therapist who provides Video/Teletherapy for clients? Click here to let us know. (ACBS staff will then update your online listing)

Are you looking for Video/Teletherapy software options? We have provided a few suggestions here.

The ACTing with Technology SIG has put together a page highlighting a few recommendations and guidelines for online/video therapy here.

 What is it?

The attached Word files are intended for ACT Clinicians to monitor their fidelity to the treatment principles of ACT. This is done by rating the therapist's practice immediately after each session.

Essentially the "ACT Core Competency Session Rating Form" is a less wordy form of the Core Competencies self rating form. The difference is that this form I've uploaded has very brief, generally three-word, descriptions of the items from the Core Competencies Self Rating Form. If you want to see how each item in the "Session Rating Form" corresponds to the ones in the "Competencies self rating form", read the "ACT Core Therapeutic Session Checklist Cross reference" file below. The Session rating form also has a checkbox for each session so that the sheet can be used for ten sessions with the one client.

How does it work?

You can score it in a number of ways. Here are some examples:

1. Check mark or cross in the box for presence of the dimension/behavior;
2. Check mark or cross for absence of the dimension/behavior;
3. Combination of both of the above - check for presence, cross for absence, dash for neutral or not applicable;
4. Score from say, 0 to 10 for degree/quality/frequency of the dimension/behavior.

Obviously if you're using this for research or for practitioner training, evaluation or supervision, you need a consistent approach across sessions and clients. N.B. US version is for Letter sized paper, UK version for A4.

Why did you do it?

I haven't had the opportunities that many ACT practitioners have had of being immersed in an ACT-focused research program or of attending a Summer Institute or World Conference. Consequently I've been trying to improve my ACT practice without the benefit of observational 'live' supervision. I've used this kind of self-monitoring sheet when learning other therapeutic approaches and found it very helpful. Using this kind of self-monitoring session rating sheet is one way I believe, of achieving expertise through effortful practice.

What's next?

If you download the session rating form and use it, please post your opinions, comments, suggestions for change/revision and findings here. If you have an extended comment or heaven forbid, actually use it in research or formal practitioner training, I'd suggest making a child page here.

As well, I'd ultimately like to see the 60-odd items here reduced to a manageable 12 or less. Workability of the tool will ensure its use. Parsimony, validity and reliability are essential.

The attached spreadsheet gives some idea of the direction in which I think this endeavour could develop. I've proposed six 'global dimensions' of in-session therapist behavior. They are Structure, Flexibility, Workability, Presence, Precision and Compassion.

These dimensions are not the same as the dimensions of the Hexaflex because the Hexaflex describes processes and I am attempting to describe either therapist traits or if you like, 'therapist qualities demonstrated in session'. Clearly though there is some degree of overlap - Being Present with Presence, and Acceptance with Flexibility (but also with Compassion).

I've developed these 'global dimensions' to give the therapist some 'touchstones' or compass points for their own practice. I welcome practitioners', trainers' and researchers' comments on any of these documents.

I've been using a process with both group, couple, and individual clients that seems to work pretty well. I stumbled upon this, but I'm sure it's been thought of before. If someone has refinements, I'd love to hear it.

 I've been using the back of old business cards to conduct a chain analysis of behaviors with clients. Business cards seem to be just the right size for this, as you can't really put much on them. I have the clients write down all of the pieces of the situation, behavioral chain, what have you, and then they lay them out.

The cool thing is, sometimes they'll lay out two cards that seem to have a lot more to them, and I can challenge them to make sure there's no more steps. For example, my mother calls me on one card, I want to die, on the next. We can tease apart all of the behavioral steps in the chain, group different parts together, shift them around, add new or different steps, change the order. It seems to work pretty well for defusion and self as context.

At the end of the session, clients take their business card chains home with them, and bring them back to session the next time. We talk about walking even with the cards in their pockets.

It's fun.

Core Processes/Metaphors Tracking

Have you ever had this situation: You are meeting with your sixth patient of the day and, in the therapeutic moment, you see a perfect opportunity to present a particular ACT metaphor....but you can't quite remember if you had done that other metaphor which sets the stage for this one.....and you ask "have we talked about the person in the hole yet?" Now, many of the perfect therapists on this list surely would never do this. However, for the rest of us, how do you keep track of what you have covered?

