Acceptance and commitment therapy

1. Introduction

Version followed: standard ACT as in Hayes, Strosahl & Wilson (1999, 1st ed.) and the ACBS "six core processes" description (Hayes), sequenced by the 12-session "Complete ACT" depression protocol hosted by ACBS (file attributed to Zettle; the excerpt names no author or date); Focused ACT (FACT) as taught by Strosahl, Robinson & Gustavsson in their ACBS 2-day workshop handout (based on Strosahl, Robinson & Gustavsson 2012). The 2nd edition (Hayes, Strosahl & Wilson 2012) is not drawn on [uncertain]; where its terms differ from 1999, this guide uses the 1999 and ACBS wording.

Acceptance and commitment therapy (ACT) is a behavioural therapy, built on functional contextualism and relational frame theory (RFT), that aims to increase psychological flexibility: contacting the present moment fully and changing or persisting in behaviour when that serves chosen values [source: ACBS Six Core Processes; Wikipedia]. ACT is defined by its processes rather than by any fixed technique [source: ACBS Six Core Processes]. Its theory of change: suffering is maintained less by painful thoughts and feelings themselves than by fusion (taking thoughts literally) and experiential avoidance (efforts to control or escape inner experience), which narrow behaviour and pull people away from what matters. Change comes from letting go of the struggle with private events (acceptance, defusion, present-moment contact, self-as-context) and building patterns of action linked to chosen values (values, committed action) [source: ACBS Six Core Processes; Wikipedia]. The model's own criterion of truth is workability: does this move the client toward what matters? [source: Wikipedia]

FACT is a brief, transdiagnostic version for short, often same-day visits in primary care, schools, jails, nursing homes and other non-traditional or under-resourced settings. It groups the six processes into three "pillars" (Open, Aware, Engaged) and assumes change can begin in the first visit [source: ACBS FACT workshop page 2025; Robinson, Strosahl & Gustavsson handout].

2. Framework

Standard ACT: no mandatory phase order. ACT is process-based; the six processes are a flexible map, not a fixed sequence, and treatment is tailored to which processes are most restricted [source: ACBS Six Core Processes; Petkus & Wetherell-based protocol NCT04280445]. The two process clusters are (a) mindfulness and acceptance (acceptance, defusion, present moment, self-as-context) and (b) commitment and behaviour change (present moment, self-as-context, values, committed action) [source: ACBS Six Core Processes].

Classic sequence (1999 book / "Complete ACT" 12-session depression protocol; weekly 60-min individual sessions) [source: Complete ACT protocol; ACBS study-group summaries of Hayes et al. 1999]:

The excerpt of the protocol ended in session 7; content of sessions 8–12 above is taken from the 1999 book's Willingness and Commitment chapter summaries, not from the protocol itself [uncertain]. A mid-programme assessment followed session 6 in the protocol, and depression and automatic-thought questionnaires were re-administered at sessions, with attention to suicide and hopelessness items [source: Complete ACT protocol].

Alternative order (values first). The older-adult protocol adapted from Petkus & Wetherell (2013): up to 12 weekly ~1-h sessions; 1 introduction; 1–3 values; 4–5 acceptance/willingness (what has worked, costs, control as the problem); 6–7 defusion; 8–9 mindfulness and self-as-context; 10–12 committed action (begun during values work); 12 "therapeutic blueprint" summary. Each session: brief outcome measure, opening mindfulness exercise, homework review, new material, homework, session ratings [source: NCT04280445 protocol]. Use values-first when the client lacks motivation to tolerate discomfort or when creative hopelessness would feel invalidating [synthesis].

Criteria for moving between phases (no formal criteria are given in the sources [uncertain]; the following is [synthesis] from the protocol's homework checks and process definitions):

• Leave creative hopelessness when the client can describe, from their own experience, that control efforts have not worked long-term and have cost them, and shows curiosity about "something else" rather than demanding a new technique.
• Leave control/willingness work when the client can distinguish clean from dirty discomfort in their diaries and talks about willingness as a choice.
• Leave defusion/self work when the client can notice a hooking thought in session and name it as a thought without arguing with it. The protocol explicitly checks at each homework review whether the client is using the exercise to control unwanted experience; if so, stay with that process [source: Complete ACT protocol].
• Values and committed action are revisited for the rest of therapy; return to any earlier process whenever a barrier blocks valued action.

FACT framework [source: Robinson, Strosahl & Gustavsson handout; ACBS FACT pages 2025, 2026]:

• Format: brief visits, often same day as the request, focused on the problem the person names and on functioning in life roles. Primary-care version: physician referral for a specific problem, physician keeps care decisions. Visit outline: introduction ~5 min; snapshot and life context ~5 min; change plan 5–10 min; charting and feedback to the referrer ~5 min. The person implements the plan and returns if and when needed; no fixed number of visits is set. Assessment happens at every visit.
• Stance mantra: treat every session as if it is the last.
• Flow within a visit: Contextual Interview (life context: Love, Work, Play, Health; problem context: Time, Trigger, Trajectory) → Workability question (marks the shift to intervention) → reframe → pillar-targeted intervention → behaviour change plan or experiment → 0–10 ratings (problem size, confidence, helpfulness).
• CAARE (2026 workshop): Context, Approach, Avoidance, Redesign, Expand, each a set of clinical tasks; the 2025 page called it "CARE". The tasks within each letter are not described in the sources [uncertain].
• Follow-up visits: purposes are named as a training topic but not described in the sources [uncertain]. [synthesis]: review the experiment with the CAN-DO checklist idea (did they do it, what happened, what was learned), re-rate, adjust the plan.

