Resources for Clinicians

In keeping with one of the values of ACBS as a society, those who create clinical tools, measures, protocols, or other aids for case conceptualization, prevention or intervention work are asked to share these clinical resources with the society. Therefore, the materials posted here are available to paid ACBS professional or student members. Reciprocity is also key, so please consider sharing with the society any materials you have found useful.

Exercises, protocols, metaphors, visual aids and other materials are always a welcome addition to any clinician's arsenal of techniques.

The resources available here are intentionally non-proprietary, but we recommend emailing the authors to find out more about their preferences for citations, etc.

Also be sure to check out available assessment measures and treatment protocols.

Choose a child page below for the topic of interest to you, or create a new child page to add your new material.

Introducing ACT to clients

This is a place to attach materials which can be given out to clients to introduce them to ACT.

A brief introduction to ACT from the March 5, 2007 issue of the Sunday Telegraph in the UK

See attachment below

A short introduction to ACT to be handed out after a first session

Russ Harris has this to say about the form which is attached below:

I've attached a word doc of a brief summary of ACT that I give my clients on the first session. Anyone can easily re-edit it to suit their clientele. (I also usually give them a copy of the "Embracing your Demons" article; it's pitched at a level the average layperson can understand.)

ACT in plain language

ACT in plain language
Submitted by Joel Guarna on February 1, 2006 - 10:38pm.

I agree that explaining ACT plainly is difficult. With my clients, I often compare and contrast ACT with CBT more generally, since CBT is more widely known. I discuss similarities and refer to some common roots to both. I then illustrate some contrasts to traditional CBT by saying that an ACT approach is "not so much about changing the content of thinking (give examples, +/- thinking, etc) or fixing 'distortions' as about changing your relationship to your thoughts, feelings, memories, and other so-called private events (relate these to their presenting issues). ACT is less about making anxiety or depression go away and more about getting you untangled from the thoughts, feelings and rxns you have and getting you (client) moving in a direction that is important to you."

I give a very lay summary that ACT is related to a basic science and theory about human language and thinking (I do NOT attempt to explain RFT in much detail) and their role in our suffering (I sometimes give examples of our pain/suffering and how it differs from nonverbal animals...if the client seems interested and appears to be following). I add that, since human language seems to complicate our dealing with private events, doing ACT as a "talk therapy" is tricky: "so, if you are up for it, we will use a lot of exercises, mindfulness practice, metaphors, and other methods to keep us both from getting tangled up in the words and ideas." I try to relate all of this to their personal issues as much as possible and use examples. I discuss this in "we" terms throughout.

Once their interest is piqued (& it usually is) and I am satisfied they have a sufficient grasp on the approach to give informed consent, I implore them to hold whatever "understanding" of this that they now have VERY lightly. I then try to back out of all this wordiness and shift back into a more experiential mode. The process is a difficult balancing act b/n providing enough info for informed consent and getting ahead of ourselves and getting too didactic and wordy.

ACT orientation diagrams

In case they are of use to anyone, I am attaching a couple of ACT orientation diagrams - variations on a theme really.

I hasten to say that these are not in any way intended to challenge the Hexaflex. Rather, they are intended for use with clients (or colleagues etc) to give a quick introduction or summary of what ACT is all about. Perhaps they might also have a role in therapy (individual or group), say in aiding discrimination training (e.g., "whereabouts on the diagram are you now?").

Get Out of Your Mind and Into Your Life (4x4) diagram:

Steve was kind enough to look at an earlier draft of this diagram which, as the name suggests, is intended to provide an overview of the book. Perhaps it could also be used as a structure for collecting client examples (e.g., pain, unworkable control attempts, etc). (I nicknamed it 4x4 because of the 4 circles and 4 arrows and it's quicker to write in the notes!) The 4 arrows of course represent 4 of the hexaflex processes, being the ACT skills enabling the client to get out of their mind (lower circles - pain/ struggle > suffering) and into their life (upper circles - values/ commitment > action).

(Putting this together made me wonder if the sequence of the arrows could suggest a sequence for the teaching of ACT skills, each building on the previous one - i.e., being in the present moment facilitating the observer perspective - in turn facilitating defusion - in turn facilitating acceptance.)

Four Cycles diagram:

Similar idea but generally a bit more detailed, though amalgamating the "self-as-context" and "being present" processes in a single "noticing" item (and a similar amalgamation - "Overthinking" - in the Struggle cycle). In this one the pivot point is in the middle ("Pain") and from there you either shuttle round the Struggle and Suffering cycles - the former specifically includes the processes associated with psychopathology according to ACT (e.g., fusion) - or, after some ACT (it is hoped), the Acceptance and Commitment cycles.

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I got a bit of feedback regarding these diagrams from my ACT follow-up group today. The view seemed to be that the 4x4 diagram provides a quicker reminder of the central ACT messages, that might be more useful in times of trouble, whereas the Four Cycles looks more complicated, but might have a role when learning ACT in more relaxed contexts. On the issue of using "noticing" to represent "self-as-context" and "being present", my group felt that "noticing" has the helpful connotation of something that is readily accessible in everyday life, whereas accessing an observer self seemed to suggest something more formal and effortful - perhaps less natural in everyday life. However, it was also said that being introduced to living in the present and the observer-self separately might be better when first learning ACT, moving to the more accessible noticing concept later.

Finally, I must mention that conversations with Mark Webster have influenced the development of these diagrams, and I believe that he in turn has been influenced by the Life Manual approach of Kevin Polk and colleagues.

David

Comparing ACT and CBT

From my website, www.whitepinepsych.com:

Treatment Approaches

Cognitive-Behavioral Therapy
What is Cognitive-Behavioral Therapy (CBT)? The history of CBT dates back to the seminal work of B.F. Skinner, the father of modern behavior therapy. At that time, behavior therapy was a reaction to the traditional Freudian forms of psychotherapy that were only loosely based on scientific principles and were difficult to subject to rigorous scientific study. Skinner held psychology accountable as a science of human behavior, forever changing the face of psychotherapy. Techniques drawn from Skinner's basic behavioral science continue to be employed with good effect in modern psychotherapy. Skinner's account, however, had its limitations. The most notable limitation was that his account of human language and cognition failed to generate a vigorous line of basic research, limiting its evolution to forms that could be employed with patients with complicated psychological problems. Instead, the field opened to the work of Albert Ellis and Aaron T. Beck, the founders of modern cognitive therapy. Ellis and Beck, and their many successors, transformed the practice of psychotherapy by emphasizing therapy techniques that aimed to change the content and manner of one's thinking, not just their overt behavior. Cognitive therapy and behavior therapy continued to cross-fertilize each other over the past several decades. Modern CBT incorporates both cognitive and behavioral techniques. CBT has become the most well-known, mainstream approach to therapy, partly because it has, by far, the strongest research support for its effectiveness in treating a wide range of emotional and behavioral problems. CBT has been found effective in treating depression, anxiety disorders, the effects of trauma, substance abuse and addiction, complications related to medical conditions, and many other conditions.

Acceptance and Commitment Therapy
What is Acceptance and Commitment Therapy (ACT, said as the word "act")? ACT, just celebrating its 25th anniversary since its inception, is an innovative form of behavior therapy that has built upon both the strengths and the weaknesses of modern cognitive-behavioral therapy (CBT). ACT is based on a behavioral account of human language and cognition called Relational Frame Theory (RFT), which has "filled in the holes" left by Skinner's theories. RFT, in contrast to Skinner's accounts, has generated a vigorous body of basic research into human language and cognition, providing fuel for the development of new treatment approaches. The "fruit" of this progress can be found in the philosophy and basic concepts underlying ACT. ACT has moved away from the traditional CBT emphasis on changing or correcting one's thoughts in order to alleviate suffering. Instead, ACT aims to alter the functions of our private experiences (thoughts, feelings, memories, bodily reactions), so they no longer entangle us. Said another way, ACT aims to change our relationship with these private events so we can become free from their grip, and free from the patterns that bind us and prevent us from living a flexible, meaningful, and enjoyable life. In the service of these aims, ACT incorporates acceptance strategies, mindfulness techniques, and a wide range of behavioral approaches already known to be effective from CBT.