I designed the attached form (see bottom) for jotting down what I have covered. I sometimes review it prior to sessions along with progress notes from those earlier sessions. Now, granted, I still occasionally check-in about whether we covered an exercise/metaphor (no big deal), though less often and less awkwardly. You will note that the exercises and metaphors often target multiple core processes, so this form is just a coarse tracking guide. But I find it helpful.

Content of the Attachment

Page 1 is the form. Page 2 is an example of what it might look like after multiple sessions (metaphors/exercises would be hand-written, of course). Upon review, the sample on Page 2 contains far more actual content than the completed forms I have used with patients.

Using the Form

Time proceeds from middle (1st session) to out (in my use of it). Going from out to in results in much crowding of the content in the middle. It also makes it more difficult to get a sense for the progress of therapy (at a glance).

Using the Form for Self-Assessment

The form can also be used as a tool for ongoing self-assessment, revealing your therapy habits. For example, even a casual glance at some of my completed forms quickly revealed that I favor Values work and Cognitive Defusion, using a handful of mindfulness techniques, mostly for getting clients and myself into the Present Moment, less so in the service of promoting Self-As-Context. While this evident pattern may merely reflect my personal style in using ACT, it also challenges me to do some self-examination about processes that I may avoid (one's style is always a work in progress, right?). I also find it useful to compare completed forms to my responses on the ACT Core Competency Self-Assessment, an excellent learning tool available on this site.

Improvements and Revisions

Feel free to edit, change, and improve the Core Processes/Metaphors Tracking Form to fit your needs. If others have similar tools/guides or improve upon this form, please share the work!

Purpose: To notice that there is a change agenda in place and notice the basic unworkability of that system; to name the system as inappropriately applied control strategies; to examine why this does not work

Method: Draw out what things the client has tried to make things better, examine whether or not they have truly worked in the client’s experience, and create space for something new to happen.

When to use: As a precursor to the rest of the work in order for new responses to emerge, especially when the client is really struggling. You can skip this step in some cases, however.

Things to avoid: Never try to convince the client: their experience is the absolute arbiter. The goal is not a feeling state, it is what the Zen tradition calls “being cornered.”

Examples of techniques designed to increase creative hopelessness:

These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal

Purpose: See thoughts as what they are, not as what they say they are.

Method: Expand attention to thinking and experiencing as an ongoing behavioral process, not a causal, ontological result

When to use: When private events are functioning as barriers due to FEAR (fusion, evaluation, avoidance, reasons)

Examples of defusion techniques

These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal

Purpose: Allow yourself to have whatever inner experiences are present when doing so foster effective action.

Method: Reinforce approach responses to previously aversive inner experiences, reducing motivation to behave avoidantly (altering negatively reinforced avoidant patterns).

When to use: When escape and avoidance of private events prevents positive action

Examples of acceptance techniques

These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal

Purpose: Make contact with a sense of self that is a safe and consistent perspective from which to observe and accept all changing inner experiences.

Method: Mindfulness and noticing the continuity of consciousness

When to use: When the person needs a solid foundation in order to be able to experience experiences; when identifying with a conceptualized self

Examples of techniques designed to increase self as context

These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal

Purpose: To clarify what the client values for its own sake: what gives your life meaning?

General Method: To distinguish choices from reasoned actions; to understand the distinction between a value and a goal; to help clients choose and declare their values and to set behavioral tasks linked to these values

When to use: Whenever motivation is at issue; again after defusion and acceptance removed avoidance as a compass

Examples of values techniques

These clinical materials were assembled by Elizabeth Gifford, Steve Hayes, and Kirk Stroshal

Please feel free to attach specific acceptance exercises you have found useful in your work (in general or with specific populaitons). 

If you have developed your own acceptance exercises and tailored them for specific patients, please share them here so that the larger ACBS community may benefit from your particular take on the work, and in turn, you may find additional exercises of use to you here.

Please feel free to attach specific defusion exercises you have found useful in your work (in general or with specific populaitons). 

If you have developed your own defusion exercises and tailored them for specific patients, please share them here so that the larger ACBS community may benefit from your particular take on the work, and in turn, you may find additional exercises of use to you here.

Please feel free to attach specific meditation exercises you have found useful in your work (in general or with specific populaitons). 

If you have developed your own meditation exercises and tailored them for specific patients, please share them here so that the larger ACBS community may benefit from your particular take on the work, and in turn, you may find additional exercises of use to you here.