3. Guiding principles

Standard ACT [source: ACBS Six Core Processes; ACBS study-group summaries of Hayes et al. 1999, pp. 205–212, 219–229, 238–244, 267–271; Complete ACT protocol]:

• Workability over truth. Ask "has this worked, in your experience?" not "is this thought true?"
• Function over form. Target what a thought or behaviour does (avoidance, rule-following), not its content or frequency.
• Acceptance serves values. Never sell acceptance as a better way to feel good; it is in service of valued action.
• Defusion changes the relationship to thoughts, not their frequency. Expect thoughts to keep showing up; measure success by reduced grip and freer action.
• Experience over persuasion. Use metaphors, exercises and in-session experiments so the client learns from direct experience, not from your arguments.
• The therapist is in the same boat. Model acceptance of your own in-session thoughts (e.g. "a good therapist would know what to do"), neither eliminating nor obeying them.
• Contingency-shaped, not scripted. Interventions are responsive to what is happening in the room; metaphors are tools, not a curriculum.
• Respond-ability, not blame. The client is able to respond differently; they are not at fault for having tried to control pain.
• Clean vs dirty pain. Aim to reduce the suffering added by struggle, not the unavoidable pain of living.
• Values are chosen, held as actions, never completed. Values are directions; goals are milestones; check that values are owned rather than adopted for approval.
• Process is the outcome. Vitality comes from living the valued direction now, not from arriving; accumulate small positives rather than attempt heroic leaps.
• Willingness is all-or-nothing in quality, adjustable in scope. Choose the size of the situation, not a half-hearted quality of openness.
• Look at thoughts, not through them. Encourage description over evaluation, including in your own speech.

FACT additions [source: Robinson, Strosahl & Gustavsson handout]:

• Treat every session as if it is the last. End each visit with something the client can use alone.
• Change can start now. Use rapid-change language and convey that meaningful change can happen in one visit.
• Clients are trapped, not broken. Look for rule-driven avoidance keeping the person stuck; build on strengths.
• Workability, not reasonableness. Don't debate whether the client's reasons make sense; ask whether the strategy works.
• Don't argue or persuade. If you are pushing, step back and ask a question.
• Your strong feelings are opportunities. Notice them and use them as information and a chance to model openness.
• No one-up position. Stay level with the client.
• Prefer "what" and "how" over "why". Ask what they would do differently, whether it is getting them what they want, who could help.
• Small experiments, imperfect follow-through expected. Frame plans as experiments and predict that perfection won't be needed.

4. Intervention inventory

Organised by process. Sources per group; all example language is illustrative unless quoted. Many ACT metaphors exist beyond those listed (the ACBS page notes "scores" of defusion techniques); this inventory covers every technique named in the sources. Well-known items not included in the sources (e.g. Chinese finger trap) are omitted [uncertain].

A. Assessment, formulation and framing

[source: Complete ACT protocol S1; Robinson, Strosahl & Gustavsson handout; ACBS FACT 2026 page]

A1. Control-strategy history (workability review)

• Purpose: map everything the client has tried to get rid of the problem, as raw material for creative hopelessness; build rapport. Use in the first session.
• Steps: 1) Invite the client to describe the problem in their own words. 2) Ask for every attempt to fix it: self-help, therapy, medication, distraction, substances, withdrawal, reassurance, self-criticism, and suicidal thinking as a way out. 3) For each, ask about short-term effect, long-term effect, and cost. 4) Summarise the list back without judgment.
• Example language (illustrative): "Let's make a list of everything you've tried to get on top of this. Then for each one: did it help in the moment, and where did it leave you a month later?"
• Watch for: suicidal ideation described as an escape strategy: assess risk by standard procedures before continuing. Working when the client starts noticing a pattern ("everything works for a bit, then it's back").

A2. FACT Contextual Interview: Love, Work, Play, Health

• Purpose: a rapid life-context snapshot that locates the problem in the person's life and reveals values and strengths. First minutes of a FACT visit.
• Steps: Ask briefly about Love (where they live, with whom, key relationships); Work (job or study, whether they enjoy it, how they support themselves); Play (fun, relaxation, community connection); Health (tobacco, alcohol, drugs, exercise, diet, sleep). Keep it to about 5 minutes.
• Example language (illustrative): "Before we get to the problem, give me a quick picture of your life: who's at home, what you do for work, what you do for fun, and how you're looking after your health."
• Watch for: domains that have shrunk (often where avoidance lives) and domains that are working (strengths to build on).

A3. Problem context: Three Ts and the Workability question

• Purpose: understand the problem's function, then pivot from assessment to intervention.
• Steps: 1) Time: when it started, how often, what comes before and after, why it's a problem now. 2) Trigger: situations or people that set it off. 3) Trajectory: how it has changed over time. 4) Workability: what have you tried, how did it work short-term and long-term, and is it consistent with what matters to you? The workability question marks the shift to intervention.
• Example language (illustrative): "So drinking settles the panic for the evening. In the long run, has it made the panic smaller, and has it taken you closer to the life you want?"
• Watch for: the client recognising the cost themselves; don't supply the conclusion.

A4. FACT 0–10 ratings

• Purpose: metrics-informed practice in every visit.
• Steps: Ask the client to rate on 0–10: (1) how big a problem this is; (2) confidence in following through with the plan; (3) how helpful the visit was. Record each visit.
• Example language (illustrative): "On 0 to 10, how confident are you that you'll try this before we next talk?"
• Watch for: low confidence (shrink the plan until confidence is high [synthesis]); low helpfulness (ask what would have been more useful).

A5. Flexibility Profile / Pillars assessment

• Purpose: case formulation by pillar.
• Steps: Rate the client low, medium or high on Open (acceptance, defusion), Aware (present moment, perspective-taking) and Engaged (values, committed action), noting examples: TEAMS content they fuse with or avoid, values expressed, and behaviour patterns. Target the weakest pillar that blocks the plan. The published Pillars Assessment Tool and Intervention Guide were named but not drawn on [uncertain].
• Watch for: over-reliance on one pillar (e.g. high insight, low engagement).

A6. Four Square Analysis

• Purpose: separate target behaviours from the mental processes that enable or block them.
• Steps: Draw a 2×2 grid with public (observable behaviour) vs private (mental processes) on one axis and workable vs not workable on the other. Fill in unworkable public behaviours, workable public behaviours to build, and the private processes (fusion, avoidance, values, awareness) that drive each. Plan a target behaviour; if a private barrier blocks it, work on that barrier first.
• Example language (illustrative): "Here's what you do that isn't working, here's what you'd like to do more of. Let's see what goes on inside you that pushes you one way or the other."
• Watch for: plans that list only public behaviours with no attention to the private barrier, which tend to fail [synthesis].