Communication au symposium Pleine Conscience des 37èmes Journées Scientifiques de l'AFTCC, Paris 12 décembre 2009

Étude d'analogues expérimentaux de la restructuration cognitive et de l'acceptation sur l'émotion et la croyance dans une pensée évoquées par un souvenir douloureux
L. CORNU (1), B. PUTOIS (1), B. SCHOENDORFF (2)
(1) Université Louis Lumière, Lyon
(2) Université Claude Bernard, Lyon
Communicant : Lydie CORNU Lydie Cornu
Problématique :
Les TCC de la 3ème vague promeuvent l’acceptation plutôt que la remise en cause des pensées et émotions douloureuses. Cette étude visait à mesurer l’impact relatif d’analogues expérimentaux de l’acceptation et de la restructuration cognitive.
Méthode :
Sujets : 44 (32 après critères d’exclusion) étudiants sains de l'Université Louis Lumière Lyon.
Matériel: Une fiche dérivée de la fiche de Beck à cinq colonnes était donnée à compléter pour un groupe et une fiche similaire mais avec des instructions d'acceptation (accueillir sensations, pensées et émotions) à un deuxième groupe. Les instructions étaient également présentées au moyen d'enregistrements audio.
Procédure : Les participants, assignés de manière aléatoire à l'un de deux groupes, Restructuration ou Acceptation, étaient invités à évoquer un souvenir difficile et à l'écrire sur la fiche, avec la pensée qui leur était venue, puis à coter sur 10 leur niveau d'émotion et de croyance dans la pensée. Le commentaire les guidait à travers les étapes de
chaque condition, puis les invitait de nouveau à coter émotion et croyance, ainsi que 15 jours plus tard.
Résultats :
Une ANOVA à mesures répétées a montré un effet principal du temps sur l'émotion évoquée F(2,60)=9.85, p<.0001, sans effet de tâche. Il y avait une interaction marginale Tâche X Temps F(2,60)=3.07, p=0.0537, indiquant que l'émotion baissait plus pour le groupe acceptation relativement au groupe restructuration. Les analyses de contraste révélèrent que la seule interaction significative était entre la phase pré-test et suivi. F(1,30)=7.56, p<0.01.
Un effet principal du temps sur la croyance F(2,60)=5.9810, p<.001, sans effet principal de la tâche ni interaction Tâche x Temps indiquait qu'il n'y avait pas de différence entre les deux groupes de réduction de la croyance.
Discussion :
Cette première exploration suggère que restructuration cognitive et acceptation réduisent tant l'émotion évoquée que la croyance dans la pensée négative évoquée par un souvenir difficile. Au suivi, cette expérience suggère que l'acceptation a un impact supérieur à la restructuration sur la seule réduction du niveau de l'émotion, mais pas sur la croyance dans la pensée.

Metaphors

Here are some metaphors that can be used when introducing ACT to clients.

Fish in the Water

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

Steve's Battlefield Metaphor (excerpted from forum)

Plain language version of ACT
Submitted by Steven Hayes on February 3, 2006 - 12:36am.

What do you think of "Get Out of Your Mind and Into Your Life."
It's not a free answer, but at $13 on Amazon, its close to that

Here is what I say to clients. 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.

Steven C. Hayes, University of Nevada

The Sh*t Metaphor

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

The Titanic metaphor

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

Two Mountains Metaphor

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."

Informed Consent for ACT

In a recent discussion on the ACT listserve, a member asked about how we handle issues of informed consent in the use of ACT. Below is my own understanding of informed consent:

In my own training and the way I train folks, therapy should always start with informed consent. Below is a thumbnail of my approach:

1) Address alternative therapies
I think it is beholden on us to mention alternative treatment approaches that have demonstrated efficacy (including pharmacotherapy) and also to mention that alternative treatments where the direct evidence base is not substantial, but appears to be sensible given the more general evidence available in the literature. If there is a gold standard, like Barlow's PCT for panic--I tell them about it.

I do not get into any kind of big theoretical discussion about, my reservations about the overselling of pharmacotherapy or my own understanding of the likely mechanisms of action in cognitive therapy. I don't do those therapies and if people want them, I can point them to folks who are well versed in them. I also do discuss allegiance effects, though I take them quite seriously. I think that whenever possible, one ought to get therapy from someone who is fully invested in that sort of work. So, if someone wanted CT for depression, I would be the wrong guy. I know smart capable people who do that sort of treatment and am happy to refer folks to them. Likewise, if someone presents with panic, I am not going to do a straight up PCT treatment with them, even though it is the gold standard. I will tell them about PCT (including that is the gold standard) and say that I would do work that has many similarities and is based on many of the same principles, but if they want that specific treatment, I refer to another provider in our clinic. (See below the section on describing the treatment I do as to some ways it might differ from a straight up PCT protocol.

2) Address risks and benefits
My addressing of risks and benefits does not look much different than risks and benefits for any treatment--i.e. not everyone benefits from any treatment, even the most successful varieties. I do not bury a client in a lit review or a checklist of diagnoses for which there is ACT evidence. I do not really buy the diagnostics much anyway. I typically tell people that the treatment we do is directly connected to a tradition that has been useful for a lot of difficulties and that the evidence for this particular looks very promising in the breadth of difficulties for which it seems useful. I also tell clients that treatment is difficult work. I tell people that they may experience significant distress during treatment. I promise to talk about how the person is doing along the way and if it looks like this treatment is not beneficial, I promise to work with them to find the best alternative treatment referral (since my group only focuses on ACT and behaviorally-oriented work).

3) Propose specific time frame
I generally tell clients that it can be a problem estimating whether treatment is useful on a moment by moment basis. Sometimes I use metaphors to illustrate this point. For example, if you plant a garden, going outside every fifteen minutes to see how it is coming along doesn't work very well. Or, going to the gym to get in shape--sometimes you feel worse physically before you start to see the benefits. Also, like physical training sometimes you see periods of progress punctuated by periods that are somewhat flat. I like to start with a time frame where we will stop and look back and ask ourselves "are we headed in the right direction." Partly the time frame depends on the client and the difficulty, but I like a window of 4-6 weeks. This does not mean I expect life to be peaches and cream in 4-6 weeks, just that I think in that time period we should have some sense that we are headed in a direction that seems to have some vitality.

4) Orient person to therapist, client roles
I tell clients that we will be working from a perspective that sees the people we call clients and the people we call therapists as being in the same boat. The rock climber metaphor from the book is a reasonable approximation of the relationship. I honestly can't recall exactly what is in the book, but like two rock climbers on opposite rock faces, there are things I might be able to see from where I stand that would be hard for them to see--not because I am all wise or something, just because I am standing in a different place. Likewise, there are things they can see and feel that I cannot--like the feel, temperature and texture of the rock. I tell clients that if I am to be most useful to them, it will help if I can see the world through their eyes, feel it with their hands. I can't, but I tell them that I will ask them to do their best to give me a sense of what it is like to live in their skin. And then I follow through. My aim is that a client leaves the room with no doubt that their experience was the most important thing in that room during that session. The combination of my somewhat different perspective and their own felt sense of their situation seems to me like the best shot at finding a way forward that works. I tell them this.

We used to say I will be very active at the beginning and that will lessen later. I tend to say something more like sometimes I will be more active and sometimes you will be.

5) Give general descriptions of operating principles
Since generally, behavioral methods are justifiable given the evidence base (exposure-based work, behavioral activation) I tell people that ACT is based on many of the same principles as the best supported treatments available, and will use many of the same methods, but that it tends to look at difficulties in the broader context of whole lives and an individual's valued directions. Therefore the treatment will end up looking at valued domains of living and the ways that these difficulties fit into that whole life. I generally tell them that the work is acceptance focused and whole life focused, rather than being focused on very specific problems. Problems are not ignored, at all; however, they are looked at in this broader way. I tell them that it will be very, very hard work and that we will not do a bit of work except in the service of the direction they would like to take their lives.

I hope this is useful.

peace,
Kelly G. Wilson

Case Formulation Frameworks: Using the "Hexaflex"

There are several ways to develop a case conceptualization of clients and their progress using the hexagon model.

ACT in Practice: Case Conceptualization in Acceptance and Commitment Therapy by Patty Bach and DJ Moran has a companion website that is hosted on the ACBS site, and provides a case conceptualization form freely available to you.

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).

There are child pages below that provide several other ways of practicing developing a case conceptualization throughout therapy.

The Hexaflex Dimensional Approach to Diagnostics

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

ACT ADVISOR Psychological Flexibility Measure

Please find attached a hexaflex-based self-report measure, and a form for recording scores on charts if the measure is used repeatedly. ACT ADVISOR (you guessed it) is an acronym for the hexaflex processes (Acceptance; Commitment & Taking action; Attention to present; Defusion; Values Identification; Self as Observer; and Resulting psychological flexibility). It is hoped that the instrument may be useful both in case formulation and in tracking progress during therapy.

The idea for using the hexaflex as a diagnostic/ case formulation tool was, I believe, originally Kelly's and his materials (see The Hexaflex Dimensional Approach to Diagnostics) influenced the development of this instrument. Steve 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 Case Formulation Framework

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

(Originally posted by Steve Hayes and moved to this location by J. Luoma)

The actView (the board for The ACT Game)

Attached is the actView. It is a simple tool for doing ACT Case Conceptualizations. You can use it to do case conceptualizations based on intake material, or you can use it after sessions as a supervision tool.

The actView is also used as a "board" for The ACT Game. A group of trainees can play at sending a client communication into the Therapy Context, observing where the communication lands in terms of stuck in Let Go, Show Up or Get Moving (or flexible in Valued Living with Less Struggling), then having a Therapist communicate an intervention designed to influence the client toward Valued Living with Less Struggling or reinforce flexibility in Valued Living with Less Struggling.

Assessment and Monitoring Tools

You can find assessment devices under the research resources section, here

Treatment Protocols

ACT is an orientation to psychotherapy that is based on functional contextualism as a philosophy and RFT as a theory. As such, it is not a specific set of techniques. ACT protocols target the processes of language that are hypothesized to be involved in psychopathology and its amelioration, such as:

cognitive fusion -- the domination of stimulus functions based on literal language even when that process is harmful,
experiential avoidance -- the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences and takes steps to alter the form or frequency of these events and the contexts that occasion them, even when doing so causes psychological harm
the domination of a conceptualized self over the "self as context" that emerges from perspective taking and diectic relational frames
lack of values, confusion of goals with values, and other values problems that can underly the failure to build broad and flexible repertoires
inability to build larger unit of behavior through commitment to behavior that moves in the direction of chosen values

and other such processes. Technological, ACT uses both traditional behavior therapy techniques (defined broadly to include everything from cognitive therapy to behavior analysis), as well as others that are more recent or that have largely emerged from outside the behavior tradition, such as cognitive defusion, acceptance, mindfulness, values, and commitment methods.