Please feel free to attach specific exercises you have found useful in your work (in general or with specific populaitons). 

If you have developed your own exercises and tailored them for specific patients, please share them here so that the larger ACBS community may benefit from your particular take on the work, and in turn, you may find additional exercises of use to you here.

I've put together a few handouts for students at the University of New South Wales, Australia. Whilst they were originally designed with students in mind the content is relevant for older adolescents to adults. Topics include: stress and anxiety, low mood / depression, relationships, mindfulness meditation, healthy lifestyle / choices with awareness, "getting unhooked from difficult thoughts" and writing oneself a letter from the future. They are intended as a brief reminder of workshop material (or session discussions) or to be used as a stand alone summary of skills. Feel free to share as appropriate.

Several members have shared Defusion worksheets to use with clients.

From Amy S. House, Ph.D. - I made up this defusion worksheet and wanted to share. I’m sure there are other similar ones out there but I couldn’t find just what I wanted so I made this. The worksheet walks clients through just a few well-known defusion strategies, with some self-compassionate perspective taking thrown in. I hope the worksheet will be helpful for some of you and your clients.

Amy's Worksheet "Noticing and Working with thoughts" is attached below.

Bartosz Kleszcz has translated Amy's worksheet into Polish. This translated version is also attached below.

Lior Gilad has translated Amy's worksheet into Hebrew. This translated version is also attached below.

Debbie Sorensen, Ph.D. shared  - "I have also struggled to find a thought awareness worksheet that was exactly what I wanted before - and have created one myself, too. I'm attaching it here...in case it's helpful to anyone who wants to draw from multiple versions." Debbie's worksheet is attached as both a word and pdf document below.

YouTube animation of FACE COVID:

https://www.youtube.com/watch?v=BmvNCdpHUYM&feature=youtu.be

Illustrated eBook of FACE COVID:

https://drive.google.com/open?id=1OG58MgC4dR2PxwNhunCoYEaCOHN4TPkq

Infographic version of FACE COVID:
https://drive.google.com/file/d/1YjGsKTP23PKVP-pSYRbDWvNoSYM47Xg2/view?usp=sharing

Text only English language version of FACE COVID:
https://drive.google.com/file/d/1Q5-WQbw1q7qM9ZU3slUeYx1_3uITGtxn/view?usp=sharing

Spanish version on e (thank you Carlos Irurzun): https://drive.google.com/file/d/1GiIq2TGHwsnsZIKz0YqBDt1RSQbw_1gI/view?usp=sharing

Spanish Version two (thanks Enrique Parada): https://drive.google.com/file/d/1IC4kKXsi51nZl06VpX6HaSgryPpiZBdT/view?usp=sharing

Italian version (thank you Salvatore Torregrossa):
https://drive.google.com/open?id=1ZoLriWDQDgeApB02k4oyqALyFZ_edolk

Dutch version (thank you John Morawski):
https://drive.google.co m/file/d/1pvZCguyZGob5Dre0Kr3sErDVpV-Q1sn2/view?usp=sharing

French version (thanks Lise Loury)
https://drive.google.com/file/d/12Lbhc48TLuk2bCv1CpUQqAy_6ov1j6Lf/view?usp=sharing

German Version (th anks Threo Schelp)
https://drive.google.com/open?id=1UdHLbMBcEcA4GppZ3aIlPILUUQCIjUa2

Vietnamese version (thanks Gia Hoang):
https://drive.google.com/open?id=1e0dBe71FZY1CwXCqz2r9940JXdQ9oBOz

Hebrew Version (thanks Lilac Friedman):
https://drive.google.com/open?id=1hJ5nO2dBOuHa6yB_TGZwYs9JeTOPwBom

Russian Version (thanks Ilya Rozov):
https://drive.google.com/open?id=1vJFwSE5MhmyqC7pIbYEc8drAnVOAuzPd

Polish Version (thanks Agnieszka Wroczyńska)
https://drive.google.com/open?id=1RtEDPYUNHMMi8sRRg-jl_6MKAurJUI9j

Swedish Version (thanks Nicklas Lasko ): https://drive.google.com/file/d/17bCyStg7LkJoHaAUKEmjWABYDoOCwiz6/view?usp=sharing

Portuguese Version one (thanks Graça Areias):
https://drive.google.com/open?id=1B0N-JEnb7OGaXs7Wd-0vF3oCSrEoplEn

