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Contents: ACT Protocol for Psychosis--Seminal Methods & Metaphors

*E = Exercise, I = Idea/Concept Shared, M = Metaphor


I

Present Moment Focus


A. Session 1: Noticing Whats Outside: The World, You and Me
1. E-Bell introduced
2. I-Value of noticing
3. E-Walk noticing the room
4. E-Interview pairings, self and another
B. Session 2: Noticing Whats Inside: Thoughts, Feelings & Physical Sensations
1. I-Internal experiences (+hallucinations) introduced
2. M-Bag/Backpack to carry thoughts m-item is in the bag, its not you
3. E-Write on card an internal exp, delineate different types, put card in bag
C. Session 3: Why I can't Be HereNoticing Whats Distracting
1. I-Identify different types of internal exp
2. E-Walk to different locations based on most noticeable current internal exp
Notice if theyre they having more than one exp
Notice peers w/similar & different exp
Write most noticeable current internal exp
3. M-Fire in the room/false alarms

II Defusion
A. Session 4: Meeting Your MindThe Co-Pilot
1. E-Thoughts about the Bell--distinguishing thoughts & other internal experiences
2. I-Origin of thoughts (& voices-auditory hallucinations)
3. M-Mind as Co-pilot (Mind = Co-pilot)take co-pilot for a flight
B. Session 5: Experiences and Thoughts
1. I-Distinguish thoughts from experiences
2. E-Sensory experience w/food (mindful eating) & what co-pilot says (use cards & bag)
3. I-Sensory exp & co-pilots comments occur almost simultaneously, where does cp get his ideas?
C. Session 6: Training Your Co-Pilot
1. E-Co-pilotquick learner, long memoryMary had a little _____.
2. I-Co-pilot learns his thoughts from people & their creationsbooks, ads, movies, etc.
Notice some thoughts uncomfortable, irritating
3. M-Passengers on our planeTake some for a flight
4. I-Trying to get rid of passengers or our co-pilot
III Acceptance
A. Session 7: Unwanted Thoughts
1. E-Willingness checksome clients w/SMI fled mention of their uncomfortable thoughts in Session 6
2. E-Getting rid of thoughts Tossing furniture/tossing thoughtsDont think of the flag
3. I-The more you dont want it, the more you have it.
4. I-What makes a thought unwanted?--Thoughts about thoughts & thoughts w/attached feelings
5. E-Co-pilots scary/sad thoughts/voices on a cardset it away based on want/dont want it
B. Session 8: Unwanted Feelings
1. I-Getting rid of emotions/feelings
2. E-Stand with Yourself: feelings on postersmove away/around them based on want/dont want them
3. I-The more you dont want it the more you abandon yourself and have it.
C. Session 9: Dropping the RopeWillingness
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1. M/E-Tug of Warpilot and control/avoidance strategies vs. co-pilot and passengersdrop the rope
2. I-Acceptance is the alternative to the strugglewilling to let the co-pilot & passengers be in the room
IV Self as Content & Context
A. Session 10: I am the Person Who
1. E-Noticing/Sharing who I AmI am a/used to be a., I like/dont like
2. I-I have many different roles and opinions that change by context & that my cp talks to me about
B. Session 11: Who is the You who notices?
1. E-Acting 101: Interview an assumed character.
2. I-I have a constant me that has been there my whole life experiencing and noticing
C. Session 12: The Constant YOU
1. E-Wisdom with Ageimages from youth
2. I-Constant me has observed my life experiences at all ages
3. E-I have survivedrecalling a difficult experience
4. E- Recognizing a constant you that notices thoughts & feelings change increases capacity to carry them
lightly
5. E- Carry your bag lightly & close
V Clarification of Personal Values
A. Session 13: Values/Goals: What Ive Been Told (optional Session)
1. M/E-Interviewing your passengers
2. I-The content from, passengers may be trying to influence aspirations, is it believable?
3. I-Can someone with SMI even consider valued action?
B. Session 14: Where do I Want to Fly?
1. E-The Best Part of My Day
2. I-Identify something that is enjoyable
3. M-Flying South
4. I-Introduce the concept of meaningful/valued directions
5. E-Choosing a DirectionValued life domain cards
6. I-Experience making an autonomous choice
7. Homework: Identifying Specific Goals
C. Session 15: Defining My Next Destination
1. E-Goal Sharing
2. I-Reinforce homework completion, highlight those who did as role models & ask for a commitment
3. E-Helping Each Other Find a New Beginning
4. I- Accentuate peers helping peers set goals & make a commitment
5. Homework: Exploring New Terrain
D. Session 16: Turbulence in Flight: What Makes for Rough Ride?
1. E-Open discussion on Values Clarification
2. E-Chain Analysis of Choosing Valued Domain & Defining Goals
3. I- Noticing thoughts and feelings about setting and completing a goal & ask for a commitment
4. Homework: Exploring New Terrain
VI Moving Ahead with Committed Action
A. Session 17: Turbulence in Flight: What Makes for a Rough Ride?
1. E-Meaningful/Valued Living: Barriers & How to Hold Them (barriers in a bag)
2. I-Barriers always arise; how theyre held makes a difference--willingness
3. Homework: Goals & Barriers
B. Session 18: Willingness in Action
1. M/E-Flying in a Meaningful Direction with Turbulence: Are You Willing? (barriers as passengers)
A.Pearson, PhD & R. Tingey, PhD

