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

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

I Present Moment Focus

A. Session 1: Noticing What’s 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 What’s Inside: Thoughts, Feelings & Physical Sensations
1. I-Internal experiences (+hallucinations) introduced
2. M-Bag/Backpack to carry thoughts m-item is in the bag, it’s 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 Here—Noticing What’s Distracting
1. I-Identify different types of internal exp
2. E-Walk to different locations based on most noticeable current internal exp
Notice if they’re 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 Mind—The 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-pilot’s comments occur almost simultaneously, where does cp get his ideas?
C. Session 6: Training Your Co-Pilot
1. E-Co-pilot—quick learner, long memory—Mary had a little _____.
2. I-Co-pilot learns his thoughts from people & their creations—books, ads, movies, etc.
Notice some thoughts uncomfortable, irritating
3. M-Passengers on our plane—Take 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 check—some clients w/SMI fled mention of their uncomfortable thoughts in Session 6
2. E-Getting rid of thoughts— Tossing furniture/tossing thoughts—Don’t think of the flag
3. I-The more you don’t want it, the more you have it.
4. I-What makes a thought unwanted?--Thoughts about thoughts & thoughts w/attached feelings
5. E-Co-pilot’s scary/sad thoughts/voices on a card—set it away based on want/don’t want it
B. Session 8: Unwanted Feelings
1. I-Getting rid of emotions/feelings
2. E-Stand with Yourself: feelings on posters—move away/around them based on want/don’t want them
3. I-The more you don’t want it the more you abandon yourself and have it.
C. Session 9: Dropping the Rope—Willingness
A.Pearson, PhD & R. Tingey, PhD
 1. M/E-Tug of War—pilot and control/avoidance strategies vs. co-pilot and passengers—drop the rope
2. I-Acceptance is the alternative to the struggle—willing 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 Am—I am a/used to be a…., I like/don’t 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 Age—images from youth
2. I-Constant me has observed my life experiences at all ages
3. E-I have survived—recalling 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 I’ve 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 Direction—Valued 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 they’re 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

A.Pearson, PhD & R. Tingey, PhD

 Spirituality

A.Pearson, PhD & R. Tingey, PhD

 Family
Relationships

A.Pearson, PhD & R. Tingey, PhD

 Friends/Social
Relationships
A.Pearson, PhD & R. Tingey, PhD
 Romantic
Relationships

A.Pearson, PhD & R. Tingey, PhD

 Career/Job
Development

A.Pearson, PhD & R. Tingey, PhD

 Recreation/
Sports

A.Pearson, PhD & R. Tingey, PhD

 Financial
Stability

A.Pearson, PhD & R. Tingey, PhD

 School/
Creative
Projects

A.Pearson, PhD & R. Tingey, PhD

 Citizenship/
Community
Groups

A.Pearson, PhD & R. Tingey, PhD

 I value this
because:
I should want it

A.Pearson, PhD & R. Tingey, PhD

 I value this
because:
Somebody else
wants me to or
they'll like it if I
do.
A.Pearson, PhD & R. Tingey, PhD
 I value this
because:
I would feel
embarrassed,
ashamed,
guilty or

A.Pearson, PhD & R. Tingey, PhD

 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.
A.Pearson, PhD & R. Tingey, PhD
 I value this
because:
I experience
fun and
enjoyment

A.Pearson, PhD & R. Tingey, PhD

 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, you’ll 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 don’t 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 today’s meeting?

_____________________________________________________________________________________

SETTING SOME GOALS

1. Please read the following statement to your peer.
“You’ll 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 goal—something you can do today that would move you along the path of your
meaningful life direction:

___________________________________________________________________________________

3. What is your medium term goal—something you can do this week that would move you along the path of
your meaningful life direction:

___________________________________________________________________________________

4. What is your long term goal—something 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, that’s 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 Happy Frightening Perplexing

Encouraging Stuck Angry Amazing
Confusing Motivating Sad Hopeless
Irritating Doubtful Hopeful Courageous
Boring Inspiring Deflating 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! YOU’RE 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 you’ll 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 Peer’s "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, it’s 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, now’s 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 2 3 4 5 6 7 8 9 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?
A.Pearson, PhD & R. Tingey, PhD
 (did all your thoughts,
worries, & voices
disappear?)
Was your co-
pilot 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!")