Portuguese Version two (thanks Bruno Carraça and C. Magalhães)
 https://drive.google.com/open?id=1UrFwi4FxNmLuqOHT50Zkp5d9nR5i7lTE

Malay Version (thanks Eugene Koh ):
https://drive.google.com/open?id=1Azgj-78tGcFgvLkKd7aLqOX8RbuUUvJN

Greek Version (thanks Maria Karekla):
https://drive.google.com/open?id=1iz7ui-hi0-tNTnvzTjOPdMGikQzG1mSx

Norwegian Version (thanks Kristin Evjen ):
https://drive.google.com/open?id=1_j1tyeIYEIyLPmaQLGi0A34jVo4jGF-8

Serbian Version (thanks Darko Tomic and Natasha Lazareski):
https://drive.google.com/open?id=1-cHQE45q9VqBvfU8Zi3xUpGlKHx5psGE

Several people got in touch asking for the PDF values cards doc we have stored, so please see attached. All cards on all pages are aligned so once printed you should be able to carefully cut several sheets at a time (if you've got a decent cutting tool). Credit to Paul Flaxman, who originally shared these cards with myself and colleagues. We just aligned them all on a PDF for ease of producing card decks!

Also, just to say, I would not see these a an alternative to the Values Conversation Cards mentioned in the original thread by Joe and developed by Louise Hayes. I find these to be a great resource and, personally, I use these in quite different contexts to the contexts in which I would typically use the attac hed.

Finally, for anyone who a) has not seen them, b) works with younger clients and c) might be interested, we worked with the charity 1625-Independent People to develop a DNA-v based tool kit, which is also in the form of a card deck. We make no cash on sales and all proceeds go to back into this fab charity (just to be clear!) so I share these here as - bias as I may be - I think they are really cool. Here's the link: The DNA-V Toolkit - A card pack for using ACT with young people : 1625 independent People (1625ip.co.uk)
 

Shared on 9/11/2021 by Duncan Gillard

There is now an entire website full of support materials for The Happiness Trap. Please visit the website for the book.  

I have also attached the introductory chapter below.

The Happiness Trap is unique amongst ACT books in that it is the only one that has been written for EVERYONE - therapists, coaches, housewives and astronauts, regardless of whether or not they have ‘mental health issues’ - which also explains ACT in a simple, easy-to-understand manner, without any technical language, or a battery of worksheets.

It is increasingly used as a resource by both therapists and coaches - not only to use with their clients, but also as a way of learning the theory and techniques of ACT in a simple, clear and entertaining manner.

Worksheets are designed for universal use and accompany the “Live Better” psychoeducation video series found here. 

To access class worksheet, please click on class title below.

"The First Step Workbook" is designed to support people in becoming more fully aware of how their lives have been affected by the use of mood altering chemicals. 

The workbook is often most useful when a person takes time to thouroughly respond to each question and then share their responses with a trusted therapist, group, mentor, or sponsor. 

After completing the workbook some people decide they want to make significant changes in their lives. 

see attachement - & feel free to change it as you like - one is a word doc. & then a jpeg

This is a treatment goal planning activity that I'm using that I really like.  I had been using a values sheet with the teens I work with to help them get in touch with sources of meaning in their stimulus-overloaded, introspection-devoid lives.  I love how values are the language of the spirit that lend nobility to our lives and work for Evangelical Fundamentalists as well as stalwart atheists.  I'd also done a life domain wheel (like life compass) some years ago as a self esteem development tool for teens though it had too much detail to capture their interest.  (That I've found such similar ideas and tools in ACT is very cool).  Anyway, I took the 80th birthday/be at your own funeral activity, combined it with the values sheet and life domain wheels to come up with a way that helps people identify highly personally relevant treatment goals.  (I'm not too computer savvy so it's not that nice to look at; but it works).

Russ Harris has shared a free eBook on a topic that comes up often in ACT training: When Clients Can't (or Don't Want to) Connect With Thoughts. 

When logged in, you will find the eBook attached below.

The ACTing with Technology SIG resources webpage has a list of smartphone apps. ACBS members can access the webpage here

The ACTing with Technology SIG has a website, which includes a section about Apps and Websites. 

On this page you can find known video/teleconferencing options that might work for you as a mental health professional. These have been submitted by ACBS members.