2. I-Chain Analysis with defusion, sitting with, problem solving, etc.


3. Homework: Commitment to a Valued Path
C. Session 19: Committed to a Valued Path
1. E-Public Commitment Statements
2. I-These statements generate power and support

Session 13b

Mental/
Physical Health
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Spirituality

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Family
Relationships
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Friends/Social
Relationships
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Romantic
Relationships

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Career/Job
Development

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Recreation/
Sports

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Financial
Stability

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School/
Creative
Projects

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Citizenship/
Community
Groups

A.Pearson, PhD & R. Tingey, PhD

I value this
because:
I should want it
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I value this
because:
Somebody else
wants me to or
they'll like it if I
do.
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I value this
because:
I would feel
embarrassed,
ashamed,
guilty or
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anxious if I
didn't

A.Pearson, PhD & R. Tingey, PhD

I value this
because:
It's less scary,
risky or will hurt
less.

A.Pearson, PhD & R. Tingey, PhD

I value this
because:
I see it as
important
whether or not
others agree.
A.Pearson, PhD & R. Tingey, PhD

I value this
because:
Doing this
makes my life
better, more
vital, or more
meaningful.
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I value this
because:
I experience
fun and
enjoyment
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while I'm
involved in it.

A.Pearson, PhD & R. Tingey, PhD

Choosing what
my partner or
coordinator
suggests or
wants

Identifying Specific Goals

(sess 13b)

INTRODUCTION:
Congratulations! If you are sitting with your partner right now looking at this handout, you and your peer have
already taken the first step towards more meaningful living.
A.Pearson, PhD & R. Tingey, PhD

This is a big deal! Right now, thank your peer for showing up to meet with you.
DIRECTIONS:
Please interview each other using this form. When you interview your partner, write his/her responses on this
form. When your partner interviews you, they will write your responses on the form they have. Before you
start, fill in your names below:
Your Name:____________________________