A.Pearson, PhD & R. Tingey, PhD

 Did you feel
overwhelmed
before or
during
completing
your goal?
A.Pearson, PhD & R. Tingey, PhD
 Did you notice
any feelings
you were
having before
or during

A.Pearson, PhD & R. Tingey, PhD

 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?
Peer
to
Peer
Worksheet:
Goals
and
Barriers


Session
16
Homework

Please
Complete
this
Form
With
Your
Partner





INTRODUCTION:

By
now,
you
will
have
identified
a
meaningful
life
direction
you
want
to
move
towards
and
at
least
one

short
term
goal
that
moves
your
life
in
that
direction.



First,
write
down
the
meaningful
life
direction
you
want
to
move
towards
(You
may
refer
to
the
following

list):





Mental/Physical
Health
 
 
 
 
 Family
Relationships


Spirituality
 
 
 
 
 
 Friends/Social
Relationships
 

Romantic
Relationships
 
 
 
 
 Career/Job
Development

Recreation/Sports
 
 
 
 
 Financial
Stability
 

School/Creative
projects
 
 
 
 Citizenship/Community
Groups


Other:__________________________________




My
Meaningful
Direction:
____________________________________________________







Write
your
goal
for
this
week
that
will
move
you
in
this
direction:




A.Pearson, PhD & R. Tingey, PhD

__________________________________________________________________________________________







DIRECTONS:



1.Read
your
meaningful
life
direction
and
goal
out
loud
to
your
peer.












2.
Barriers
to
goals
(either
you
or
your
partner
will
read
the
following
statement
out
loud):


Sometimes things seem to get in the way or interfere with completing something that is meaningful to us. 
Consider the past couple of weeks of goal setting that you’ve been asked to do in the group. Have you 
completed the goals you set out to meet (both you and your partner should answer this question with one 
another). If you haven't, it can be disappointing. However, in some ways not completing a goal is just as 
valuable as completing it. When we don't complete it we have the chance to get to know ourselves better if 
we're willing to look at what got in the way of meeting the goal.  This can actually open up more choices for us. 








3.
Specific
Barriers
to
Your
Goal
(either
you
or
your
partner
read
the
following
statement
aloud):


If you have not completed the goal you intended to meet, consider some reasons for this. Listed below are 
some different barriers that may have blocked you from completing your goal. Please read these out loud, and 
circle those that you experienced while working this past week on your goal.   Barriers
to
Completing
Your

Goal




Thoughts:

Nothing
's
out
there
for
you
 
 You
can't
change
 You're
not
worthwhile
 It's
too
hard



You're
not
smart,
pretty,
or
 
 You'll
fail
 
 "They"
won't
let
you
 
 You're
unstable

wealthy
enough



You're
not
capable
 
 
 This
stuff
is
stupid
 The
voices
will
get
in
the
 
You
forgot


 
 
 
 
 
 
 
 way
or
stop
you



You're
confused
&
don't
get
it
 You'll
be
punished
 You
don't
deserve
it

 
 What's
the
point
 


 


Emotions:

Feeling
depressed
 
 
 Feeling
anxious
 
 Feeling
upset
 
 Feeling
sad



Feeling
frustrated

 
 
 Feeling
angry
 
 
 Feeling
Afraid/Scared



Physical
Sensations:


A.Pearson, PhD & R. Tingey, PhD

Stomach/bowels
are
uneasy
 
 Very
tired
 
 Muscle/joint
pain

 
 Light
headed



Head/neck/back
aches.
 