ACT protocols are thus instances of a strategy. ACT protocols can vary from very short interventions done in minutes or hours, to those that take many sessions. When an ACT strategy is aplied to a given problem it will include specific interventions designed to help with that specific difficulty, and thus every population will lead to different ACT protocols ... and there will be variation even with specific populations based on the creativity of the researcher/clinician and relative emphasis on various ACT/RFT-sensible processes. For all of these reasons and many more, the world ACT community has chosen not to ossify the treatment through processes of centralization, certification and the like, preferring to trust its development to open scientific processes. These include sharing of protocols, identification of processes of change, outcome research, basic research, and so on.

Protocols cited or displayed here are not the ACT approach to any given problem, but an ACT approach in the eyes of the serious researchers who post them. They are not "official" or "recognized" or approved by anyone by virtue of their posting here, but are offered as a resource to the world ACT community so that development of the approach can be accelerated. Clinical use of the protocols is the responsibility of those who choose to use them. If you plan to use these protocols in research, you should of course interact with the listed authors.

Site Members: If you have an ACT treatment protocol you would like listed here, click on the "add child page" link at the bottom of this page. When adding your content, remember that you can attach relevant files and documents.

At-Risk Adolescents

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.

Agoraphobia

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.

Acceptance and Commitment Training for Substance Abuse Counselors

Acceptance and Commitment Training for Substance Abuse Counselors protocol.

Experimental tests to date:
Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (in press). Using Acceptance and Commitment Training to Increase the Effectiveness of Continuing Education in Pharmacotherapy for Substance Use. Journal of Consulting and Clinical Psychology.

ACT For Sleep Problems

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

ACT Made Simple: Togus One Week Protocol

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

ACT Treatment Outlines for Anxiety and Depression (Forman et al., 2007 effectiveness study)

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

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.

ACT With Couples

This is not actaully a protocol as such, but this page seemed like the most logical place on the website to locate it. It is a powerpoint presentation from a half-day workshop I have given a few times, on the use of ACT with couples. I have a book on this coming out in early 2009 (called 'ACT With Love' - published by New Harbinger) The link below allows you to download it from my website: www.actmindfully.com.au

http://www.actmindfully.com.au/upimages/ACT_with_Couples_-_Russ_Harris.ppt

Chronic Pain Treatment Protocol

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.

Developmentally Disabled and Psychotic Individuals

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. (see publications list).

Diabetes Management

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.

Epilepsy

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, A. 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. (in press). Evaluation of mediators of change in the
treatment of epilepsy with Acceptance and Commitment Therapy. Journal of Behavioral Medicine

Experiential Adolescent Group Program

Louise Hayes and Julie Rowse. (2008). Acceptance and Commitment Therapy: Experiential Adolescent Group Program. Available from l.hayes@ballarat.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.

General Therapy Manual

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!)

Group Treatment of Depression

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

H.E.A.T. (Honorably Experiencing Anger and Threat) Protocol

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

Helping Psychotic Patients Cope with Positive Psychotic Symptoms

Experimental tests to date:

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.

For further information contact: Patty Bach (pattybach@earthlink.net), Department of Psychology, Illinois Institute of Technology, 3300 South Federal Street, Chicago, IL 60616

Math Anxiety

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.

OCD

An eight session ACT for OCD protocol.

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.

Communication au symposium Pleine Conscience des 37èmes Journées Scientifiques de l'AFTCC, Paris 12 décembre 2009

Étude pilote de prise en charge en groupe par l’ACT de patients TOC rechutés et/ou résistants et souffrant de comorbidité et suivi à 1 an.
B. SCHOENDORFF (1), B. PUTOIS (2), C. BARNEL (3), E. MOLLARD (4)
(1) Université Claude Bernard, Lyon
(2) Université Louis Lumière, Lyon
(3) Hôpital cardiologique Louis Pradel, Lyon
(4) Hôpital neurologique Pierre Wertheimer, Lyon
Communicant : Benjamin PUTOIS bputois@gmail.com
Problématique :
En proportion non négligeable, des patients souffrant de TOC ne répondent pas aux meilleurs traitements validés (TCC et/ou ISRS). Cette population souffre souvent de comorbidités tels des troubles de la personnalité. Cette étude pilote évalue l’efficacité potentielle d’un traitement ACT en groupe chez cette population.
Méthode :
Étude pilote sous forme de groupe fermé (11 séances d’intervention manuélisées et 3 séances de suivi) à l’hôpital Wertheimer de Lyon, N=9. 6 participants présentaient une comorbidité, dont 5 troubles de la personnalité. YBOCS moyen 28,7. 11 groupes hebdomadaires de 3 heures pendant 11 semaines puis suivi à 3 mois, 6 mois et 1 an. Mesures principales : Y-BOCS, et mesures autoévaluées de handicap, temps passé et malaise dû aux obsessions/compulsions. Nombreuses autres mesures dont AAQ (Hayes), MAAS (Brown&Ryan) et de qualité de vie (Marks).
Résultats :
Les 9 participants ont complété l’étude, mais seulement 7 ont participé aux séances de suivi.
L’acceptabilité du traitement était bonne chez tous les participants, et haute à très haute chez 6.
L’amélioration pré-post du score Y-BOCS était significative pour le groupe de 9 (z=2,67, p<,01 ; d=2,13) et
maintenue à tous les points de suivi (3 mois, 6 mois et 1 an) pour les 7 participants présents aux séances de suivi (suivi 1an : z=2,34 ; p=,02 ; d=1,92).
L’effet du traitement était également significatif sur la dimension handicap (à 1 an : p<,05 ; d = 0,91), et tendanciel sur la dimension malaise (à 1 an : p= 07 ; d=0,99).
Discussion :
Cette étude pilote de type « preuve de concept » suggère que l’ACT peut présenter une intervention adaptée et acceptable chez les patients « difficiles » souffrant de TOC résistants et/ou rechutés et souffrant d’importantes comorbidités. On peut faire l’hypothèse que les interventions de défusion cognitive, visant à distancer radicalement des pensées sont particulièrement bien adaptées à un trouble dont les victimes souffrent au premier chef de la tyrannie de pensées qui se « collent à eux » et contre lesquelles ils combattent en vain. On remarquera aussi la forte acceptabilité du traitement chez cette population réputée difficile.

Postpartum Depression

An ACT protocol designed for use with postpartum depression.

Experimental tests to date:

None

For further information contact: Espen Klausen (eklausen@hotmail.com), M. S., Department of Psychology, University of Wisconsin-Milwaukee.

Psychotherapy for methamphetamine dependence

An individual outpatient psychotherapy protocol for use with methamphetamine dependence. It combines motivational interviewing techniques and cognitive therapy relapse prevention techniques within an ACT framework.

Severe Substance Abuse Problems

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.

Skin picking

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. (in press). A preliminary investigation of ACT for chronic skin picking. Behaviour Research and Therapy.

Stigma Toward People With Psychological Disorders

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.

Trichotillomania

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.

Weight Maintenance

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.

Worksite Stigma and Burnout

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

Worksite Stress Interventions

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

Young Children

Experimental tests to date:

None Published

For further information contact: Amy Murrell (amurrell@unt.edu) or Kelly Wilson (kwilson@olemiss.edu), University of Mississippi.

Organizing Sessions

This section is for posting tools used by the therapist for organizing or facilitating sessions.

ACT Session Checklist

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:

Check mark or cross in the box for presence of the dimension/behavior;
Check mark or cross for absence of the dimension/behavior;
Combination of both of the above - check for presence, cross for absence, dash for neutral or not applicable;
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 (see page 27 especially).

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.

Business Card Behavioral Analysis

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

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!

Techniques and Components

Here are techniques you may find useful for some of the treatment components of the ACT model.

Facing the Current Situation ("Creative Hopelessness")/Control is a Problem

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:

Creative hopelessness	Are they willing to consider that there might be another way, but it requires not knowing?
What brought you into treatment?	Bring into sessions sense of being stuck, life being off track, etc.
Person in the Hole exercise	Illustrate that they are doing something and it is not working
Chinese handcuffs Metaphor	No matter how hard they pull to get out of them, pushing in is what it takes
Noticing the struggle	Tug of war with a monster; the goal is to drop the rope, not win the war
Driving with the Rearview Mirror	Even though control strategies are taught, doesn’t mean they work
Clear out old to make room for new	Field full of dead trees that need to be burned down for new trees to grow
Break down reliance on old agenda	“Isn’t that like you? Isn’t that familiar? Does something about that one feel old?”
Paradox	Telling client their confusion is a good outcome
Feedback screech metaphor	It's not the noise that is the problem, it’s the amplification
Control is a problem	How they struggle against it = control strategies (ways they try to control or avoid inner experience).
The paradox of control	“If you aren’t willing to have it, you’ve got it.”
Illusion of control metaphors	Fall in love, jelly doughnut, what are the numbers exercise
Consequences of control	Polygraph metaphor
Willingness vs. control	Two scales metaphor
Costs of low willingness	Box full of stuff metaphor, clean vs. dirty discomfort

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

Cognitive Defusion (Deliteralization)