Partner I'm interviewing:_____________________________

As you can tell, youll be helping one another. Now, please decide who would like to go first and begin.
INTERVIEW QUESTIONS:
Please ask your peer the following questions and write their response on the line provided:
1. What meaningful life direction have you chosen? (You may want to remind your partner that we worked on
this and chose one during our last ACT group).
___________________________________________________
2. On a scale of 1 to 10, where 1 is I really dont want to find 3 goals along my meaningful life direction right
now" and 10 is I really do want to find 3 goals right now, what number fits best for you?
___________________________________________________
3. Why were you willing to show up for todays meeting?
_____________________________________________________________________________________
SETTING SOME GOALS
1. Please read the following statement to your peer.
Youll be setting three goals today that will move you along the path of the meaningful life direction you've
chosen. One will be a short term goal (something you could do today); one will be medium term (something
you could do this week); and one will be long term ( something you could do further in the future, like next
month or even next year). ...Ask your peer if they have any questions.
Now, ask your peer the following questions and write their response on the line provided:
2. What is your short term goalsomething you can do today that would move you along the path of your
meaningful life direction:
___________________________________________________________________________________
3. What is your medium term goalsomething you can do this week that would move you along the path of
your meaningful life direction:
___________________________________________________________________________________
4. What is your long term goalsomething you can do next month or next year that would move you along
the path of your meaningful life direction:
___________________________________________________________________________________
*NOTE: Did your peer have some trouble finding goals? If so, thats okay! Just go to the next section!
CHECK YOUR PEER'S REACTION & ASK FOR A COMMITMENT:
A.Pearson, PhD & R. Tingey, PhD

1. Ask your peer, "How did it feel to come up with goals that move you along the path of your meaningful
life direction?" Write their response:
____________________________________________________________________________________
2. Ask you peer, "As you came up with your goals, did you have any feelings similar to these?" Read the
words below and circle it if they say, "YES."
Scary
Encouraging
Confusing
Irritating
Boring

Happy
Stuck
Motivating
Doubtful
Inspiring

Frightening
Angry
Sad
Hopeful
Deflating

Perplexing
Amazing
Hopeless
Courageous
Energizing

2. Ask your peer, "Would you be willing to make a commitment to do your short term goal before the next
ACT group?" Circle their response: YES
NO
GREAT JOB! YOURE DONE! Now, go ahead and switch roles, completing this worksheet for the other
person.

A.Pearson, PhD & R. Tingey, PhD

Exploring New Terrain

(sess 14-15)

INTRODUCTION/DIRECTIONS:
This is the second meeting with your peer. This is the meeting where youll talk about the short term goal you
committed to in group to complete this week.
First, thank your peer again for showing up to meet. Taking steps toward the life you want is a big deal!
You will be interviewing each other again. You will write your partner's responses on this form and he/she will
write your responses on the form they have. Again, fill in your names below:
Your Name:____________________________

Partner I'm interviewing:_____________________________

INTERVIEW QUESTIONS:
Please ask your partner to give you the information below & write their response on the line provided:
1. Please update me on any changes you've made to the meaningful life direction you've chosen and the goals
you set by telling me what they are:
My Peers "Meaningful Life Direction": ______________________________________________________
Short Term Goal: ________________________________________________________________________
Medium Term Goal: ______________________________________________________________________
Long Term Goal: _________________________________________________________________________
Short Term Goal Check in Time: Now that you have the most updated information on your peer, its time for
you both to check in with one another about the short term goal you each committed to complete. Ask your
partner the question below and use the form that matches his/her response:
2. Have you completed your goal this week?
IF NO: USE FORM #1 with your partner
IF YES: USE FORM #2 with your partner
*If your PARTNER completed a short term goal, CONGRATULATE HIM/HER!
If not, nows the time to RECOMMIT to completing the goal this week.

A.Pearson, PhD & R. Tingey, PhD

FORM #1: USE THIS FROM IF YOUR PARTNER HAS NOT COMPLETED HIS/HER GOAL
Please arrange a second time to meet during the week AFTER your peer has completed their goal. Fill in the
spaces below with the following information:
Meeting time following completion of partner's short term goal:
Day: ___________
Time:__________
Goal to be completed by your partner before the next ACT group:
__________________________________________________________________________________________
__________________________________________________________________________________________

Please ask your partner if they are willing to make a verbal recommitment to complete this goal.