A7. TEAMS: observe, describe, detach

• Purpose: a shared vocabulary for private experience (Thoughts, Emotions, Associations, Memories, Sensations).
• Steps: Teach the five categories; in session, when the client reports an inner event, ask them to observe it, describe it by category, and detach (hold it as an event rather than a fact or command).
• Example language (illustrative): "Which part of TEAMS is that: a thought, a memory, a sensation?"
• Watch for: faster, more neutral labelling over time.

A8. FACT focus questions and reframe

• Purpose: redefine the problem so it seems solvable and points toward an intentional path.
• Steps: 1) Focus questions: what are you seeking? what have you tried? how has it worked? what has it cost? what life would you choose? 2) Validate the emotions and behaviours and acknowledge what the problem behaviour does for them. 3) Link the pain to what they value. 4) Reframe using one of: the "30,000 feet" big-picture view; a focus on positive values; presenting the problem as necessary for learning ("you are in the perfect position"); expressing confidence they will learn and act differently. 5) Move to change questions (what would you do differently? would you try this as an experiment?).
• Example language (illustrative): "You hurt this much about your son because being a good father matters so much to you. That pain is pointing at something."
• Watch for: client relief or curiosity; a reframe that feels dismissive means validation was too short [synthesis].

B. Creative hopelessness and control as the problem

[source: Complete ACT protocol S1–3; ACBS study-group summaries of Hayes et al. 1999 pp. 238–244]

B1. Creative hopelessness induction

• Purpose: loosen the client's faith that the solution is better control of inner experience; open space for something new. Session 1 in the classic sequence.
• Steps: 1) Review the list from A1. 2) Note together that each strategy was reasonable and that the problem persists. 3) Suggest that the efforts themselves may be part of what keeps the problem going, and that they add "dirty" pain (e.g. being depressed about being depressed). 4) Do not offer a new solution; let the not-knowing stand.
• Example language (illustrative): "You've worked hard at this, and you're not short on effort or intelligence. What if the problem isn't that you haven't found the right way to get rid of these feelings, but that getting rid of them is the game that can't be won?"
• Watch for: hopelessness about the strategy, not about the self or the future; if the client hears "you're hopeless", repair immediately and check mood and risk [synthesis].

B2. Man in the hole (Digging out of a hole)

• Purpose: give an image for the self-defeating nature of control efforts.
• Steps: Tell, in your own words: a person is blindfolded in a field with a tool bag, falls into a hole, and the only tool is a shovel; digging makes the hole deeper. Ask what they have been digging with. Suggest the first step is to let go of the shovel. If asked "so how do I get out?", say the current task is to stop digging and accept being in the hole for now, not to find the exit.
• Example language (illustrative): "What if you put the shovel down? Not because I have a ladder to give you, but because digging hasn't got you out."
• Watch for: the client asking for a better shovel (a new coping trick); point it out gently.

B3. Response-ability reframe

• Purpose: replace blame with capacity to respond.
• Steps: Distinguish being to blame from being able to respond; note the client could not have known what they didn't know.
• Example language (illustrative): "Not your fault. Your response, though, is something you get to choose from here."

B4. Inner vs outer world (control works outside the skin)

• Purpose: show that deliberate control works for the external world but backfires for thoughts and feelings.
• Steps: Use an outer example (you dislike the wall colour, you repaint it). Contrast with an inner one (you dislike the anxiety, you try to get rid of it, and it grows). Ask the client to check their experience.
• Example language (illustrative): "If you don't like the wall, you paint it. Does that rule work for sadness?"

B5. Polygraph metaphor

• Purpose: show that demanding calm creates anxiety.
• Steps: Describe being hooked to a perfectly sensitive anxiety detector with a severe consequence if any anxiety registers; ask what would happen. Link to the client's demands that they not feel depressed or anxious.
• Watch for: the client seeing how "I must not feel this" generates more of it.

B6. Million-dollar test (fall in love on command)

• Purpose: show that positive feelings cannot be willed either.
• Steps: Offer a hypothetical large reward to fall in love with a stranger right now, or to genuinely feel happy now; ask if they could. Compare with doing something loving, which they could.

B7. Jelly donuts (thought suppression)

• Purpose: show that trying not to think adds rather than subtracts.
• Steps: Ask the client not to think about warm jelly donuts for a minute; then suggest replacing them with ice cream; ask what is now on their mind (donuts plus ice cream).

B8. Tug of war with a monster

• Purpose: show the alternative to struggle.
• Steps: Describe pulling on a rope against a monster at the edge of a pit; however hard you pull, it pulls back. Ask what options exist besides winning. Arrive at: drop the rope. Can be done physically with a real rope or towel (the FACT handout lists a drop-the-rope exercise).
• Example language (illustrative): "The monster's still there. But your hands are free."
• Watch for: "dropping the rope" being used as a new trick to make the monster leave.

B9. Why control persists

• Purpose: normalise the control agenda.
• Steps: Discuss four reasons: it works outside the skin; others tell us to do it ("snap out of it"); others appear to succeed at it; and it gives short-term relief.

B10. Three numbers exercise

• Purpose: demonstrate that the mind accumulates and cannot delete on command.
• Steps: Give the client a three-number sequence to remember; later ask if they can forget it for a reward; check recall at the end of the session or next session.

B11. Two scales (Depression/Anxiety and Willingness)

• Purpose: shift the target from reducing distress to increasing willingness.
• Steps: Describe two dials: one for distress, one for willingness. When willingness is low, the distress dial locks high. The client can't set the distress dial directly but can choose to set willingness high; then distress is free to go up or down.
• Example language (illustrative): "You've been working the depression dial. That one's not wired to your hand. This one is."
• Watch for: turning willingness up in order to turn distress down (a disguised control agenda).

B12. Clean vs dirty discomfort

• Purpose: separate unavoidable pain from added suffering.
• Steps: Define clean discomfort (natural pain of living, e.g. grief at a loss) and dirty discomfort (pain added by struggling with it, e.g. shame about grieving). Assign a diary of each.
• Watch for: the client reporting less dirty discomfort as willingness rises.

B13. Box full of stuff

• Purpose: illustrate costs of avoidance.
• Steps: Describe stuffing painful items into a box until it is full, so the person must arrange life to avoid opening it and life shrinks; ask what has shrunk in theirs.