 Sore
feet



Practical
Issues:

Don't
know
how
 
 
 No
time
 
 Don't
have
support
 
 No
money




Other
Reasons?
________________________________________________________________________




3.
Willingness?
Please
read
the
following
statement
aloud
to
your
partner:


What is willingness? Willingness is going forward, flying in a new direction, trying a new goal, even with the 
barriers you checked above. It is putting energy into something new, even when your co‐pilot gives you reasons 
why you shouldn’t, or you feel anxious or afraid, or you're tired, or think you're somehow incapable of 
completing it. Willingness is doing what is meaningful to you, even when your co‐pilot tells you otherwise. It is 
flying your plane in the direction you choose rather than the direction your co‐pilot wants. 

4.
How
Willing
Are
You‐‐
rate
your
willingness.


If
you
circled
some
barriers
above
for
not
completing
your
goal,
are
you
willing
to
commit
to
completing
the

goal
you
wrote
on
this
handout,
even
with
those
barriers
that
have
made
it
difficult?
RATE
YOUR
WILLINGNESS

1
 2
 3
 4
 5
 6
 7
 8
 9
 10








(1
=
Not
At
All
Willing,


10
=
Very
Willing)


Circle
the
number
that
matches
your
willingness.




Peer
to
Peer
Worksheet:
Commitment
to
a
Valued
Path

Session
17
Homework

Please
Complete
Part
One
of
this
Form
With
Your
Partner


NAME:____________________________________


DIRECTIONS:

Please
interview
each
other
using
the
first
page
(part
1)
of
this
form.
So,
give
this
form
to
your
partner
so

he/she
can
ask
you
the
questions
on
this
first
page.
He/she
will
then
give
you
your
form
back
so
you
can
work

on
the
next
two
pages.



PART
ONE:

INTERVIEW
QUESTIONS:

Please
ask
your
peer
the
following
questions
and
write
their
response
on
the
line
provided:



1.  Did you complete your short term goal from last week?

_______________



2.

If not, what barrier(s) seemed to get in the way of completing it?




__________________________________________________________________________________________



__________________________________________________________________________________________


A.Pearson, PhD & R. Tingey, PhD
Read
to
your
peer
the
following
statement:




Please consider once more the meaningful life direction you wish to pursue by making short term and long 
term goals. Here again is a list of valued domains (read
them
to
your
peer):



Mental/Physical
Health
 
 
 
 
 Family
Relationships


Spirituality
 
 
 
 
 
 Friends/Social
Relationships
 

Romantic
Relationships
 
 
 
 
 Career/Job
Development

Recreation/Sports
 
 
 
 
 Financial
Stability
 

School/Creative
projects
 
 
 
 Citizenship/Community
Groups


Other:__________________________________


Ask
your
peer:


Which of these meaningful life directions have you been working towards?  

Write
your
partner's
valued
direction
here:

______________________________________________________________


**Please
return
your
partner's
form
to
him/her.
The
next
part
you
will
each
complete
for
yourself.

PART
2:

QUESTIONS
FOR
YOU
TO
ANSWER
(not
your
peer):

1.
Please
write
a
short
term
goal
in
the
space
provided
below
that
moves
you
along
your
meaningful
life

direction
(this
can
be
the
same
goal
you’ve
already
been
working
on,
or
it
can
be
a
different
one):


__________________________________________________________________________________________



2.
Please
write
a
long
term
goal
in
the
meaningful
life
direction
of
you've
chosen
in
the
space
below
(i.e.
a
long

term
goal
is
one
that
may
take
a
month
or
more
to
complete):

__________________________________________________________________________________________


What are some common barriers that typically get in the way of completing your goals?   
 