A.Pearson, PhD & R. Tingey, PhD

FORM #2: USE THIS FROM IF YOUR PARTNER HAS COMPLETED HIS/HER GOAL.
Ask your peer the following questions and write their response on the line provided:
1. Was completing the goal like flying your airplane without your co-pilot (did all your thoughts, worries, &
voices disappear)?
________________________________________________________________________________________
2. Was your co-pilot shouting at you a lot about why you shouldn't, couldn't, or wouldn't complete your goal?
________________________________________________________________________________________
3. Were other passengers on your plane saying critical or discouraging things to you before or during
completing your goal? (things like"You can't do this; What's the point!")
_________________________________________________________________________________________
4. Did you feel overwhelmed before or during completing your goal?

5. Did you notice any feelings you were having before or during completing your goal?

6. Would you be willing to complete this goal again, or choose a new goal for this week?
(1 = Not At All Willing, 10 = Very Willing) Circle the number indicating your partner's willingness:
1

10

7. What goal can you commit to completing before group next week? (write it in space below):
__________________________________________________________________________________________

A.Pearson, PhD & R. Tingey, PhD

Session 15 Posters

Was
completing the
goal like flying
your airplane
without your
co-pilot?
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(did all your thoughts,


worries, & voices
disappear?)

Was your copilot shouting


at you a lot?
about why you
shouldn't, couldn't, or
wouldn't complete
A.Pearson, PhD & R. Tingey, PhD

your goal?
Were other passengers
on your plane saying
mean things to you
before or during
completing your goal?
(things like"you can't
do this!")
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Did you feel


overwhelmed
before or
during
completing
your goal?
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Did you notice


any feelings
you were
having before
or during
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completing
your goal?
Would you be
willing to
complete this
goal again, or
choose a new
A.Pearson, PhD & R. Tingey, PhD

goal for this


week?
PeertoPeerWorksheet:GoalsandBarriers
Session16Homework
PleaseCompletethisFormWithYourPartner

INTRODUCTION:
Bynow,youwillhaveidentifiedameaningfullifedirectionyouwanttomovetowardsandatleastone
shorttermgoalthatmovesyourlifeinthatdirection.
First,writedownthemeaningfullifedirectionyouwanttomovetowards(Youmayrefertothefollowing
list):

Mental/PhysicalHealth

FamilyRelationships
Spirituality

Friends/SocialRelationships
RomanticRelationships

Career/JobDevelopment
Recreation/Sports

FinancialStability

School/Creativeprojects

Citizenship/CommunityGroups
Other:__________________________________

MyMeaningfulDirection:____________________________________________________

Writeyourgoalforthisweekthatwillmoveyouinthisdirection:
A.Pearson, PhD & R. Tingey, PhD

__________________________________________________________________________________________

DIRECTONS:

1.Readyourmeaningfullifedirectionandgoaloutloudtoyourpeer.

2.Barrierstogoals(eitheryouoryourpartnerwillreadthefollowingstatementoutloud):
Sometimesthingsseemtogetinthewayorinterferewithcompletingsomethingthatismeaningfultous.
Considerthepastcoupleofweeksofgoalsettingthatyouvebeenaskedtodointhegroup.Haveyou
completedthegoalsyousetouttomeet(bothyouandyourpartnershouldanswerthisquestionwithone
another).Ifyouhaven't,itcanbedisappointing.However,insomewaysnotcompletingagoalisjustas
valuableascompletingit.Whenwedon'tcompleteitwehavethechancetogettoknowourselvesbetterif
we'rewillingtolookatwhatgotinthewayofmeetingthegoal.Thiscanactuallyopenupmorechoicesforus.