B14. Joe the Bum (unwelcome guest)

• Purpose: show the "fantasy of unwillingness": that life would be fine if only welcome guests came, and refusing the unwanted one brings peace.
• Steps: Tell the story of hosting a party for the whole neighbourhood when an unwanted guest arrives; you can guard the door and miss your party, or let him in and enjoy it while he is there. The story details are paraphrased from the general ACT literature; only its point was confirmed in the sources [uncertain]. The FACT handout lists a related "welcome the unwelcome" guest-house metaphor.
• Example language (illustrative): "You don't have to like him. You just have to stop guarding the door."

B15. Monitoring diaries and programming exercise (homework)

• Purpose: bring the control agenda into daily awareness.
• Steps: After S1, daily journal of "digging" behaviours (distraction, self-blame, avoidance). After S2, Daily Experiences Diary (depressive reactions) and Daily Struggles Diary (whether they fought them). After S3, Identifying Programming exercise (childhood events and rules learned about feelings) and Clean vs Dirty Discomfort diary. Write your own forms [source: Complete ACT protocol].
• Watch for: non-completion; see Section 5.

C. Cognitive defusion

[source: ACBS Six Core Processes; Complete ACT protocol S4–5; Robinson, Strosahl & Gustavsson handout (Open/defusion list)]

Goal of every defusion technique: lower the literal believability and behavioural grip of a thought, not its frequency or content. Check: "Does it have less pull on what you do?" not "Did it go away?"

C1. "Your mind is not your friend" framing

• Purpose: set up defusion by describing the mind as a useful threat-detecting machine that is not a reliable guide to well-being.
• Steps: Explain that minds evolved to spot danger and so generate negative content; we can't do without the mind, but we needn't obey everything it says.
• Example language (illustrative): "Your mind is great at building bridges and doing your taxes. As a life coach, it's been less reliable."

C2. Narrated motor task

• Purpose: show that verbal control can interfere with a skill.
• Steps: Ask the client to do something simple (stand up, walk across the room) normally, then again while narrating every step aloud or following verbal instructions. Ask what they noticed (usually clumsier).

C3. Word repetition ("Milk, milk, milk")

• Purpose: show that words are sounds; meaning fades with repetition.
• Steps: 1) Ask what comes to mind with "milk" (white, cold, taste). 2) Both say "milk" aloud rapidly for about a minute. 3) Ask what happened to the meaning. 4) Repeat with a short word for a painful self-judgment (e.g. "stupid"), 20–45 seconds. 5) Rate believability or distress before and after.
• Example language (illustrative): "Notice what happened to 'milk'. Now let's try the word your mind uses against you."
• Watch for: giggling or mild absurdity (often a sign it's working); distress if the word is tied to trauma or abuse (choose a milder word, get consent first [synthesis]).

C4. Passengers on the bus

• Purpose: show that thoughts and feelings can ride along while the client drives in a valued direction.
• Steps: Describe the client as bus driver; passengers (thoughts, feelings, memories) threaten and shout directions. Deals made with them (turning where they say) give them more power; stopping to fight them leaves the bus stalled. Ask: could you keep driving where you choose while they shout? Can be acted out, with the therapist voicing passengers while the client walks a chosen route [synthesis].
• Example language (illustrative): "They're loud and scary-looking. Have any of them ever actually taken the wheel?"
• Watch for: the client naming their own passengers; later referring to them spontaneously ("the 'you'll fail' passenger is up").

C5. Soldiers in the parade (or leaves on a stream)

• Purpose: practise watching thoughts go by without boarding them.
• Steps: 1) Eyes closed, settle. 2) Imagine sitting on a reviewing stand while soldiers march past carrying placards; place each thought (as words or images) on a placard and let it pass. Leaves on a stream is the alternative image. 3) When the client notices they have been hooked (following a placard into the parade, or the parade stopped), note what thought hooked them and return to the stand. 4) Debrief: which thoughts hooked them, what that was like. Run 5–10 minutes [synthesis on duration].
• Watch for: reports that the parade stopped or that they were "doing it wrong": these are the data; the skill is noticing and returning.

C6. Contents on cards

• Purpose: carry difficult thoughts willingly rather than avoid them (homework after the defusion session).
• Steps: Write the client's own sticky negative thoughts on index cards; the client carries them and reads them at intervals, noticing them as words.

C7. Reasons vs causes

• Purpose: loosen reason-giving as justification for staying stuck.
• Steps: 1) Together, list reasons the client is depressed; then add some invented ones. 2) Ask whether the "bad" reasons make the depression any less real. 3) Note that reasons are stories that come after the fact, not causes that must be removed before action. Homework: log reasons offered as causes during the week.

C8. Dishes of ice cream ("why" chain)

• Purpose: show that reasons for choices are often after-the-fact.
• Steps: Ask the client to choose between two flavours; ask why; ask why again to each answer until they can't say. Draw the parallel to emotional reasons.

C9. "And" instead of "but"

• Purpose: remove the built-in fight between two experiences.
• Steps: Point out that "I want to go, but I'm anxious" sets anxiety against going; "I want to go and I'm anxious" describes both. Agree a convention: both of you catch and replace "but" in session.

C10. Evaluation vs description ("I'm having the thought that…")

• Purpose: distinguish evaluations from properties of things; loosen self-labels.
• Steps: 1) Use a chair: describe it (wooden, brown) vs evaluate it (ugly). Show that evaluations live in the interaction, not the object. 2) Apply to self-labels. 3) Agree a convention: "I'm having the evaluation that I'm incompetent" / "I'm having the thought that…" / "I notice I'm having the thought that…".
• Watch for: the conventions becoming a way to argue with the thought; they are for noticing.

C11. Physicalising

• Purpose: create distance from an emotion and promote willingness.
• Steps: 1) Ask the client to imagine placing the feeling (e.g. depression) 1–1.5 m in front of them. 2) Ask about its size, colour, shape, speed, weight, temperature, texture. 3) Ask whether they could make room for it as it is. 4) Repeat for any reaction to it (e.g. disgust), then return to the first. 5) Ask if it has changed.
• Example language (illustrative): "If it had a colour, what would it be? How big? Is it moving or still?"