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

‘The Mind”	Treat “the mind” as an external event; almost as a separate person
Mental appreciation	Thank your mind; show aesthetic appreciation for its products
Cubbyholing	Label private events as to kind or function in a back channel communication
“I’m having the thought that …”	Include category labels in descriptions of private events
Commitment to openness	Ask if the content is acceptable when negative content shows up
Just noticing	Use the language of observation (e.g., noticing) when talking about thoughts
“Buying” thoughts	Use active language to distinguish thoughts and beliefs
Titchener’s repetition	Repeat the difficult thought until you can hear it
Physicalizing	Label the physical dimensions of thoughts
Put them out there	Sit next to the client and put each thought and experience out in front of you both as an object
Open mindfulness	Watching thoughts as external objects without use or involvement
Focused mindfulness	Direct attention to nonliteral dimensions of experience
Sound it out	Say difficult thoughts very, very slowly
Sing it out	Sing your thoughts
Silly voices	Say your thoughts in other voices -- a Donald Duck voice for example
Experiential seeking	Openly seek out more material, especially if it is difficult
Polarities	Strengthen the evaluative component of a thought and watch it pull its opposite
Arrogance of word	Try to instruct nonverbal behavior
Think the opposite	Engage in behavior while trying to command the opposite
Your mind is not your friend	Suppose your mind is mindless; who do you trust, your experience or your mind
Who would be made wrong by that?	If a miracle happened and this cleared up without any change in (list reasons), who would be made wrong by that?
Strange loops	Point out a literal paradox inherent in normal thinking
Thoughts are not causes	“Is it possible to think that thought, as a thought, AND do x?”
Choose being right or choose being alive	If you have to pay with one to play for the other, which do you choose?
There are four people in here	Open strategize how to connect when minds are listening
Monsters on the bus	Treating scary private events as monsters on a bus you are driving
Feed the tiger	Like feeding a tiger, you strengthen the impact of thoughts but dealing with them
Who is in charge here?	Treat thoughts as bullies; use colorful language
Carrying around a dead person	Treat conceptualized history as rotting meat
Take your mind for a walk	Walk behind the client chattering mind talk while they choose where to walk
How old is this? Is this just like you?	Step out of content and ask these questions
And what is that in the service of?	Step out of content and ask this question
OK, you are right. Now what?	Take “right” as a given and focus on action
Mary had a little ….	Say a common phrase and leave out the last word; link to automaticity of thoughts the client is struggling with
Get off your buts	Replace virtually all self-referential uses of “but” with “and”
What are the numbers?	Teach a simple sequence of numbers and then harass the client regarding the arbitrariness and yet permanence of this mental event
Why, why, why?	Show the shallowness of causal explanations by repeatedly asking “why”
Create a new story	Write down the normal story, then repeatedly integrate those facts into other stories
Find a free thought	Ask client to find a free thought, unconnected to anything
Do not think “x”	Specify a thought not to think and notice that you do
Find something that can’t be evaluated	Look around the room and notice that every single thing can be evaluated negatively
Flip cards	Write difficult thoughts on 3 x 5 cards; flip them on the client’s lap vs. keep them off
Carry cards	Write difficult thoughts on 3 x 5 cards and carry them with you
Carry your keys	Assign difficult thoughts and experiences to the clients keys. Ask the client to think the thought as a thought each time the keys are handled, and then carry them from there

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

Acceptance

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

Unhooking	Thoughts/feelings don’t always lead to action
Identifying the problem	When we battle with our inner experience, it distracts and derails us. Use examples.
Explore effects of avoidance	Has it worked in your life
Defining the problem	What they struggle against = barriers toward heading in the direction of their goals.
Experiential awareness	Learn to pay attention to internal experiences, and to how we respond to them
Leaning down the hill	Changing the response to material – toward the fear not away
Amplifying responses	Bring experience into awareness, into the room
Empathy	Participate with client in emotional responding
In vivo Exposure	Structure and encourage intensive experiencing in session
The Serenity Prayer	Change what we can, accept what we can’t.
Practice doing the unfamiliar	Pay attention to what happens when you don’t do the automatic response
Acceptance homework	Go out and find it
Discrimination training	What do they feel/think/experience?
Mindreading	Help them to identify how they feel
Journaling	Write about painful events
Tin Can Monster Exercise	Systematically explore response dimensions of a difficult overall event
Distinguishing between clean and dirty emotions	Trauma = pain + unwillingness to have pain
Distinguishing willingness from wanting	Bum at the door metaphor – you can welcome a guest without being happy he’s there
How to recognize trauma	Are you less willing to experience the event or more?
Distinguishing willingness the activity from willingness the feeling	Opening up is more important that feeling like it
Choosing Willingness: The Willingness Question	Given the distinction between you and the stuff you struggle with, are you willing to have that stuff, as it is and not as what it says it is, and do what works in this situation?
Focus on what can be changed	Two scales metaphor
Caution against qualitatively limiting willingness	The tantruming kid metaphor – if a kid knew your limits he’d trantrum exactly that long; Jumping exercise – you can practice jumping from a book or a building, but you can step down only from the book – don’t limit willingness qualitatively
Distinguish willing from wallowing	Moving through a swamp metaphor: the only reason to go in is because it stands between you and getting to where you intend to go
Challenging personal space:	Sitting eye to eye

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

Self as Context

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

Observer exercise	Notice who is noticing in various domains of experience
Therapeutic relationship	Model unconditional acceptance of client’s experience.
Metaphors for context	Box with stuff; house with furniture; chessboard
“confidence”	con = with; fidence = fidelity or faith – self fidelity
Riding a bicycle	You are always falling off balance, yet you move forward
Experiential centering	Make contact with self-perspective
Practicing unconditional acceptance	Permission to be – accept self as is
Identifying content as content	Separating out what changes and what does not
Identify programming	Two computers exercise
Programming process	Content is always being generated – generate some in session together
Process vs outcome	Practice pulling back into the present from thoughts of the future/past
ACT generated content	Thoughts/feelings about self (even “good” ones) don’t substitute for experience
Self as object	Describe the conceptualized self, both “good” and “bad”
Others as objects	Relationship vs being right
Connecting at “board level”	Practice being a human with humans
Getting back on the horse	Connecting to the fact that they will always move in and out of perspective of self-as-context, in session and out.
Identifying when you need it	Occasions where “getting present” is indicated (learning to apply first aid)
Contrast observer self with conceptualized self	Pick an identity exercise
Forgiveness	Identify painful experiences as content; separate from context

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

Valuing as a Choice

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

Coke and 7-Up	Define choice and have the client make a simple one. Then ask why? If there is any content based answer, repeat
Your values are perfect	Point out that values cannot be evaluated, thus your values are not the problem
Tombstone	Have the client write what he/she stands for on his/her tombstone
Eulogy	Have the client hear the eulogies he or she would most like to hear
Values clarification	List values in all major life domains
Goal clarification	List concrete goals that would instantiate these values
Action specification	List concrete actions that would lead toward these goals
Barrier clarification	List barriers to taking these actions
Taking a stand	Stand up and declare a value without avoidance
Pen through the board	Physical metaphor of a path – the twists and turns are not the direction
Traumatic deflection	What pain would you have to contact to do what you value
Pick a game to play	Define a game as “pretending that where you are not yet is more important than where you are” -- define values as choosing the game
Process / outcome and values	“Outcome is the process through which process becomes the outcome”
Skiing down the mountain metaphor	Down must be more important than up, or you cannot ski; if a helicopter flew you down it would not be skiing
Point on the horizon	Picking a point on the horizon is like a value; heading toward the tree is like a goal
Choosing not to choose	You cannot avoid choice because no choice is a choice
Responsibility	You are able to respond
What if no one could know?	Imagine no one could know of your achievements: then what would you value?
Sticking a pen through your hand	Suppose getting well required this – would you do it
Confronting the little kid	Bring back the client at an earlier age to ask the adult for something
First you win; then you play	Choose to be acceptable

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

Exercises & Metaphors

Please feel free to attach specific exercises and metaphors you have found useful in your work (in general or with specific populaitons). Please do not upload attachments that are essentially full treatment manuals or protocols -- those can be uploaded here www.contextualpsychology.org/treatment_protocols. 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 and metaphors of use to you here.

"Writing" Acceptance exercise

This exercise is a fun way to help clients understand acceptance.

1st part: The clinician gives a sheet of paper and a pen to the client and says "I'm going to ask you to write a sentence if you're okay". Then the clinician puts an obstacle (a piece of carton board, for ex) in front of client's eyes and says "Wait a minute, is this annoying you if I put this in front of your eyes? Would you prefer if I'd take it off? Well I'm sorry but I'm going to let it there though. However, as you said you prefer to see while you're writing, I allow you to do everything you want to try to see what you're writing. You can move your head, you can get up... Just do everything you can to see what you're writing. Is that okay? So let's go!"

Usually, after 20 to 30 seconds the client has still not written anything readable because s/he has been too occupied with trying to avoid the obstacle so we stop the first part of the exercise. The clinician then says "How was it? Was it difficult? Have you been able to write the sentence? Can we read it?" Obviously not.

2nd part: The clinician says "Well, I'm going to propose you another approach to help you write this sentence finally. I'm sorry but I'm going to let the carton in front of your eyes again. But this time, I propose you not to try to bypass the obstacle but to concentrate your efforts on writing. Maybe it won't be easy but just do your best to
write the best you can so as we will be able to read the sentence." Generally, the client very quickly writes a sentence that we are able to read and we can debrief then.

A possibility is to ask the client to write some action linked to his/her value and to write on the carton the thing s/he tries to avoid (a painful thought for ex).

Also: sometimes clients or participants in workshops get the thing during the first part of the exercise (i.e. s/he stops trying to avoid the obstacle and starts writing the sentence). This is good too because it means they understand the approach by themselves.
But it can be also interesting to encourage them to do as much as possible to see while writing so as to make them observe the difference between the two approaches.