Thoughts—what
my
copilot/passengers
say:

Nothing
's
out
there
for
you
 
 You
can't
change
 You're
not
worthwhile
 It's
too
hard


You're
not
smart,
pretty,
or
 
 You'll
fail
 
 "They"
won't
let
you
 
 You're
unstable


wealthy
enough


You're
not
capable
 
 
 This
stuff
is
stupid
 The
voices
will
get
in
the
 
You
forgot



 
 
 
 
 
 
 
 way
or
stop
you


A.Pearson, PhD & R. Tingey, PhD

You're
confused
&
don't
get
it
 You'll
be
punished
 You
don't
deserve
it

 
 What's
the
point


 


Emotions:

Feeling
depressed
 
 
 Feeling
anxious
 
 Feeling
upset
 
 
 Feeling
sad


Feeling
frustrated

 
 
 Feeling
angry
 
 
 Feeling
Afraid/Scared


Physical
Sensations:

Stomach/bowels
are
uneasy
 
 Very
tired
 
 
 Muscle/joint
pain

 
 Light
headed


Head/neck/back
aches.
 
 Sore
feet


Practical
Issues:

Don't
know
how
 
 
 No
time
 
 
 Don't
have
support
 
 No
money



Other
Reasons?
________________________________________________________________________
















Defining
Your
Personal
Barriers:




3.

Please
describe
three
specific
barriers
that
seem
to
get
in
the
way
of
completing
meaningful
goals
in
your

life.
These
can
be
thoughts
that
your
co‐pilot
says,
feelings
you
do
not
want
to
have,
or
other
barriers
that

seem
to
make
new
goals
very
hard
to
complete.
You
may
use
the
list
of
reasons
to
help
you
define
your

personal
barriers:




1.
__________________________________________________________


2.
__________________________________________________________


3.
__________________________________________________________


4.

How
willing
are
you
to
complete
your
short
term
and
long
term
goal
even
with
the
barriers
you
listed

above?


1
 2
 3
 4
 5
 6
 7
 8
 9
 10







(1
=
Not
At
All
Willing,


10
=
Very
Willing)


Circle
the
number
that
matches
your
willingness.


A.Pearson, PhD & R. Tingey, PhD

5.

What
do
you
think
might
help
you
be
more
willing
to
move
forward
on
your
meaningful
life
path,
even
with

the
barriers
you
encounter?


Here are some things that have helped other people:  



1.
Support
from
peers





2.
Sharing
difficult
feelings
and
thoughts
with
someone
you
trust




3.
Practicing
being
present
by
taking
a
walk
or
sitting
quietly
and
letting
yourself
feel
whatever
comes
up.





4.
When
difficult
thoughts
happen,
reminding
yourself
that
it
is
your
co‐pilot
or
passengers
on
the
plane




5.
Discussing
your
values
and
goals
with
a
trusted
healthcare
provider,
a
spiritual
guide
or
someone
in
a

helping
role.




6.
Practicing
good
self
care
physically
and
mentally.


Can you think of others? You may write them below.



__________________________________________________________________________________________


__________________________________________________________________________________________


6.

How
willing
are
you
to
use
some
of
these
suggestions
to
assist
you
in
completing
your
short
term
and
long

term
goal
even
with
the
barriers
you
listed
above?


1
 2
 3
 4
 5
 6
 7
 8
 9
 10







(1
=
Not
At
All
Willing,


10
=
Very
Willing)


Circle
the
number
that
matches
your
willingness.
















Session 18 posters

A.Pearson, PhD & R. Tingey, PhD

 Your
Meaningful
Life Direction

Your Short-Term
A.Pearson, PhD & R. Tingey, PhD
 Goal

A.Pearson, PhD & R. Tingey, PhD

Your Long-Term
Goal

A.Pearson, PhD & R. Tingey, PhD

 The Likely
Barriers
To Completing
Your Goals
A.Pearson, PhD & R. Tingey, PhD
 Your
Willingness to
Complete Your
Goals, Even
A.Pearson, PhD & R. Tingey, PhD
 with the
Barriers (1 – 10)

What would
help You in this


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