C12. Brief defusion techniques (FACT and ACBS lists)

Each is a short in-session move; teach once, then use as needed.

• Thanking the mind: when an unhelpful thought appears, the client says (aloud or silently) "thanks, mind" in a light tone. Illustrative: "Thank your mind for that one."
• Mind as an external voice / naming the mind: treat the mind as a separate commentator; the client may give it a name and notice what it is saying now. Illustrative: "What's your mind telling you right now?"
• Singing or voicing the thought: sing the thought to a familiar tune or say it in a cartoon voice, then ask how it lands.
• Giving the thought a shape, size, colour or speed: as in physicalising, applied to a thought.
• Watching a thought dispassionately: notice the thought arise and pass without engaging it.
• How old is this thought? ask when the client first remembers having it; note it is an old, familiar story.
• Examining the history: trace the feelings, memories and earlier thoughts that come along with a thought, as events, not evidence.
• Wearing the evaluation as a badge: write a feared self-label (e.g. "boring") on a sticker worn during a planned activity, practising doing what matters while "labelled". Get explicit consent and keep it private if the client prefers [synthesis].
• Watch for (all): clients using defusion to make thoughts disappear; mockery (the aim is lightness toward the thought, never toward the client).

D. Contact with the present moment

[source: ACBS Six Core Processes; Robinson, Strosahl & Gustavsson handout (Aware/present moment list); Complete ACT protocol S5 homework; NCT04280445 protocol]

D1. Opening mindfulness exercise

• Purpose: every session begins in the present and builds the skill by repetition.
• Steps: 2–5 minutes of breath, body or sound awareness at the start of each session; brief debrief [duration is synthesis].

D2. FACT present-moment set

Use one in-session (often 1–3 minutes in FACT visits [synthesis]), then assign it.

• Body awareness: notice posture, contact points, temperature.
• Shifting attention: deliberately move attention between sounds, body, and thoughts, building flexible attention.
• Following the breath: rest attention on breathing; when it wanders, notice where and return.
• Body scan: move attention slowly through the body, describing sensations without changing them.
• Watching pace: notice speed of speech, movement and thinking; deliberately slow down.
• Giving emotions a bodily form: let the body take the posture of an emotion or a chosen stance (e.g. an upright "power pose") and notice what changes.
• Sensory exploration of an object: examine an object (a stone, a raisin) with each sense as if for the first time.
• Example language (illustrative): "Let's take thirty seconds. Notice your feet on the floor, the chair under you, and whatever your mind is doing."
• Watch for: using exercises to relax or escape distress; the aim is contact, including with discomfort. Trauma survivors may find closed eyes or body focus distressing: offer eyes open, external focus, and the option to stop [synthesis].

D3. Practising awareness of experience (homework)

• Purpose: daily 5–10 minutes of noticing and describing whatever is present.
• Steps: Client sits, notices thoughts, feelings and sensations, labels them descriptively; logs briefly. At review, check whether it was used to control feelings.

E. Self-as-context (observing self, perspective-taking)

[source: ACBS Six Core Processes; Complete ACT protocol S6; ACBS study-group summary of Hayes et al. 1999 pp. 180–187; Robinson, Strosahl & Gustavsson handout (Aware/perspective list)]

Three senses of self: conceptualised self (content: "the me I think I am"); ongoing self-awareness (process: noticing experience as it happens); observing self (context: the perspective from which experience is seen). The aim is to loosen attachment to the conceptualised self, not to eliminate self-description.

E1. Mental polarity exercise

• Purpose: show that peace cannot be found at the level of self-content.
• Steps: Ask the client to try to believe a mildly positive self-statement, then increasingly extreme ones ("I am a completely perfect person"), noticing what the mind answers; repeat with negative statements. Note that each extreme calls up its opposite.

E2. Chessboard

• Purpose: introduce the observing self as the context for thoughts and feelings.
• Steps: 1) Describe a chessboard with black and white pieces (painful vs "good" thoughts and feelings) at war. 2) Point out that if you are the white pieces, half of you is your enemy and the war never ends. 3) Ask: who are you, the pieces, the player, or the board? 4) Guide toward the board: in contact with all pieces, holding them, not at war. 5) Note the board can move, carrying all the pieces, in a valued direction.
• Example language (illustrative): "The board doesn't care which side wins. It just holds them both. And it can still move."

E3. Observer exercise

• Purpose: experiential contact with a continuous observing self.
• Steps: 1) Eyes closed; notice body sensations, then emotions, then thoughts, each time noting "there is a part of you that notices this". 2) Recall a memory from last summer, then adolescence, then early childhood; notice who was there noticing then, and that the same "you" is noticing now. 3) Consider body, roles, emotions and thoughts as things that have changed over life while the observer has not. 4) Return; ask the client to describe the experience briefly. Homework: continue practice with a written inventory of what was noticed.
• Watch for: dissociation-prone clients may drift; keep it short, eyes open, grounded [synthesis].

E4. Surfer, sky and prison images

• Purpose: quick reminders of the observing stance.
• Steps: Use as fits: surfer (riding the water without being pulled under) vs swimmer; sky and weather (the observer is always there whatever the weather); seeing the "prison" of verbal rules from inside and outside. Encourage looking at a thought rather than through it.

E5. FACT perspective-taking set

• Noticing who is noticing: at any point, ask the client to notice that they are noticing. Illustrative: "Who is it that's aware of that thought?"
• Container metaphors (suitcase, closet): the self as the container that holds experiences; you can carry the suitcase without being its contents.
• Bicycle balance: balance comes from continual small corrections while moving, not from holding still.
• Letter from a wiser future self: the client writes a letter to themselves now from an older, wiser self who got through this.
• Rewriting the story: the client divides their life story into book chapters, or selects photographs, and considers what new chapter could come next.
• Details beyond the names and one-line descriptions in the handout are [synthesis].

F. Values

[source: ACBS Six Core Processes; Complete ACT protocol S7; ACBS study-group summaries of Hayes et al. 1999 pp. 205–212, 219–229; Robinson, Strosahl & Gustavsson handout (Engaged/valuing list); ACBS FACT 2026 page]

Values are chosen qualities of action, global directions that are never completed (a value links many goals), expressed through behaviour rather than feelings. Everyone can identify values; obstacles are usually fusion and avoidance, or a history where pursuing goals brought pain, not a skill deficit. Five guiding questions (paraphrased from the 1999 book summary): what are your values; can you act on them when thoughts and feelings say otherwise; what stands in the way; are you willing to have whatever shows up on the way; how would anyone know you hold them?