3.SpecificBarrierstoYourGoal(eitheryouoryourpartnerreadthefollowingstatementaloud):
Ifyouhavenotcompletedthegoalyouintendedtomeet,considersomereasonsforthis.Listedbeloware
somedifferentbarriersthatmayhaveblockedyoufromcompletingyourgoal.Pleasereadtheseoutloud,and
circlethosethatyouexperiencedwhileworkingthispastweekonyourgoal.BarrierstoCompletingYour
Goal

Thoughts:
Nothing'soutthereforyou

You'renotsmart,pretty,or
wealthyenough

You'renotcapable

You'reconfused&don'tgetit

Emotions:

Youcan'tchange

You'renotworthwhile

It'stoohard

You'llfail

"They"won'tletyou

You'reunstable

Thisstuffisstupid

Thevoiceswillgetinthe
wayorstopyou

Youforgot

You'llbepunished

Youdon'tdeserveit

What'sthepoint

Feelingdepressed

Feelingfrustrated

PhysicalSensations:

Feelinganxious

Feelingupset

Feelingsad

Feelingangry

FeelingAfraid/Scared

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Stomach/bowelsareuneasy

Head/neck/backaches.

PracticalIssues:

Verytired

Muscle/jointpain

Lightheaded

Sorefeet

Don'tknowhow

Notime

Don'thavesupport
Nomoney

OtherReasons?________________________________________________________________________

3.Willingness?Pleasereadthefollowingstatementaloudtoyourpartner:
Whatiswillingness?Willingnessisgoingforward,flyinginanewdirection,tryinganewgoal,evenwiththe
barriersyoucheckedabove.Itisputtingenergyintosomethingnew,evenwhenyourcopilotgivesyoureasons
whyyoushouldnt,oryoufeelanxiousorafraid,oryou'retired,orthinkyou'resomehowincapableof
completingit.Willingnessisdoingwhatismeaningfultoyou,evenwhenyourcopilottellsyouotherwise.Itis
flyingyourplaneinthedirectionyouchooseratherthanthedirectionyourcopilotwants.
4.HowWillingAreYourateyourwillingness.
Ifyoucircledsomebarriersabovefornotcompletingyourgoal,areyouwillingtocommittocompletingthe
goalyouwroteonthishandout,evenwiththosebarriersthathavemadeitdifficult?RATEYOURWILLINGNESS
1
2
3
4
5
6
7
8
9
10
(1=NotAtAllWilling,10=VeryWilling)Circlethenumberthatmatchesyourwillingness.

PeertoPeerWorksheet:CommitmenttoaValuedPath
Session17Homework
PleaseCompletePartOneofthisFormWithYourPartner
NAME:____________________________________
DIRECTIONS:
Pleaseintervieweachotherusingthefirstpage(part1)ofthisform.So,givethisformtoyourpartnerso
he/shecanaskyouthequestionsonthisfirstpage.He/shewillthengiveyouyourformbacksoyoucanwork
onthenexttwopages.
PARTONE:INTERVIEWQUESTIONS:
Pleaseaskyourpeerthefollowingquestionsandwritetheirresponseonthelineprovided:

1.Didyoucompleteyourshorttermgoalfromlastweek?_______________

2.Ifnot,whatbarrier(s)seemedtogetinthewayofcompletingit?

__________________________________________________________________________________________

__________________________________________________________________________________________
A.Pearson, PhD & R. Tingey, PhD

Readtoyourpeerthefollowingstatement:

Pleaseconsideroncemorethemeaningfullifedirectionyouwishtopursuebymakingshorttermandlong
termgoals.Hereagainisalistofvalueddomains(readthemtoyourpeer):
Mental/PhysicalHealth
Spirituality

RomanticRelationships
Recreation/Sports
School/Creativeprojects

FamilyRelationships
Friends/SocialRelationships

Career/JobDevelopment
FinancialStability

Citizenship/CommunityGroups

Other:__________________________________
Askyourpeer:
Whichofthesemeaningfullifedirectionshaveyoubeenworkingtowards?