The ACTing with Technology SIG has put together a page highlighting a few recommendations and guidelines for online/video therapy as well.

(Looking for a therapist in your area who does video/teletherapy?  Look here!)

If you have more suggestions, please login to your ACBS account and add a “comment” at the bottom of this page, and we’ll incorporate your suggestion into this page.

Please check each system to verify that any system you choose conforms with any necessary security and privacy requirements in your Country/Province/State as needed. ACBS endorses no particular system, or its privacy statements.

Doxy.me

Doxy.me is easy to use, doesn’t require downloading the program from the client and is free for one-to-one sessions. In the paid version you can have group sessions, share your monitor, and other features.

doxy.me

Zoom

Zoom is also good for individual and group sessions. If you need to facilitate group sessions or need extra options, Zooms paid plans can be more affordable compared to doxy.me. (Zoom has free and paid versions.  Secure and non-secure versions.)

https://zoom.us/healthcare

Some ideas to Protect against malicious Zoombombing.

G Suite

https://cloud.google.com/security/compliance/hipaa

https://support.google.com/a/answer/3407054?hl=en

JITSI

Jitsi is a free and open source, fully encrypted video conferencing solution that you can use all day, every day, for free - with no account needed. You can also download it for free and run it internally at an organisation not only for staff but for customers and partners too.

To get going just use any room name to create a VC space and invite others to use it.

Some of its features are:
* Auto-view the active speaker or click on any attendee to see their video
* Android and iOS apps
* Text chatting (web only)
* Lock a room with a password
* and more....

https://meet.jit.si/
 

THERAPlatform

THERAPlatform is an all in one practice management system. The video portion features ability to use an interactive whiteboard, view videos, share documents and write progress notes during video sessions (as well as in-person sessions). It's secure and HIPAA-compliant. I have no affiliation with THERAplatform and am currently trying it out. On trial, it had better connectivity than experienced with other HiPAA-compliant video systems.

theraplatform.com
 

Whereby

https://whereby.com/ easy to use - no extra downloads. (privacy compliance unknown)
 

Here is a short film in Hindi ( with English subtitles) with an ACT relevant theme like living in the Present, Acceptance etc..

Synopsis from Youtube:
------------------

The story is about Anindya who is on the verge of committing sucide. But the very night he has a surreal encounter with life and death personified. Will anindya change his decision???

This final scene (around 20 min, subtitled in english), on website below, of indian movie Mohabbatein won best scene of year 2000. I think it illustrates in a simple dialogue between son-in-law and father-in-law, a life with pain/value versus a life without pain and changes.

In my humble opinion, I don't think the complete movie is worth watching, the best scenes being the ones between son-in-law and father-in-law. Plus, it is easy to understand this scene even if we didn't see the complete movie. Megha is the dead daughter. The beginning of this sequence is a little slow but climax will come. It is after 4 min that it is starting to unravel...... and around 10 min when the father talks to his students.

Indian movies have often this naïvely sentimental way of presenting things and often emphasize intensity of feelings by spectacular settings (nature is often present ---- thunder, lightning, strong wind, sunrays, etc.....).

For a relax way of learning ACT in life!

Cristel

https://www.youtube.com/watch?v=0QBeyPHDNVo

here's a link to M!ndi's animated story on youtube "Struggling with Internal Hijakers?"

+ M!ndi's message packs!!!

The attached files are the messages that you receive with the iphone app and desktop versions of M!ndi.

We hope you find them useful. Please feel free to use with your clients. And direct them to M!ndi's web page..

NeLi and James

This section of ContextualScience.org is for practitioners looking for a film to prescribe to their clients. Along the lines of the suggestions made in Rent Two Films and Let's Talk in the Morning, by John and Jan Hesley or "The Motion Picture Prescription: Watch This Movie & Call Me in the Morning - 200 Movies to Help You Heal Life's Problems", by Gary Solomon. I've found many films contain moments or plot turns that are highly suitable as metaphors for ACT processes. I invite the ACT community to contribute to this resource so we can help our clients and learn from each other.

Here's Jason Luoma's suggested ratings format and modifications to my original proposal. Thanks Jason! 

 At a recent lab retreat, Steve's lab came up with the idea of each movie receiving a hexaflex point rating. This similar to the 0, 1, or 2 two thumbs up from Ebert and Roper, but instead goes from 1 to 6, depending upon the number of ACT processes illustrated. The ultimate prize goes the person who can come up with a movie that illustrates all six ACT processes. Will YOU take up the challenge? It can come from multiple scenes in one movie. The ultimate challenge would be to identify one scene that illustrates all six processes. Go fot it!