F1. Argyle socks exercise (values as actions vs feelings)

• Purpose: show that values held as feelings can't be chosen, whereas values held as actions can.
• Steps: Ask the client to try to feel passionately about a trivial cause (e.g. argyle socks being worn by everyone). Notice it doesn't work. Then ask if they could commit to act on it anyway (wear them, tell people). Draw the parallel: they can act on caring for their family even on days they feel nothing.

F2. Choices vs decisions

• Purpose: establish values as freely chosen, so they don't collapse when supporting reasons change.
• Steps: Define a decision as a selection made because of reasons and a choice as a selection made with reasons present but not because of them. Take a value (e.g. honesty), ask why they hold it, and then why that reason matters, until it becomes clear that the value is simply chosen.
• Example language (illustrative): "You don't need a winning argument for loving your daughter. You can just choose it."

F3. "What do you want your life to stand for?" (eulogy / tombstone / graduation party)

• Purpose: contact values through imagined perspective.
• Steps: 1) Eyes closed; imagine attending your own funeral (or, gentler FACT variants, a tombstone inscription or a celebration such as a graduation party). 2) Imagine the people closest to you speaking. 3) Ask what you would want them to say about how you lived, not what you fear they would say. 4) Write it down; extract values in each domain.
• Watch for: the client describing what they fear will be said (note it as content, return to what they would choose). Do not use the funeral version with a client at elevated suicide risk or recently bereaved without careful judgment; use the celebration version [synthesis].

F4. Values forms: narrative, rating, goals–actions–barriers

• Purpose: systematic values assessment and the bridge to action.
• Steps: 1) Values narrative: across life domains (e.g. family, intimate relations, parenting, friendship, work, education, recreation, spirituality, citizenship, health; the 1999 domain list is not drawn on in full [uncertain]) the client writes briefly what matters in each. 2) Values rating: the client rates each domain's importance and how consistently they have lived it recently; gaps show targets. 3) Goals–actions–barriers: for at least one high-priority domain, name a value, a specific goal in its service, concrete actions (one-off or repeated), and expected barriers. Check the links action → goal → value. Write your own forms; do not reproduce published worksheets. Domains may be left blank; if so, ask what mattered earlier in life.
• Watch for: goals dressed as values ("lose weight", "get promoted"); ask what that would be in service of.

F5. Probing ownership of values

• Purpose: separate owned values from those driven by approval (therapist, parents, culture) or by rules such as "a good person would value…".
• Steps: For each value, ask what would happen if the external consequence were absent.
• Example language (illustrative): "If your parents never found out, would this still matter to you?"

F6. Gardening, skiing and path-up-the-mountain metaphors

• Purpose: goals vs values and process as outcome.
• Steps: Gardening: stay with a chosen plot and tend it rather than keep switching because other grass looks greener. Skiing: the goal (reaching the lodge) gives direction, but being lifted there by helicopter would miss the point: the skiing is the living. Path up the mountain: day-to-day snapshots can look like zigzags or descent while the overall path climbs; judge by direction over time.

F7. FACT values exercises

• Value jars: the client sorts or allocates effort across life-domain "jars" to see what they want to fill [details synthesis].
• Taking a stand: the client physically stands and states, aloud, what they stand for.
• Flipping coins: pain on one side, values on the other: you can't keep one face and throw away the other. Illustrative: "The reason this hurts is the same reason it matters."
• No one knows: imagine achieving your goal but no one ever knowing; what would still matter? (tests for approval-driven values).
• Bull's Eye, True North, Web of Life: named FACT values/direction tools. Bull's Eye: the client marks how close current behaviour is to the centre (living fully by a value) in key domains; True North: a compass direction to orient by; Web of Life: not described in sources [uncertain]. Exact formats beyond the names are not drawn on [uncertain].

G. Willingness and committed action

[source: ACBS Six Core Processes; ACBS study-group summaries of Hayes et al. 1999 pp. 238–249; Robinson, Strosahl & Gustavsson handout (Open/acceptance and Engaged/committed action lists; Life Path); ACBS FACT 2026 page; Wikipedia]

Willingness: noticing the struggle and letting it go, even when it is hard; it is not wanting. Committed action: building larger patterns of value-linked behaviour, using any behaviourally sound method (exposure, skills training, shaping, goal setting) plus homework. Committed action is "funded by valuing" (summary of Hayes et al. 1999).

G1. Willingness as all-or-nothing (jumping exercise)

• Purpose: show that willingness can be limited in scope but not in quality.
• Steps: Ask the client to jump off a book, then a chair; note the jump is the same act; only the height (context) changes. Then show that stepping down (keeping a foot on the chair) is not a smaller jump but not a jump. Willingness works the same way: choose a small situation and be fully willing in it. You "cannot jump a canyon in two steps" (Zen saying cited in the 1999 book summary).
• Example language (illustrative): "Pick the height. But when you jump, jump."
• Safety: do not use real heights; a step or a book is enough [synthesis].

G2. Setting willingness on high (review of planned actions)

• Purpose: keep the focus on willingness rather than on barriers when planning.
• Steps: Review planned actions domain by domain; develop at least one high-priority target. Ask what stands in the way of setting willingness high right now, and whether unwillingness has protected them from those reactions over the long haul.

G3. Swamp metaphor

• Purpose: walking through pain in the service of a valued direction.
• Steps: Describe heading toward a mountain you want to reach and meeting a swamp in the path. You don't wade in because you like mud; you go through because that's the way to where you're going. Ask what the client's swamp is.

G4. Expanding balloon

• Purpose: frame growth at the edge of discomfort.
• Steps: Life as a balloon whose edge is the growth zone. At each difficult moment ask: "Are you big enough to have this?" Yes expands the balloon; no contracts it. Willingness doesn't get easier, but it becomes habitual.

G5. Take your keys with you

• Purpose: a portable reminder to carry difficult experiences into action.
• Steps: Hand the client a key ring (or use theirs): each key a difficult thought, feeling or sensation. They carry them everywhere and they don't stop them going places; some may even open doors. Suggest they touch the keys when hooked outside the session.

