Worksheets LearningACT2ed

Learning ACT, 2d edition
ACT Core Competency Rating Form
ACT Core Competency Rating Form

A number of statements are listed on the competency rating form. Please use the scale below to rate how true
each statement is for you (or the person you are rating) when using ACT, writing your rating next to each item.
Note that the asterisk (*) denotes competencies that are either modified or new for this edition.
R ating scale
1 2 3 4 5 6 7 ?
never true very seldom seldom sometimes frequently almost always true don’t know
true true true true always true
Developing Willingness and Acceptance
1 The therapist communicates to clients that they are not broken but are using unworkable
strategies.
2 The therapist helps clients make direct contact with the paradoxical effects of emotion
control strategies.
3 The therapist actively uses the concept of workability in clinical interactions.
4 The therapist actively encourages the client to experiment with stopping the struggle for
emotional control and suggests willingness as an alternative.
5 The therapist highlights the contrast between the workability of control and willingness
strategies.
6 The therapist helps the client investigate the relationship between willingness and suffering.
7 The therapist helps the client make contact with the cost of unwillingness relative to valued
life directions.
8 The therapist helps the client experience the qualities of willingness.
Copyright © 2017 Jason B. Luoma, Steven C. Hayes, and Robyn D. Walser / New Harbinger Publications.
Permission is granted to the reader to reproduce this form for personal use.
Learning ACT, 2d edition ACT Core Competency Rating Form
9 The therapist uses exercises and metaphors to demonstrate willingness as an action in the
presence of difficult internal experiences.
10 The therapist models willingness in the therapeutic relationship and helps the client
generalize these skills outside therapy.
11 The therapist can use a graded and structured approach to willingness assignments.
Undermining Cognitive Fusion
12 The therapist identifies the client’s emotional, cognitive, behavioral, or physical barriers to
willingness.
13 The therapist suggests that attachment to the literal meaning of these experiences makes
willingness difficult to sustain (in other words, the therapist helps clients see private
experiences for what they are, rather than what they advertise themselves to be).
14 The therapist actively contrasts what the client’s mind says will work with what the client’s
experience says is working.
15 The therapist uses language tools (e.g., verbal conventions), metaphors, and experiential
exercises to create a separation between the client and the client’s conceptualized
experience.*
16 The therapist works to get the client to experiment with “having” difficult private
experiences, using willingness as a stance.
17 The therapist uses various exercises, metaphors, and behavioral tasks to reveal the hidden
properties of language.
18 The therapist helps clients elucidate their story and helps them make contact with the
evaluative and reason-giving properties of the story, as well as the arbitrary nature of causal
relationships within the story.*
19 The therapist detects fusion in session and teaches the client to detect it as well.
20 The therapist uses various interventions to reveal both the flow of private experience and
that such experience is not toxic.
Getting in Contact with the Present Moment
21 The therapist can defuse from client content and direct attention to the moment.
22 The therapist brings his or her own thoughts or feelings in the moment into the therapeutic
relationship.
23 The therapist uses exercises to expand the client’s sense of experience as an ongoing process
(e.g., mindfulness exercises or imagery exercises that support the client in focusing on the
ongoing flow of internal experiences).*
24 The therapist detects when clients are drifting into a past or future orientation and teaches
them how to come back to the present moment.
25 The therapist conceptualizes client behavior at multiple levels and emphasizes the present
moment when doing so is useful.*
26 The therapist practices and models getting out of his or her own mind and coming back to
the present moment in session.
Distinguishing the Conceptualized Self from Self-a s-Context
27 The therapist uses metaphors and exercises to help clients distinguish between the content
of consciousness and consciousness itself so as to increase a sense of self as a location,
container, or context for all experience, fostering a greater ability to act with these
experiences, rather than for or against them.*
28 The therapist uses metaphors and exercises to reduce clients’ attachment to conceptualized
selves or conceptualized others that create problematic rigidity or interfere with flexible
responding.*
29 The therapist helps clients contact an expansive and interconnected sense of self through
building a sense of being part of a larger whole that extends across time, place, and person,
whether that be a group, humanity as a whole, or the continuity of consciousness itself.*
30 The therapist helps clients flexibly take perspectives toward themselves, others, and their
own experience that build flexible and compassionate ways of responding; such perspectives
include but are not limited to viewing the self from different conceptualized selves (e.g.,
loving self), the perspectives of others (real or imagined), perspectives of time (past, future),
and perspectives of place.*
Defining Valued Directions
31 The therapist helps the client clarify valued life directions.*
32 The therapist helps clients commit to what they want their life to stand for and focuses the
therapy on this process.*
33 The therapist teaches the client to distinguish between values and goals.
34 The therapist distinguishes between outcomes achieved and involvement in the process of
living.
35 The therapist states his or her own therapy-relevant values and models their importance.
36 The therapist respects client values and, if unable to support them, offers a referral or other
alternative.