I'd suggest when you review a movie, at the start you give it a hexaflex rating according to how many processes the movie illustrates.

The six processes are:

1. Contact with the present moment
2. Acceptance
3. Defusion
4. Self-as-context
5. Values
6. Commitment

For example, a movie that illustrates four of these proceses would get four hexaflex points! So as a format for ratings, I'd suggest the following:

1. Film name
2. Number of Hexaflex Points
3. Character, moment or plot point
4. ACT principle illustrated and which processes it involves.

Also you might want to put the number of hexaflex points in the title section.

Julian: Here's an example (one of my favorites ;-)):

1. The Matrix
2. 1 Hexaflex point (but see Camilla's additional point below)
3. Neo, the Keanu Reeves character, is asked to choose between the red pill or the blue pill
4. Choosing and Willingness - sometimes you can't know the outcome before you choose. Are you willing to have the consequences of choosing and just choose?

Here's Jason's example:

1. Indiana Jones and The Last Crusade
2. 3 hexaflex points
3. When Indiana is just about to get to the holy grail, he finds himself stuck at the edge of a seemingly bottomless chasm. He reads a riddle that suggests that the only way to get across the chasm is to take a leap of faith. So he steps out into mid air, seemingly to fall to his death. Instead, he finds that there is actually a hidden bridge that was built to blend seemlessly into the backdrop of the chasm and his step lands on terra firma. Whew!
4. The scene illustrates committed action, in that Indiana takes a step towards his quest even when unsure of the outcome. It illustrates willingness/acceptance in that the move is leadp of faith, requiring him to make room for his fear. And it illustrates defusion in that while his mind tells him he is going to fall to his death, he is willing to suspend that judgment, and when he actually steps out into a seeming void, he finds that this was an illusion.

To contribute your film, click on add child page below. In the Body section of the Edit page, include the following: 

1. Your Film
2. Number of Hexaflex points
3. The part where the character says something
4. ACT Principle represented

Simple as that!

Hope we have a lot of fun and learning with this,

Julian McNally

Sometimes it can be useful to play a piece of music at the beginning of a session or a group to more rapidly create a particular emotional tone for doing a certain piece of work in ACT.

If you use any music with clients, workshops, or groups, please share below so that others can benefit.

For example, I know that John Forsyth said that sometimes he uses Johnny Cash's cover of "Hurt" as an opening for his workshops.

To contribute your song, click on "add child page" below.
In the Body section of the Edit page, type

1. My song
2. ACT Principle: Defusion (or whatever it is)
3. Any recommendations on how to use the song

Hint: You can copy and paste the text above so that you don't have to keep track of all the HTML code.

Looking forward to the ideas. Cheers!

ACT POEMS
A key feature of clinical ACT work is the de-literalization of language and cognition. Metaphor, story, experiential exercises, art work and other techniques can facilitate this perspective shift for clinicians and clients alike. Although poetry uses the medium of language, the art and magic of poetry is often written from and can be received by the spaciousness of the self as context.
These poems can be used in clinical settings to illustrate, inspire and motivate around the six core processes of ACT.
“Poetry connects us to what is deepest in ourselves. It gives us access to our own feelings, which are often shadowy, and engages us in the art of making meaning. It widens the space of our inner lives. It is a magical, mysterious, inexplicable (though not incomprehensible) event in language.” Quote from Edward Hirsch.
“Life is neither meaningful nor meaningless. Meaning and its absence are given to life by language and imagination. We are linguistic beings who inhabit a reality in which it makes sense to make sense. For life to make sense it needs purpose. Even if our aim in life is to be totally in the here and now, free from past conditioning and any idea of a goal to be reached, we still have a clear purpose – without which life would be meaningless. A purpose is formed of words and images. And we can no more step out of language and imagination than we can step out of our bodies.” Stephen Bachelor - Buddhism without Beliefs

I've also attached the poster I did for Parma World Con and these same poems in word format. Enjoy :-)

ACT Poems

The Serenity Prayer
Grant me the serenity to
Accept the things I cannot change;
Courage to change the things I can; and
Wisdom to know the difference

DEFUSION

The Guest House-- Jelaluddin Rumi, translation by Coleman Barks
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honourably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.
Be grateful for whatever comes.
because each has been sent
as a guide from beyond.