G6. Eye contact exercise

• Purpose: live, in-session practice of willingness with a common avoided experience.
• Steps: Therapist and client sit facing each other and hold eye contact for a set time (a few minutes [synthesis]), noticing urges to look away, laugh or talk, and letting them be while staying present. Debrief what showed up. Warn that people in the client's life may notice and react to changes like this.
• Watch for: high distress in clients with trauma or social anxiety; agree on duration and a stop signal in advance [synthesis].

G7. Looking for Mr Discomfort

• Purpose: in-session confrontation of discomfort, renegotiating the client's relationship with it (1999 book p. 247).
• Steps: Procedure not described in the sources [uncertain]. [synthesis]: rather than wait for discomfort, the client actively seeks it in session (e.g. recalling an avoided situation), notices and describes it by component (sensation, memory, emotion, thought), and practises having it.

G8. In-session and between-session exposure (ACT-style)

• Purpose: contact avoided experiences in service of values, to broaden behaviour (not to reduce anxiety per se).
• Steps: 1) Get informed consent: explain the purpose (values, not symptom elimination), what will happen, and that the client can stop. 2) Screen for contraindications: acute suicidality, psychosis, active substance intoxication, medical conditions worsened by arousal, unsafe current environment (e.g. ongoing abuse); for trauma memories, ensure stability and adequate training [synthesis]. 3) Choose a values-linked situation. 4) Break the experience into its parts (bodily sensations, memories, emotions, thoughts) and practise having each as it is, not as what it claims to be. 5) When the client "can't stand it", direct attention to the external environment and back to the valued direction. 6) Debrief: what showed up, what did you do, did it move you toward what matters?
• Watch for: subtle avoidance (distraction, safety behaviours) and "white-knuckling" (enduring with clenched struggle is not willingness).

G9. FEAR and ACT algorithms

• Purpose: portable formulation and plan.
• Steps: Teach FEAR as sources of stuckness (Fusion, Evaluation, Avoidance, Reason-giving) and ACT as the alternative (Accept reactions and be present, Choose a valued direction, Take action). Write on a pocket card.

G10. Barrier analysis

• Purpose: handle barriers that arise when valued action starts.
• Steps: 1) Identify the barrier type (thought, feeling, memory, sensation, or external). 2) Ask whether the client can make room for it while acting. 3) Explore which aspect of it is hardest to have without defence, and work on that with defusion or acceptance. 4) Check whether the barrier is functioning as emotional control or avoidance. External barriers get problem-solving [synthesis].

G11. Committed action planning (FACT list)

• Purpose: turn values into specific behaviour.
• Steps: 1) Values writing or stating the value. 2) State values and costs: what moving in this direction will cost emotionally. 3) Set specific, time-limited goals, small enough for high confidence. 4) Predict barriers and plan responses. 5) Public commitment (tell someone). 6) Arrange the environment (cues, removing obstacles). 7) Progress monitoring. Aim to "accumulate small positives": small consistent steps beat heroic inconsistent ones.
• Example language (illustrative): "What's one thing, this week, that someone watching you would recognise as you being the father you want to be?"

G12. Behavioural experiment and CAN-DO checklist (FACT)

• Purpose: frame plans as experiments, so any outcome yields learning.
• Steps: Agree the experiment, predict what will show up, rate confidence. The CAN-DO checklist for evaluating an experiment was named but its contents not found [uncertain].
• Example language (illustrative): "Would you be willing to try this as an experiment, just to see what happens?"

G13. Life Path (FACT)

• Purpose: a visual, one-page path from avoidance to valued direction; usable individually or in classes.
• Steps (seven questions from the handout, paraphrased): 1) What is important to move toward now? 2) What are you trying to control or avoid? 3) Mark where you are now. 4) Turn that into a directional arrow. 5) What behaviours would show movement? 6) When you get stuck, how will you help yourself? 7) Who will help you? Draw it as a line with avoidance on one side and the valued direction on the other [layout is synthesis].

G14. Process vs outcome of commitment; handling lapses

• Purpose: prevent fear of breaking commitments from blocking commitment.
• Steps: Distinguish keeping a commitment (an ongoing process of returning to the direction) from never lapsing. When a lapse happens, notice it, own it without self-attack, and recommit; revisit Passengers on the bus. Use "willingness never gets easier, but it can become a habit".

G15. Therapeutic blueprint (ending)

• Purpose: consolidate learning for after therapy.
• Steps: In the final session summarise the processes and exercises that helped, review measures, and write next steps and supports; invite the client to "re-author" their problem areas in terms of living with rather than eliminating them [source: NCT04280445 protocol].

G16. FACT Quick Guide

• A one-page pocket card with three or more interventions per process for in-visit selection; build your own from this inventory [source: Robinson, Strosahl & Gustavsson handout].

5. Handling problems

Source-based guidance is tagged; most problem-specific responses below are [synthesis], because the sources give stance principles and named culprits rather than troubleshooting protocols.

Committed action not done (non-adherence). The 1999 book names four likely culprits: the action isn't linked to the client's values; it reflects someone else's wishes; the client is hooked by literal thinking and reason-giving; or the step is too big or under-prepared [source: summary of Hayes et al. 1999 pp. 244–249]. Response: check each in turn; re-link the action to the value in the client's own words; ask whose goal it is; defuse the reasons that showed up ("What did your mind say just before you didn't?"); shrink the step until confidence is 7+/10 (FACT confidence rating) [synthesis]. Treat the non-completion as data, not failure; review it as an experiment (G12).

Homework done, but used to control feelings (e.g. mindfulness to get rid of anxiety, defusion to make thoughts vanish). The protocol checks for this at every review [source: Complete ACT protocol]. Response: validate the wish, ask whether it worked, and reframe the exercise as practice in noticing; return to creative hopelessness if the control agenda is still dominant [synthesis].

Client demands a technique to get rid of the feeling / "So how do I get out of the hole?" Response: acknowledge the wish; say plainly that the current step is to stop digging, not to find the exit [source: Complete ACT protocol S1]; ask what their experience says about more control. Do not argue or persuade [source: FACT handout].