Defusion Exercises

For he's a jolly good (insert X)

Another good silly song is "for he's a jolly good fellow" including the "so say all of us".

The most fun I've had with it was a client with Schizophrenia and OCD, fused with the idea that people in the shopping mall knew about an incident where he made "obscene" phone sex calls to some girls he was interested in. It was paralysing his ability to go out in public with his friends. He saw himself as a sick pervert.

So we sang "For he's a jolly good pervert...." Try it - its almost impossible to get through twice without collapsing in laughter.

It has considerably (but not totally) weakened the power of the idea.

News of the World

This defusion exercise was submitted by Jacqueline A-Tjak on November 15, 2006

Hi ,

Let me take the bite. I went to a performance with six men. The performance was about 'music is everywhere'. They started by reading a newspaper and making sounds by manipulating the newspaper. And then they started to repeat a sentence, words from the sentence, that turned it into music. The phrase they used was something like: News of the world. One would repeat the phrase, others would say just some words in a certain rythm. I thought it was a great defusion experience. The content of the words disappeared completely. They were noises, sounds, fun. I intend to use this in my therapyroom.

Jacqueline

School of Fish

A cognitive defusion and acceptance exercise including instructions (see attached, pdf format).

What it is (from the exercise instructions): "In some ways, our experience of anxiety is like our experience of a school of fish. Imagine a school of fish seen from a distance. What you see is a large, looming, perhaps frightening shape moving through the water. It looks more like a large fish, perhaps a shark, than a group of tiny fish... If we got closer we would see the frightening object for what it is: not an object at all, but several smaller objects occurring in about the same space at the same time. "

So Who Are You?

This defusion exercise was posted by Hermann Meyer on November 29, 2006

Here is one of the best
I have come accross:

"So Who Are You?"

The witnessing of awareness can persist through waking, dreaming and deep sleep. The Witness is fully available in any state, including your own present state of awareness right now. So I'm going to talk you into this state, or try to, using what are known in Buddhism as "pointing out instructions." I am not going to try to get you into a different state of consciousness, or an altered state of consciousness, or a non-ordinary state. I am going to simply point out something that is already occurring in your own present, ordinary, natural state.

So let's start by just being aware of the world around us. Look out there at the sky, and just relax your mind; let your mind and the sky mingle. Notice the clouds floating by. Notice that this takes no effort on your part. Your present awareness, in which these clouds are floating, is very simple, very easy, effortless, spontaneous. You simply notice that there is an effortless awareness of the clouds. The same is true of those trees, and those birds, and those rocks. You simply and effortlessly witness them.

Look now at the sensations in your own body. You can be aware of whatever bodily feelings are present-perhaps pressure where you are sitting, perhaps warmth in your tummy, maybe tightness in your neck. But even if these feelings are tight and tense, you can easily be aware of them. These feelings arise in your present awareness, and that awareness is very simple, easy, effortless, spontaneous. You simply and effortlessly witness them.

Look at the thoughts arising in your mind. You might notice various images, symbols, concepts, desires, hopes and fears, all spontaneously arising in your awareness. They arise, stay a bit, and pass. These thoughts and feelings arise in your present awareness, and that awareness is very simple, effortless, spontaneous. You simply and effortlessly witness them.

So notice: you can see the clouds float by because you are not those clouds-you are the witness of those clouds. You can feel bodily feelings because you are not those feelings-you are the witness of those feelings. You can see thoughts float by because you are not those thoughts-you are the witness of those thoughts. Spontaneously and naturally, these things all arise, on their own, in your present, effortless awareness.

So who are you? You are not objects out there, you are not feelings, you are not thoughts-you are effortlessly aware of all those, so you are not those. Who or what are you?

Say it this way to yourself: I have feelings, but I am not those feelings. Who am I? I have thoughts, but I am not those thoughts. Who am I? I have desires, but I am not those desires. Who am I?

So you push back into the source of your own awareness. You push back into the Witness, and you rest in the Witness. I am not objects, not feelings, not desires, not thoughts.

But then people usually make a big mistake. They think that if they rest in the Witness, they are going to see something or feel something-something really neat and special. But you won't see anything. If you see something, that is just another object-another feeling, another thought, another sensation, another image. But those are all objects; those are what you are not.

No, as you rest in the Witness-realizing, I am not objects, I am not feelings, I am not thoughts-all you will notice is a sense of freedom, a sense of liberation, a sense of release-release from the terrible constriction of identifying with these puny little finite objects, your little body and little mind and little ego, all of which are objects that can be seen, and thus are not the true Seer, the real Self, the pure Witness, which is what you really are.

So you won't see anything in particular. Whatever is arising is fine. Clouds float by in the sky, feelings float by in the body, thoughts float by in the mind-and you can effortlessly witness all of them. They all spontaneously arise in your own present, easy, effortless awareness. And this witnessing awareness is not itself anything specific you can see. It is just a vast, background sense of freedom-or pure emptiness-and in that pure emptiness, which you are, the entire manifest world arises. You are that freedom, openness, emptiness-and not any itty bitty thing that arises in it.

Resting in that empty, free, easy, effortless witnessing, notice that the clouds are arising in the vast space of your awareness. The clouds are arising within you-so much so, you can taste the clouds, you are one with the clouds. It is as if they are on this side of your skin, they are so close. The sky and your awareness have become one, and all things in the sky are floating effortlessly through your own awareness. You can kiss the sun, swallow the mountain, they are that close. Zen says "Swallow the Pacific Ocean in a single gulp," and that's the easiest thing in the world, when inside and outside are no longer two, when subject and object are nondual, when the looker and looked at are One Taste. You see?

Metaphors

The purpose of this section is to allow members to share new ACT-relevant metaphors that have come out of their therapeutic or accademic work. If adding a metaphor (by adding a child page), please say something about it. For example, how it might be used or what ACT-relevant points it might be trying to make.

Becoming a Lawyer for your Family Traditions

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.

Flyfishing and getting hooked

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."

Intro to metaphors in ACT

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!

Life as a cycling race

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.

life direction metaphor

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."

Life's a beach - struggling in the rip

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)

nothing here

Opioid Substitution

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?

Room full of adhesive tape

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.

The mind as a GPS

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...

Thoughts as sales representatives

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 ?

Trumps

This came up in the context of 'creative hopelessness' when discussing a clients attempt to control anxiety etc. with rationality.

"So you have experienced that when playing cards with your mind the 'Rational' doesn't trump 'Feelings' or 'Thoughts'"

Waiting for the wrong train.

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.

Trains leaving the here and now station metaphor

Airan,

Thanks for the train metaphors; I'm going to use them. The following similar metaphor popped up in my mind while reading your note:

What about asking a client (or ourselves) to make a choice between two trains ready to leave the here and now station? One is an uncomfortable train and is moving in a valued direction; the other is your luxury, ultra-comfortable train and is moving exactly in the opposite direction. Which one are you going to choose?

Best,

Koke

Your life as a movie

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

Tin Can Monster exercise -- Audio files

Attached is the Tin-Can Monster exercise, which I recorded using the script from GOOYMAIYL. This is a really powerful willingness/acceptance exercise.

I recorded separate tracks for each experiential domain (bodily sensations, emotions, behavioral predispositions, thoughts, memories). This enables clients to repeat tracks to cycle through as many experiences in a domain as they'd like before going on to the next domain. To go through the whole exercise just once takes a fairly long time (45 min) but people can do this acceptance work in smaller chunks over time.

To download the tracks, you must first LOGIN to the site (and be a current paid member) & then when you click on the link & the dialog box appears, click "SAVE" not "play."

Values Exercises

Exercises related to clarifying values and promoting valued actions.

Batteries Exercise: Alternative to Life/Values Compass

This is an alternative to the Life/Values Compass exercise and can be used to organize behavioral activation efforts. I have used this as a metaphor when talking with clients about issues that are otherwise a bit abstract: helping connect them to the contingencies in their natural environment. Several clients have appreciated the metaphor as a simple and common language for having this discussion. Attached, you can find it in exercise form. I would recommend doing this after you have done some other values assessment/clarification so the client has specifics in mind for each valued domain.

Trying On a Value

This exercise is a good one for helping clients who do not have a strong sense of their values.

Rather than needing to 'know' which value is important to them in order to behave, is it possible to behave for a while to learn from direct experience how it feels to a) commit to behaving consistent with a freely chosen value, and perhaps b) learn over time which values may have meaning for the person?

Some work with the client around this issue (e.g., willingness, defusion/letting go of 'needing' to know the answer) will be helpful.

My experience is that it's a good idea to assign this as homework for an extended period of time -- at least a few days, a week or two, or longer if possible -- to help the client build up a longer history of behaving consistently with this value before coming to any 'decisions' about continuing to move forward in the direction of that or another chosen value.

Understanding metaphors in ACT

Below you will find an article 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).

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.

Visual Aids

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

ACT Related Illustrations

The content of the illustrations are as follows:

(A) Illustrates some of the problems engendered by control/avoidance/non-acceptance

(B) Compares and contrasts the medical model vs. the ACT model of psychopathology (including the importance of distinguishing means vs. ends in psychotherapy)

(C) A chart containing multiple examples comparing the behaviorist model vs. cognitive model of causation (i.e., do thoughts really cause behaviors?)