Also From Rumi
Out beyond our ideas
Of wrong doing
And right doing
There is a field.
I’ll meet you there.

When the soul lies down in that grass
The world is too full to talk about.
Ideas, language, even the words
You and me
Have no meaning.

INSIDE by NeLi Martin
I don’t work for the CIA
MI5 or the FBI,
But I have a secret life
Inside.
While they talk and share –
Try to connect,
I’m running a different show,
It’s like multi-plex.

ACCEPTANCE

Kindness – Namoi Shihab Nye
Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.

Before you learn the tender gravity of kindness,
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,
you must know sorrow as the other deepest thing.
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.

Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to mail letters and
purchase bread,
only kindness that raises its head
from the crowd of the world to say
it is I you have been looking for,
and then goes with you everywhere
like a shadow or a friend.

St. Francis And The Sow by Galway Kinnell
The bud
stands for all things,
even those things that don't flower,
for everything flowers, from within, of self-blessing;
though sometimes it is necessary
to reteach a thing its loveliness,
to put a hand on its brow
of the flower
and retell it in words and in touch
it is lovely
until it flowers again from within, of self-blessing;

as St. Francis
put his hand on the creased forehead
of the sow, and told her in words and in touch
blessings of earth on the sow, and the sow
began remembering all down her thick length,
from the earthen snout all the way
through the fodder and slops to the spiritual curl of
the tail,
from the hard spininess spiked out from the spine
down through the great broken heart
to the blue milken dreaminess spurting and shuddering
from the fourteen teats into the fourteen mouths sucking
and blowing beneath them:
the long, perfect loveliness of sow.
 

INTREPID ADVENTURER by NeLi Martin

Intrepid adventurer
– Soft with determination
– Brave and courageous.
Many lands and landscapes traversed
Many encounters
In the quest for Freedom,
Truth,
Love.

Meanwhile
Loneliness, cold with despair, lies coiled.
Huddled into itself.
Asleep.

Shame hatred and unworthiness – all
Keep me from seeing
The task is also
To be willing to be found.

Gratitude
Humility
Gladness…

I find I am found

Joy

STEEL WOOLY THOUGHTS - NeLi Martin April 2005

The harshness of confusion
Scratches and tears at the flesh –
Wounds deepen
As I flail in pitiful attempts
At understanding.

Not realising
Freedom lies
Patiently awaiting my surrender.

LET THE WOUND LIE OPEN by Michael Leuni, Common Prayer Collection

When the heart
Is cut or cracked or broken
Do not clutch it
Let the wound lie open
Let the wind
From the good old sea blow in
To bathe the wound with salt
and let it sting
Let a stray dog lick it.
Let a bird lean in the hole and sing,
A simple song like a tiny bell
And let it ring
Let it go. Let it out.
Let it all unravel.
Let it free and it can be
A path on which to travel.

ANGER by NeLi Martin
Angry bitter in my teeth
Angry acid on my tongue
- How could you?
- Why would you?
Vengeance will be ……. Whose?
Nothing sweet
Here, is my life
Bound and battered by
Outrage and
Righteous
Indignation
And you just want to see my churlish
Girlish
Femme fatale.
But this bubbling cauldron of rage
This endless fury
Cannot, And never will
release me
Into the world.

Fair of Face and Full of Grace (Not) – NeLi Martin
The cards are dealt.
They flutter through the air
So full of possibility;
Innocent.
Anticipation …..
Gives way to expectation.
However, what is revealed
In the stark light
Of everyday life
Seems to deflate.
Let down.
In comparison to some
Just not fair.
BUT IT’S NOT FAIR
IT’S JUST NOT FAIR!
This is not the life I dreamed.
You don’t understand…
There was that promise –
That I would be special.
My life was supposed to mean
Something
To someone.
It’s not fair!
You don’t understand.
Misunderstood.
Miserably misunderstood
Misery.

Stuck raging
Railing against injustice.
It’s not fair for me
It’s not fair for you.
Join me in my struggle.
Unite in opposition.
Strengthen the struggle
(the cause devours its own baby)
United railing and rallying and raging
Against injustice.
Against –
Against –
Angst –
Angst ridden.
Suffering.
Suffering succotash, here again!