Creative hopelessness lands as personal hopelessness or invalidation. Response [synthesis]: slow down; clarify that it is the strategy that is hopeless, not the person; increase validation ("you have been doing what anyone would"); consider moving to values first (Section 2 alternative order) so the struggle has a purpose. Check mood and suicidal ideation by standard assessment if hopelessness rises.

Intellectualising or arguing with metaphors ("that metaphor doesn't fit"). Response: drop it; metaphors are tools, not truths, and the stance is contingency-shaped, not scripted [source: summary of Hayes et al. 1999 pp. 267–271]. Move to an experiential exercise in the room and ask what the client notices [synthesis]. Notice your own fusion with "I need to win this point" and let it go [source: same].

Stuck: little movement after several sessions. Response [synthesis]: redo the Flexibility Profile and Four Square; identify which pillar is blocking (often Engaged: no clear valued target; or Open: unrecognised avoidance); check that goals are the client's own (F5); check that the therapist has not become the source of the rules ("to please my therapist"); simplify to one domain and one small action. In FACT, treat each visit as the last and ensure the person leaves with one usable plan [source: FACT handout].

Overwhelm or dysregulation during an exercise. Response [synthesis]: stop the exercise; ground with eyes open and external focus (D2 shifting attention, feet on the floor); name what happened descriptively; reduce dose next time (shorter, eyes open, less evocative content). Get consent and agree a stop signal before exposure, observer or eulogy work. Willingness is chosen in scope; the client can pick a smaller "jump" [source: G1 basis, Hayes et al. 1999 summary].

Suicidal ideation. The protocol monitors suicide and hopelessness items on measures each session and treats suicidality as one of the client's control/escape strategies to be explored in history-taking [source: Complete ACT protocol]. Response [synthesis]: conduct standard risk assessment whenever ideation appears; build a safety plan and lethal-means counselling (safe storage or removal of means with family involvement where appropriate); do not treat suicidal thoughts only as "just thoughts" to defuse until risk is assessed; link reasons for living to values. Avoid funeral-based values exercises at elevated risk (use celebration variants).

Ruptures (client feels dismissed, lectured, or that suffering is minimised). Response [synthesis, consistent with FACT stance of no one-up position and treating therapist feelings as opportunities]: name the moment non-defensively; ask what landed wrong; acknowledge your part; model willingness by noticing your own discomfort aloud if useful ("I notice my mind telling me I've messed this up, and I'd like to understand what happened"); return to the client's values as the shared purpose.

Client believes acceptance means resignation or tolerating harm. Response [synthesis]: distinguish acceptance of inner experience from approval of external situations; committed action includes changing what can be changed outside the skin (B4). Never use acceptance language to discourage leaving abuse, seeking medical care or addressing injustice.

Values work stalls: "I don't know what I value" / blank domains. Response: ask what mattered earlier in life [source: summary of Hayes et al. 1999 pp. 219–229]; use the pain–values coin ("what does this pain tell you you care about?") [source: FACT handout, synthesis wording]; consider whether a chaotic history makes wanting feel dangerous, and work with that fear as a barrier rather than as a deficit [source: summary pp. 205–212].

Values that are approval-driven or culturally imposed. Probe ownership (F5), respectfully; values shaped by culture or religion can be fully owned; the question is the client's relationship to them, not their source [synthesis]. The older-adult protocol explicitly includes religion within values work [source: NCT04280445 protocol].

Brief/FACT-specific difficulties [synthesis]: (a) not enough time: use one Contextual Interview question per domain, one pillar, one plan; (b) referrer expects symptom elimination: chart and feedback in functional terms (what the person will do) [source: FACT visit structure]; (c) person doesn't return: assume the first visit may be the last, so leave a written plan and Life Path; (d) groups: use Life Path classes and group commitment statements [source: FACT handout skill modules].

Therapist drift and fusion with "getting it right". The 1999 book highlights the therapist's rule "good therapists would know what to do" as a trap; accept such thoughts while staying committed to therapy goals [source: summary pp. 267–271]. Use peer consultation through ACBS and the FACT competency self-assessment to track your own practice [source: ACBS FACT pages; formal certification not confirmed [uncertain]].

Sources

Sources:

• Focused ACT (FACT): workshop page, ACBS World Conference 2025
• [Robinson, Strosahl & Gustavsson: FACT 2-day workshop handout (ACBS)](https://contextualscience.org/files/Robinson Strosahl Gustavsson 2-day June 17-18 handout 2.pdf)
• Focused ACT workshop page, ACBS World Conference 2026
• The Six Core Processes of ACT (Hayes, ACBS)
• Complete ACT: 12-session ACT for depression protocol (ACBS file, attributed to Zettle) (excerpt through session 7)
• ACT for older adults protocol, NCT04280445 (adapted from Petkus & Wetherell 2013)
• ACT Study Group for Beginners (ACBS), index to Hayes et al. 1999 summaries
• ACT Book Summary: pp. 180–187
• ACT Book Summary: pp. 205–212
• ACT Book Summary: pp. 219–229
• ACT Book Summary: pp. 238–244
• ACT Book Summary: pp. 244–249
• ACT Book Summary: pp. 267–271
• Acceptance and commitment therapy (Wikipedia)

Further reading (not drawn on directly; known via the summaries and handouts above):

• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford.
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2nd ed.). Guilford. [uncertain]
• Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2012). Brief Interventions for Radical Change: Principles and Practice of Focused Acceptance and Commitment Therapy. New Harbinger.
• Robinson, P. J., & Gustavsson, T. (2015). Inside This Moment: Promoting Radical Change in Acceptance and Commitment Therapy. New Harbinger.
• Robinson, P. J., & Reiter, J. T. (2014/2016). Behavioral Consultation and Primary Care / Real Behavior Change in Primary Care (2nd ed.). [exact edition named in handout: Real Behavior Change in Primary Care, 2nd ed., 2014] [uncertain]
• Petkus, A. J., & Wetherell, J. L. (2013). ACT with older adults: rationale and considerations. Cognitive and Behavioral Practice. [uncertain]
• Strosahl, K. D., & Carlsson, J. (2023). Crisis Integration with Acceptance and Commitment Therapy. [uncertain]