Building Patterns of Committed Action
37 The therapist helps the client identify values-based goals and build an action plan linked to
them.*
38 The therapist encourages the client to make and keep commitments in the presence of
perceived barriers (e.g., fear of failure, traumatic memories, sadness, being right) and to
expect additional barriers as a consequence of engaging in committed action.
39 The therapist helps the client appreciate the qualities of committed action (e.g., vitality,
sense of growth) and to take small steps while maintaining contact with those qualities.
40 The therapist keeps the client focused on larger and larger patterns of action to help the
client act on goals with consistency over time.
41 The therapist nonjudgmentally integrates client slips or relapses into the process of keeping
commitments and building larger patterns of effective action.
The ACT Ther apeutic Stance
42 The ACT therapist speaks to the client from an equal, vulnerable, compassionate, genuine,
and sharing point of view and respects the client’s inherent ability to move from unworkable
to workable responses.
43 The therapist is willing to self-disclose when it serves the interest of the client.*
44 The therapist avoids the use of formulaic ACT interventions, instead fitting interventions
to the particular needs of particular clients. The therapist is ready to change course to fit
those needs at any moment.
45 The therapist tailors interventions and develops new metaphors, experiential exercises, and
behavioral tasks to fit the client’s experience and language practices and the social, ethnic,
and cultural context.
46 The therapist models acceptance of challenging content (e.g., what emerges during
treatment) while also being willing to hold the client’s contradictory or difficult ideas,
feelings, and memories without any need to resolve them.
47 The therapist introduces experiential exercises, paradoxes, or metaphors as appropriate and

deemphasizes literal sense making of the same.
48 The therapist always brings the issue back to what the client’s experience is showing and
does not substitute his or her opinions for that genuine experience.
49 The therapist does not argue with, lecture, coerce, or attempt to convince the client.
50 ACT-relevant processes are recognized in the moment and, when appropriate, are directly
supported in the context of the therapeutic relationship.
Learning ACT, 2d edition Frequently Asked Questions
Frequently Asked Questions
In this document, we review a number of common questions posed by therapists new to the ACT approach and
provide brief responses. If you have any additional questions, one good place to ask them is on the ACT Listserv
maintained by the Association for Contextual Behavioral Science (links are at http://www.contextualscience
.org/networking).
Question: How do I introduce an experiential exercise or metaphor?
Answer: The extensive use of experiential exercises and metaphors that is characteristic of ACT can be anxiety
provoking for therapists not accustomed to this approach. Because ACT is an experiential therapy, exercises and
stories—as well as less didactic, second-order tools for change—are emphasized and used frequently in sessions.
Ideally, metaphors and exercises are contextualized to the client and the specific nature of a client’s difficulties.
For example, you can incorporate thoughts or feelings clients have expressed into metaphors or can let one of
the client’s comments evoke a particular exercise. Contextualizing metaphors and exercises helps avoid the
pitfall wherein therapists sometimes try to squeeze a variety of metaphors or exercises into a session without a
coherent theme.
On the other hand, it can sometimes be difficult to see how to directly connect a particular metaphor or
exercise to a client’s experience, even if you sense that the intervention may be helpful for the client. In this case,
it may still be worthwhile to do the exercise in a more general form. In any case, we recommend that you get
permission from clients before conducting exercises. You can simply say something like, “I’m thinking of an
exercise that might be helpful for you. Are you willing to do a short eyes-closed exercise with me?”
If you’re a beginning ACT therapist, there are a number of steps you can take to make sessions more experi-
ential. One is to follow a specific treatment manual. Manuals generally use a step-by-step approach and help
therapists prepare for sessions by providing guidance that you can study until you’re able to deliver each session
consistently. If you aren’t following a manual but are instead integrating ACT into work you already do, or if
you’re using ACT in a less structured way, we recommend developing a loose plan for which flexibility processes
and exercises you might use in upcoming sessions. This way you can review the relevant metaphors and exercises
prior to the session, choose three or four that you might use, and then practice to ensure that you can deliver
them accurately and understand their intended purpose. A good way to prepare is to read scripts aloud, since
you’ll be speaking and listening in therapy, not reading silently. Generally, it isn’t a good idea to read the text of
exercises in session with clients (although this can be useful when first learning or when conducting more
extended eyes-closed exercises, such as the Observer Exercise in chapter 5). Reading exercises can interfere with
pace and timing, causing them to sound stilted or odd at times. It’s better to commit such interventions to
memory, to imbue them with your own style, and to be clear about the purpose of the exercise and let that guide
your delivery. For more guidance on getting experiential in session, review chapter 4 of Learning ACT.
Question: How do I explain ACT to clients and get informed consent?