(D) A visual depiction of cognitive defusion

(E) Some illustrations that speak to the approach-avoidance conflict associated with willingness

Hexagon Models

This is a hexaflex (Hexagon Model of Psychological Flexibility) image that I generated in Word based on the image found in the Practical Guide. It took FOREVER, so I figured it might be worth posting. It IS modifiable if you right or control click and "Ungroup" into the shapes and text boxes I used to make it. Hope this is useful to someone!

--- note added later by Steve Hayes: I've also posted two images that can be placed into documents. One is the Hexaflex model, and a related model of psychopathology. These are MS office "png" images but are not modifiable (the originals are in CorelDraw).

By the way, we deliberately placed these Hexaflex images in multiple places -- including the list serve -- so that no copyright would be enforcable on them by publishers. If you need a citation, however, an easy one is

Hayes, S. C., Luoma, J., Bond, F., Masuda, A., and Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44, 1-25.

Clinical significance tester

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

Get Out of Your Mind and Into Your Life--Support Materials

This is a note from Steve Hayes about the book

I wanted to say a little about what we are learning about the impact of Get Out of Your Mind and Into Your Life

We have used or are using the book as part of our protocols in four scientific studies. The book is very flexible -- you can fit it to almost any issue, so these studies are in several different areas.

One study that is now done is Jason Lillis’s dissertation on weight maintenance. It’s a really neat study, and I predict it will get some publicity when it comes out in a journal.

In that study everyone in the ACT condition got a 6 hour workshop on ACT (not really focused on weight – but focused on doing what you value and learning to sit with difficult thoughts and feelings that get in the way). And everyone in the ACT condition also got the book.

When we then asked at the follow up if people used the book we divided up the groups into those who used it very little and those who used it regularly and carefully. We compared that last group (the readers and regular users) to people in the ACT condition who got the workshop but did not use the book much.

(In truth, in other analyses we also compared the frequent readers to the control group, and the effects there were huge, but that comparison includes the workshop in one group and not the other so it is really not as relevant to the question of whether the book itself was helpful).

At a three month follow up, those who read and used the book carefully in the ACT condition:
• Had a higher quality of life
• Were less judgmental toward themselves
• Felt less judged by others
• Were more accepting of difficult thoughts and feelings about weight issues
• Were more successful in living their values
• Had more intrinsic and less avoidant or socially compliant values

All of these folks got an ACT workshop, and the workshop itself had a really big impact – so this was over and above that. Overall (not dividing the group by whether they read Get Out of Your Mind carefully) people in the ACT condition lost more weight over 3 months, lowered their diastolic blood pressure, had better overall mental health, were more distress tolerant, and so on through a long list of good effects. But on top of that the book seemed to make an impact.

Tami Lazzarone has recently completed a randomized trial of the book with 236 teachers and staff in K - 12. At post those who read the book had small to medium improvements in general mental health, anxiety, depression, and burnout. At a 3 month follow up all of these effects were larger -- mostly medium to large. At the process level changes were found in mindfulness, acceptance, and psychological flexibility and these post changes mediated follow up outcomes.

Takashi Muto has done much the same thing with a Japanese translation of the book -- applying it to college students from Japan who are adjusting to life in the US. It is still underway but at post the effects are very good.

Anyway, let me just say this: there are a lot of books out there that say they will help you. It is one thing to say that. It is another to put a book on the line and see, objectively, how it works in controlled studies. So far the results coming in are very supportive.

BUT
How do we get everyone who buys it to read it carefully and to do the exercises? It seems to take that to make a real difference.

But probably a third of the folks who buy it will get bogged down and some will just abandon the book.

That really distresses me, since I know some of those people are suffering and could be helped if they gave the book a chance.

The bogging down may be due to my science geek writing style (I’m learning, but it is hard for me not to talk like a geek after 30 years in the University, even with a professional writer like Spencer Smith helping me). But the other part is this: this is a tricky area!

The human mind does not like being dethroned, and it is hard to use words to rein in the word machine. That is especially true in a non-interactive medium like a book.

But I do think there are steps that can help.

I suggest this if you buy this book:

1. Join the Yahoo list serve ACT for the Public. This is the link:
http://health.groups.yahoo.com/group/ACT_for_the_Public/join

It’s free. Post to it when and if you get stuck. Don’t abandon the book before you get help with it. Please.

2. It is hard to really do the book carefully right off from the beginning. It takes a while to see what it is really up to.

I suggest that you skim the whole thing in a day or two, skipping the exercises and not stopping if you get confused.

Then let it sit for a day or so.

Then if you sense that there may be something of value for you in the book, open it up at page one and read it carefully, doing the exercises as you go. That process will take at least a month. If an exercise or sections bogs you down, put a post-it note there and move on … you can come back later. And you can post an email about the issue on the list serve.

I hope this helps and good luck

Steve Hayes

The Happiness Trap - Support Materials

There is now an entire website full of support materials for The Happiness Trap. Please visit http://www.thehappinesstrap.com
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.

Peer Consultation

Another great way to create resources and support is to form a Peer Consultation Group. They are not hard to form. Just go here so advice on how to do so: http://www.contextualpsychology.org/act_peer_supervision_groups

Psychological Flexibility: The Matrix videos (Kevin Polk)

Kevin Polk 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.

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

Check out the series on YouTube:

Surfing Your Stress To Success: Kevin Polk's iView Videos

These two videos give the audience a taste of how to approach using the iView -- or finding the place from which we notice all things (moving toward values and moving away from unwanted private experiences).

Contact Kevin for additional information.

Workshop materials

Feel free to add handouts, forms, or any other therapist aids that you might use in a workshop.

Handouts from Introductory and Advanced ACT Workshops by Russ Harris

Russ Harris (from Australia) responded to a query about handouts that could be shared with the ACT community by volunteering a couple handouts that he uses in his workshops (see below). After looking at them, I find them to be a very valuable and practical aid for ACT therapists. If you want to talk to him about them, his contact info is described in the handouts.

ACT brief handouts for clients

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.

ACT Relevant Books, Films and Songs

Below are lists of books, films and songs relevant to ACT.

A life of being right versus a living life - a short scene

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

http://www.dailymotion.com/video/x1io9w_mohabbatein-part-7_shortfilms

ACT Onscreen: Films for Clients

This section of Contextualpsychology.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:

Contact with the present moment

Acceptance

Defusion

Self-as-context

Values

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:

Film name

Number of Hexaflex Points

Character, moment or plot point

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 ;-)):

The Matrix
1 Hexaflex point (but see Camilla's additional point below)
Neo, the Keanu Reeves character, is asked to choose between the red pill or the blue pill
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:

Indiana Jones and The Last Crusade
3 hexaflex points
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!
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, you type this at the beginning: <ol> <li>My Film</li><li>Number of Hexaflex points</li> <li>The part where the character says something</li> <li>ACT Principle: What's it all about Alfie?</li> </ol>

Which ends up looking like this:

My Film
Number of Hexaflex points
The part where the character says something
ACT Principle: What's it all about Alfie?

Simple as that! Hope we have a lot of fun and learning with this, Julian McNally

Hint: I think you can copy and paste the text above so that you don't have to keep track of all those "greater than" & "less than" signs.

A Beautiful Mind - 4 Hexaflex points (acceptance, defusion, values, committed action)

Beautiful Mind
Pretty much the whole thing. The main character, John Nash (Nobel Prize winner in economics), has schizophrenia and despite active hallucinations and delusions, he chooses NOT to be on antipsychotic medication (side effects are blunted affect and he isn't as clear in his genious mathematical ability). Nash chooses to just let his hallucinations be present and not to let his behavior be guided by belief in them as literal "truth". In turn, they follow him around for the rest of his life; a vital life full of meaningful experiences with his wife and his work.
ACT Principles: acceptance, willingness, defusion, choice and valued action.

About Schmidt (2002)

This movie is all about psychological inflexibility. Warren Schmidt (magnificent played by Jack Nicholson) is a man who's identity is built around his work (he is vice-president of an insurance-company). The film starts with his retirement's party: beautiful words spoken, compliments given..., but only one day later he discovers that he's not welkome anymore at the office, and all his work ends up in a garbage can. Soon after that his wife suddenly dies, and although he feels like a prisoner in his marriage for over 42 years, he loses in a short time everything. From that moment on his orderly life becomes chaotic and impulsive. He start's traveling with his king-size camper, visiting his daughter, finding out that he has never connected to her because of his work and now she doesn't need him anymore. He's afraid of intimacy and is running away from it or he spoils the moments were it's growing.
He can only connect to his "true" feelings in the letters to Ngudu, a foster-child in Africa he has adopted for $22 a month, and to whom he writes from time to time (although the child is to young to read his letters). It is there where psychological flexibility starts, painfully facing the life he lived.

I would say a movie about self-as-content, experiential avoidance, lack of values and impulsive behaviors. Must-see!!!

American Beauty

American Beauty
Much of the movie can be cast into terms relevant to clinical work with ACT. I often refer to people having an "American Beauty" moment in which they wake up one day and realize how their lack of mindfulness/life momentum has led them very far off-course from a path consistent with their values (like the Kevin Spacey character and others).
ACT Principle: There are numerous illustrations of mindfulness (and lack thereof) and the cost of experiential avoidance in the behaviors and choices of the characters.