Writeyourpartner'svalueddirectionhere:
______________________________________________________________

**Pleasereturnyourpartner'sformtohim/her.Thenextpartyouwilleachcompleteforyourself.
PART2:QUESTIONSFORYOUTOANSWER(notyourpeer):
1.Pleasewriteashorttermgoalinthespaceprovidedbelowthatmovesyoualongyourmeaningfullife
direction(thiscanbethesamegoalyouvealreadybeenworkingon,oritcanbeadifferentone):
__________________________________________________________________________________________
2.Pleasewritealongtermgoalinthemeaningfullifedirectionofyou'vechoseninthespacebelow(i.e.along
termgoalisonethatmaytakeamonthormoretocomplete):
__________________________________________________________________________________________
Whataresomecommonbarriersthattypicallygetinthewayofcompletingyourgoals?

Thoughtswhatmycopilot/passengerssay:
Nothing'soutthereforyou

Youcan'tchange

You'renotworthwhile

It'stoohard

You'renotsmart,pretty,or
wealthyenough

You'llfail

"They"won'tletyou

You'reunstable

You'renotcapable

Thisstuffisstupid

Thevoiceswillgetinthe
wayorstopyou

Youforgot

A.Pearson, PhD & R. Tingey, PhD

You'reconfused&don'tgetit

Emotions:

You'llbepunished

Youdon'tdeserveit

What'sthepoint

Feelingdepressed

Feelinganxious

Feelingupset

Feelingsad

Feelingfrustrated

Feelingangry

FeelingAfraid/Scared

Stomach/bowelsareuneasy

Verytired

Muscle/jointpain

Lightheaded

Head/neck/backaches.

Sorefeet

Notime

Don'thavesupport

PhysicalSensations:

PracticalIssues:
Don'tknowhow

Nomoney

OtherReasons?________________________________________________________________________

DefiningYourPersonalBarriers:

3.Pleasedescribethreespecificbarriersthatseemtogetinthewayofcompletingmeaningfulgoalsinyour
life.Thesecanbethoughtsthatyourcopilotsays,feelingsyoudonotwanttohave,orotherbarriersthat
seemtomakenewgoalsveryhardtocomplete.Youmayusethelistofreasonstohelpyoudefineyour
personalbarriers:

1.__________________________________________________________
2.__________________________________________________________
3.__________________________________________________________
4.Howwillingareyoutocompleteyourshorttermandlongtermgoalevenwiththebarriersyoulisted
above?
1
2
3
4
5
6
7
8
9
10
(1=NotAtAllWilling,10=VeryWilling)Circlethenumberthatmatchesyourwillingness.

A.Pearson, PhD & R. Tingey, PhD

5.Whatdoyouthinkmighthelpyoubemorewillingtomoveforwardonyourmeaningfullifepath,evenwith
thebarriersyouencounter?
Herearesomethingsthathavehelpedotherpeople:
1.Supportfrompeers
2.Sharingdifficultfeelingsandthoughtswithsomeoneyoutrust
3.Practicingbeingpresentbytakingawalkorsittingquietlyandlettingyourselffeelwhatevercomesup.
4.Whendifficultthoughtshappen,remindingyourselfthatitisyourcopilotorpassengersontheplane
5.Discussingyourvaluesandgoalswithatrustedhealthcareprovider,aspiritualguideorsomeoneina
helpingrole.
6.Practicinggoodselfcarephysicallyandmentally.
Canyouthinkofothers?Youmaywritethembelow.
__________________________________________________________________________________________
__________________________________________________________________________________________
6.Howwillingareyoutousesomeofthesesuggestionstoassistyouincompletingyourshorttermandlong
termgoalevenwiththebarriersyoulistedabove?
1
2
3
4
5
6
7
8
9
10
(1=NotAtAllWilling,10=VeryWilling)Circlethenumberthatmatchesyourwillingness.

A.Pearson, PhD & R. Tingey, PhD

Session 18 posters

Your
Meaningful
Life Direction

Your Short-Term
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Goal

A.Pearson, PhD & R. Tingey, PhD

Your Long-Term
Goal

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The Likely
Barriers
To Completing
Your Goals
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Your
Willingness to
Complete Your
Goals, Even
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with the
Barriers (1 10)
What would
help You in this
Process

A.Pearson, PhD & R. Tingey, PhD