American History X - Hexaflex points: 6

American History X
6 hexaflex points
I think this film could be seen as illustrating all the Hexaflex points:
Contact with the present moment- (this is the one I'm least sure about): there is a scene between the main character (white supremacist Derrick Vinyard) & a fellow prisoner (Lamont), who is black, where Derrick manages to make contact with the humour of Lamont's impression of 'angry sex' despite his deeply ingrained mind story of racial hatred.
Acceptance - two scenes stand out here: the first is when Derrick is recovering in the prison hospital after being raped & he is visited by his old school principal, Dr Sweeney, & for the first time in the film Derrick accepts any other emotion than anger, which is demonstrated by his crying (sadness) & acknowledgment of not knowing what to do (uncertainty). Second example is toward the end of the film when Derrick is asked by the police to help deal with the inevitable inter-racial tensions following an attack &, despite Derrick not wanting to get involved, he reluctantly agrees to help as he sees that he must accept his responsibility for the situation.
Defusion - the whole of the film post Derrick's release from prison is about him defusing from his racist beliefs & trying to achieve the same with his younger brother, Danny.
Self-as-content: Similarly, Derrick & Danny both identify strongly with their white supremacist beliefs throughout most of the film, even to the point of tattooing swastikas on to themselves, adopting the skinhead hairstyle, indulging in racist attacks etc. It is only when they can stand back from this view can they find compassion & a flexibility of mind.
Values: during the previosuly mentioned scene when Derrick is in the prison hospital & is visited by Dr Sweeney, he is asked by his ex-principal "Has anything you've done made your life better?" This is clearly a turning point for Derrick who then accepts Dr Sweeney's advice & acts on it by reading the books he has brought him. He also defuses from his racist view of the man & sees his true worth. His belief in his racist values is also undermined when he sees the leader of the white supremacist gang trade drugs with a Mexican gang - he remains true to his values at that point by leaving their protection, but pays a heavy price when he is then raped by the gang members.
Commitment: On leaving prison Derrick commits to turning his back on his racist way of life & behaving truer to his values of being a good example for his younger brother & trying to do his best for his family (with whom he previously fought & bullied). ?

Another movie with ACT-like messages is Happy Feet

I don't have time right now for the whole hexaflex thing but I just saw Happy Feet. For those of you who don't know, it is an animated Disney film with penguin stars. It was great, and there are wonderful messages in there about acceptance and valuing. It would be great to watch with children to spark discussions about all kinds of things from prejudice to global warming. Plus, it was just really darn cute!

Amy

Click

Briefly... Click is a movie that brings values work to life, an example of the dangers of striving and clinging. Leads the viewer to ask the question: I only live once, am I living it the way I want?

Crash (defusion. commited action and values)

There is not a particular scene in Crash that I think demonstrates the issues of values and defusion, I think as a therapist you could use the film as a whole to talk about values and defusion (evaluation, that is). The movie is about racism in Los Angeles, how ordinary people do nasty things to each other on the basis of prejudice and how people make choices in the service of their values and in the service of fear.
To start with evaluation: You could ask a client who are the bad guys and who are the good guys. The nice thing about the movie is that all the characters are doing things that hurt other people and that help other people. So there is no good or bad. And you could talk about how prejudice is something we all do, because of relational framing. And that you can ACT in a different way.
The aspect of values and commited action is closely related. You can talk with a client about the characters: When do they move in the direction of their values and when are they moving in a opposite direction. And relate this to values that clients have for themselves.

Jacqueline

I ♥ Huckabees

I ♥ Huckabees
Pretty much the whole film, but especially the conversations between the Dustin Hoffman and Anjelica Huston characters.
ACT Principles: Live a rich, meaningful life and what has experiential avoidance cost you?

Indiana Jones and The Last Crusade: 3 hexaflex points (acceptance, defusion, committed action)

Indiana Jones and The Last Crusade
3 hexaflex points
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!
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 leap 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.

It's a wonderful life (5 ACT processes)

It’s a wonderful life: ACT processes

1. Contact with the present moment (and lack of): This I think is
illustrated through George’s suicide attempt. He believes he has lost the money from the Building and Loan and that he his a failure and that now Potter will win (and it will be his fault). Such is George’s sense of dejection and impending rejection by the towns people that he attempts to escape by jumping from the bridge. Not only does George not want to be in contact with the present moment, but he wants to have never been born at al.

Georges decision at the end of the movie to have his life back demonstrates this beautifully I think. Before he realises the towns people have all come to help him out he takes his life back and contacts the present moment (which at that point is one of uncertainty over the missing money). He allows himself to be present and open to their criticism and the consequences of losing the money to find their love, help and support instead

2. Acceptance: This is perhaps demonstrated by George’s desire to keep living with the uncertain consequences he faces. I think the key message George takes from Clarence is that it is that upsetting things happen AND it's a wonderful life.

3. Defusion/fusion. Not explicit, but George does not explicitly decide that he has not let the towns people down, it is possible that he stills feels this way, but he has defused from it enough to allow himself to be present with the towns people and the consequences of losing the money.

4. Values: George values helping the town people. He values his family, he values making the town a better place and protecting it from exploitation from Potter

5. Commitment: In the movie, George not only values his values but is actively committed to not letting Potter exploit the town for his own financial gain. His actions are focused on changing the physical (i.e. fighting against Potter- a workable change agenda)

6. Self-as-context: not sure about this one, might there be a sixth process hiding in the movie somehwere

Moonstruck

1. Moonstruck
2. 1 Fusion (with rules)
3. Right from beginning to end, ths movie is so filled with just about every character following rules that clearly are so restrictive on their lives. This makes the movie very funny, enjoyable and accessible, yet incredibly profound. The huge exception to this when the character played by Nicholoas Cage tells a confused woman (Cher) something like "Life is not a storybook, that you can look up to see what to do next. Love is about destroying life ... ..."
4. In the context of the movie, these audacious words, just hit out, with an irresistable invitation to vitality - a vivid contrast to following rules blindly (fusion) without any reference to values. The mother with her more philosophical approach would seem to be a contrast to blind rule following, however this is at the cost of avoiding strong emotions (and whatever actions) at her husbands behaviours.

My Life Without Me (2003): 5 hexaflex points

My Life Without Me (2003)
It’s a beautiful movie of a young woman, Ann. Mother of 2 little kids, living a hard life with little future: low job, husband unemployed, poor housing, little money, little support of her family. One day she discovers that she’s seriously ill and has little time to live. This changes her life and way of life radical. She makes a list of things she wants to do and starts doing them, living life to the max. Very good!
ACT Principle: Acceptance, Values, Committed Action, Self as context, Mindfulness

SPY KIDS

I have been using film clips since I was a school counselor and would do in-class interactive social skills lessons. I will bring DVD's into my office and play them for a client on my laptop. One clip I like to use with couples is from the first SPY KIDS film where the mother is telling her kids the story of how she met and married their father. The sequence is beautifully put together in terms of how she and her soon to be husband were spies working on different sides and began dating and hid their connection and then made the commitment. The mother narrates how her commitment to getting married was scarier than any spy mission. The scene of their wedding is a great illustration of commitment and action even in the face of turbulence and threats. Their wedding is interrupted by an attacking helicopter. There is a great shot of the priest holding the Bible while pages are blown out of it by the gusts from the helicopter's blades (challenges to our values and commitment). The last part of the scene that my couples find the most powerful is when the couple is running away and they look into each other's eyes as if telling each other, "I am in this with you no matter what." They then jump off a cliff together and escape into a speeding boat.

Therapeutically, after I show the clip I will invite the client to track in their body to see what was stirred by the images. Film clips are a great way to help clients move from image to sensation and process through fight, flight, and freeze responses.

- Max Stoltenberg, LPC, CHt

The Zookeeper

The Zookeeper - a Ralph Ziman film starring Sam Neill
Number of Hexaflex points: 3
A moving film set in an unspecified Eastern European country that has a Bosnian like civil war raging, in which a zookeeper, Ludovic (a superb performance by Sam Neill) is haunted by his past, when he wielded power over a local populace. Only after he meets Ankica ( who, with her son, are refugees from the fighting seeking sanctuary in the now all but deserted zoo) who recounts the horrors she has experienced at the hands of someone in that position, does he begin to accept what he has done, allowing him to emotionally thaw out a little. He also hides his feelings for his dead wife, literally in a box hidden away, which is found by Ankica who tells him his feelings are 'beautiful', again allowing him to accept the caring side of himself (toward people) more.
There is an interesting portrayal of the (sometimes) subtle difference between running away from our experience & moving toward a valued direction: Ludovic appears to hold the value of being a good person strongly (represented by him being only one of two people willing to stay on & care for the animals when everyone else has left), but Ankica questions whether this is in fact a cover for running away from connectedness with other people, & by extension, himself.

Committed action is demonstrated by Ludovic as he begins his emotional thawing & looks after both Ankica & her son, Zioig, as well as his caring for the zoo animals, & toward the end of the film, himself. This is an interesting portrayal of achieving psychological flexibility: he finally agrees to deviate from his rigid pattern of behaviour (staying with the animals) & leave when it is clear that all is lost. He shows anger initially when this course of action is suggested, much like someone holding on to behaviour that is self-defeating but at least familiar.
Score: 3/5.

Three Kings (1999) movie

The scene in Three Kings is a post-Desert Storm battle among soldiers. George Clooney and Spike Jonez are taking cover from the hail of gunfire. Spike's character is afraid of going out and shooting back and the following ensues:

Archie Gates (G.Clooney): You're scared, right?

Conrad Vig (Spike): Maybe.

Archie Gates: The way it works is, you do the thing you're scared shitless of, and you get the courage AFTER you do it, not before you do it.

Conrad Vig: That's a dumbass way to work. It should be the other way around.

Archie Gates: I know. That's the way it works.

- I like this one when talking to 25-39 year old anxious males...Probably not useful for everyone, but I dig it.

Walk The Line

Walk The Line
The June Carter character exemplified committed action in the service of a value that was dear to her. The value I would identify (not verbalized by her in the film), would be something like 'Marriage as a committed friendship' or 'Building intimacy'. Some of the elements of committed action on her part included remaining Johnny's friend when he was at his least likeable, rejecting his excessive and self-destructive behaviors while continuing to love him, even remarrying when she couldn't have Johnny. Mind you, he also exemplified similar committed action in continuing to ask her to marry him despite repeatedly being blocked in achieving the desired outcome :).
ACT Principle: Outcome is the Process through which Process Becomes the Outcome

Yes Man (2008)

Yes Man (2008)
The movie is about a man distraught over his girlfriend breaking up with him. He refuses to do anything except stay home and watch videos. His friend drags him to a motivational seminar where the message is "Say YES to Life!" He does and his life changes radically for the better. A very fun romantic comedy with Jim Carrey and Zooey Deschanel.

ACT Relevant Books/Stories

The purpose of this is to share ACT relevant books or stories that might help make ACT relevant points. Like the songs and metaphors pages it would be good to share the story/book or gist of it, and any ACT relevant points it might be making.

Perhaps

This story helps illustrate that events are not inherently "good" or "bad"

The Little Prince

From The Little Prince by Antoine de Saint-Exupery

This is from one of my favourite books. It has many ACT relevant moments in it, this is just one of them:

The next planet was inhabited by a tippler.

This was a very short visit, but it plunged the little prince into deep dejection. "What are you doing there?" he said to the tippler, whom he found settled down in silence before a collection of empty bottles and also a collection of full bottles.

"I am drinking," replied the tippler, with a lugubrious air.

"Why are you drinking?" demanded the little prince.

"So that I may forget," replied the tippler.

"Forget what?" inquired the little prince, who already was sorry for him.

"Forget that I am ashamed," the tippler confessed, hanging his head.

"Ashamed of what?" insisted the little prince, who wanted to help him.

"Ashamed of drinking!" The tippler brought his speech to an end, and shut himself up in an impregnable silence.

And the little prince went away, puzzled. "grown-ups are certainly very, very odd," he said to himself, as he continued on his journey.

I think this makes some nice ACT-relevant points about fusion, experiential avoidance and the futility of avoidance/control strategies. The tippler is fused with his feeling of shame to the extent that he must avoid it by drinking. However, the costs and consequences of his drinking is further shame that he also fuses with and must avoid, also by drinking. The tippler is essentially drowning in an alcoholic quicksand. The more he drinks to escape, the more bad stuff shows up, so the more he has to drink to escape a little bit more. The Little Prince, who is essentially a child who has lived alone and has not been exposed to a verbal community where fusion and avoidance repertoires have fully developed sees this as being very odd indeed.

Things the grandchildren should know

For a great example of someone dignifying their values with pain, I can whole-heartedly recommend the autobiography
"Things the grandchildren should know"
by Mark Everett (Lead singer of the band Eels).

http://en.wikipedia.org/wiki/Things_the_Grandchildren_Should_Know

From publisher:

How does one young man survive the deaths of his entire family and manage to make something of his life? The insecure son of a misunderstood genius of quantum mechanics, Mark Oliver Everett's upbringing was "ridiculous, sometimes tragic, and always unstead." But somehow he survived this and ensuing tragedies, channeling his experiences into his critically acclaimed music with the Eels. Told with surprising candor, his memoir is an inspiring and remarkable story, full of hope, humor, and wry wisdom.

ACT Relevant Songs

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, you can type this at the beginning to make your posting come out as a list (beware includes HTML code ;-)):

My song
ACT Principle: Defusion (or whatever it is)
Any recommendations on how to use the song

Which ends up looking like this:

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!

Drive--Incubus

Hi,

Great idea! I haven't used this with clients, but I've always thought the song "Drive" by Incubus is very ACT consistent. Here's the first verse:

"Sometimes, I feel the fear of uncertainty stinging clear
And I can't help but ask myself how much
I'll let the fear take the wheel and steer.
It's driven me before, and it seems to have a vague,
haunting mass appeal.
But lately I'm beginning to find that I
should be the one behind the wheel."

Could be used in conjunction with the monsters-on-the-bus exercise, or any number of exercises that focus on avoidance.

Mary

Live Like You Were Dying--Tim McGraw

Song: Live Like You were Dying--Tim McGraw

ACT concepts:

Mindfulness/Awareness:

"...and I watched an eagle as it was flying"

Values:

"and I loved deeper and I spoke sweeter
and I gave forgiveness I'd been denying
and he said someday I hope you get the chance
to live like you were dying

He said I was finally the husband
that most the time I wasn't
and I became a friend a friend would like to have
and all the sudden going fishin
wasn't such an imposition
and I went three times that year I lost my dad"

Again, not sure how to use this in therapy, but pretty ACT consistent.

The Competition - Kimya Dawson

The Competition - Kimya Dawson
ACT Principle: Acceptance
This song is great for helping people grasp the concepts of acceptance and willingness in the midst of strong emotions and unhelpful thoughts. Popular with adolescents and younger generation clients (especially those who have seen the film Juno and may be familiar with other songs by Kimya Dawson).

Lyrics : http://www.lyricsmania.com/lyrics/kimya_dawson_lyrics_9452/remember_that_i_love_you_lyrics_76275/the_competition_lyrics_757133.html

The Trouble with Humans

Great album and song title by Chip Taylor and Carrie Rodriques

The Trouble With Humans states, "I don't want to talk it-I just want to feel it." The song continues:
The trouble with humans-is they're only human
The Trouble with trouble-is it's always at hand
But if we don't look around it-if we look right on through it
We'll find the power-together we'll stand

Two ACT consistent Eels songs.

For a great example of someone dignifying their values with pain, I can whole-heartedly recommend the autobiography "Things the grandchildren should know" by Mark Everett (Lead singer Eels). http://en.wikipedia.org/wiki/Things_the_Grandchildren_Should_Know

His songs also hint at vital living:
-----------------------------------------------------

Hey Man (Now You're Really Living) :

Do you know what it's like to fall on the floor?
Cry your guts out till you got no more
Hey man, now you're really living

Have you ever made love to a beautiful girl?
Made you feel like it's not such a bad world
Hey man, now you're really living

Now you're really giving everything
And you're really gettin' what you gave
Now you're really livin' what this life is all about

Well, I just saw the sun rise over the hill
Never used to give me much of a thrill
But, hey man, now I'm really living

Do you know what it's like to care too much?
About someone that you're never gonna get to touch
Hey man, now you're really living

Have you ever sat down in the fresh-cut grass
And thought about the moment and when it will pass
Hey man, now you're really living

Now you're really giving everything
And you're really gettin' what you gave
Now you're really livin' what this life is all about

Now, what would you say if I told you that
Everyone thinks you're a crazy old cat
Hey man, now you're really living

Do you know what it's like to fall on the floor?
Cry your guts out till you got no more
Hey man, now you're really living

Have you ever made love to a beautiful girl?
Made you feel like it's not such a bad world
Hey man, now you're really living...

----------------------------------------------

P.S. You rock my world:

I was at a funeral the day i realized
I wanted to spend my life with you
Sitting down on the steps at the old post office
The flag was flying at half-mast
And I was thinkin' 'bout how everyone is dying
And maybe it's time to live

I don't know where we're going
I don't know what we'll do

Walked into the thrif-tee
Saw the man with the hollow eyes
who didn't give me all my change
But it didn't bother me this time
'cause I know I've only got
this moment
And it's good
I went to the gas station
Old woman honked her horn
Waiting for me to fix her car

I don't know where we're going
I don't know what we'll do

Laying in bed tonight I was thinking
and listening to all the dogs
and the sirens and the shots
And how a careful man tries
to dodge the bullets
While a happy man takes a walk

And maybe it's time to live

----------------------------------------------------

Various ACT Related Song Lyrics

Here are some ACT themes covered by various songs. See the attached file for the actual lyrics (note, some of them are abridged):

Suffering is Universal:

R.E.M. - Everybody Hurts
TOAD THE WET SPROCKET - Little Buddha

The Problem:

RADIOHEAD - Fitter Happier
NADA SURF - Stalemate
SUPREME BEINGS OF LEISURE - What's the Deal

Acceptance:

THE BEATLES - Let it Be
JAMES BROWN - Mind Power
NITIN SAWHNEY - Letting Go

Mindfulness:

MEREDITH MONK - Walking Song (no lyrics, just breathing)

Self as Context:

AKRON/FAMILY - Franny/You're Human
NINE INCH NAILS - Only
T.REX - Cosmic Dancer

Values:

ECHO AND THE BUNNYMEN - What are you Going to do with Your Life?
LIONEL RITCHIE - Time
TIM MCGRAW - Live Life Like You were Dying

Willingness:

DURAN DURAN - Finest Hour
SLY AND THE FAMILY STONE - Stand!
FRANK SINATRA - My Way

Coupon for ordering "The Psychological Record" (2009)

Below is a 2009 coupon for $10 off a subscription for The Psychological Record. It is good for students and new subscribers.

Coupon & Subscription Information Link

Polk & Hambright's "The Matrix" in PDF form

Here is a pdf of the Matrix as shown by Kevin Polk and Jerold Hambright in a format that is easy for clients to understand (by Benji Schoendorff).

The matrix in spanish

Below is a version of the matrix in spanish. Enjoy!
Fabián