Answer: Developing an adequate description of the process of therapy and general agreement on goals and tasks
can be a bit difficult in ACT because of its linguistic orientation. Because ACT is experiential and often attempts
to undermine the more insidious effects of language, the process of therapy cannot be directly described. When
clients come to therapy, their understanding of their situation and of what they’ve been trying to do to change
their situation are often part of the problem. However, it may be less than helpful to immediately and directly
share that with clients, as it could seem to imply that they need to get over the problem or find a way to resign
themselves to it. One solution is to speak metaphorically about the purpose of ACT.
The following dialogue provides a model of how you can discuss informed consent with a client, in this case,
one who struggles with chronic worry.
Therapist: I want to take a minute to share with you what we do in acceptance and commitment therapy. Really,
what happens is contained in its name: we’ll be working on acceptance and on taking action in ways
that you consider to be important for the life you want to create. Some of what happens in ACT is
pretty straightforward. For instance, I’ll be asking you to do things between sessions. I’ll also be invit-
ing you to do things in session that you might not typically think of as therapy, at least not in the way
therapy is represented in popular media, and that may be quite different from any prior therapy expe-
riences you may have had. For instance, we’ll be doing exercises designed to help move you forward
in your life, and these may involve engaging in role-plays or standing up and moving around.
Additionally, this isn’t the kind of therapy where, as the therapist, I just sit back and listen. I will
listen, but I’m going to be working alongside you, talking, engaging, and exploring how to make things
different for you. I should also note that if there are times when you feel confused or upset, that isn’t
an indication that things are getting worse; it may be part of the process. Some therapies are oriented
toward helping people get the problems they’ve been struggling with, their thoughts and emotions,
under control. My approach isn’t like that. I want to help you get your life back, but this may mean
opening up to certain experiences. Does this sound okay to you?
Client: How is opening up going to help?
Therapist: That’s a bit difficult to answer right now, in part because one factor that keeps us stuck in our strug-
gles is the logical, problem-solving mind. I assume you’ve been doing what seems best—what seems
logical. But I also assume that hasn’t been good enough: otherwise you probably wouldn’t be here. So
I can’t answer your question in a typical way. The closest I can come in this moment is to say this:
stepping out of the struggle will involve changing how you relate to your own thoughts and feelings
and learning to operate more on the basis of your direct experience and deepest yearnings. What that
means concretely—well, that’s what therapy will make clear. And I want to affirm that, ultimately,
the person who will determine whether we’re moving ahead or not is you, not me. So although I will
need some time to work this through with you, I’m not asking for a blank check.
Generally, it is a good idea to talk about what the empirical evidence has to say about the effectiveness of
ACT, as well as various alternative treatments. It’s also common for ACT therapists to ask clients to commit to
an initial number of sessions of therapy and refrain from an evaluation of whether it’s working until the end of
that period. At the same time, you’ll want to reaffirm the importance of direct progress, as viewed by the client.
In other words, you’re seeking a commitment for a reasonable but limited period of time, and you aren’t saying,
“Just trust me.”
It can be helpful to warn clients about possible ups and downs. The experience of ACT can be compared to
riding a roller coaster that’s gradually going uphill but sometimes may appear to descend to a level lower than
where the client entered therapy. For clients who appear to engage in a high degree of experiential avoidance,
it’s useful to predict that urges to drop out of therapy may develop when the process becomes intense. That will
normalize these urges. Doing this early in therapy, before the glue of the therapeutic relationship has had time
to set, can help reduce the chance of premature dropout and give the therapist time to lay out ACT’s seemingly
counterintuitive and often unusual approach, which may sometimes be confusing, evocative, or painful to clients.
From an ACT perspective, the core of the treatment contract is developing a sense of shared values and a
general description of the direction of therapy, and articulating the choice to work together in this direction.
Clients generally come to therapy implicitly endorsing the dominant cultural story: that they need to feel better
in order to live better. Under the sway of this story, they may find themselves endlessly pursuing feeling better
while putting living better on the back burner. Because ACT is oriented toward helping clients find the freedom
to move in the direction of their chosen values, it’s essential for the ACT therapist to have an initial sense of
what really matters to the client, which may or may not be linked to feeling better. The treatment contract is
built around this shared sense of the client’s values and must be consistent with the client’s larger life goals and
dreams.
Other books provide more elaborate guidance on how to provide informed consent, including Harris, 2009
(pp. 61–69), and (Hayes, Strosahl, & Wilson, 2012 (pp. 176–180).
Question: Is experiential avoidance always a bad thing?
Answer: The short answer is no. The long answer is it depends. On the one hand, the ACT stance on experi-
ential avoidance is pragmatic: experiential avoidance is “bad” when it doesn’t work as defined in the context of
a client’s values. If, on the other hand, experiential avoidance isn’t harmful to the client’s pursuit of a values-
based life, then there’s no reason to target it. That said, research over the past few decades seems to suggest that
using experiential avoidance as a broad pattern of coping is one of the most destructive and harmful psychologi-
cal processes (Bond et al., 2011). It has been related to many problematic outcomes, from high-risk sexual behav-
ior to hair pulling, from panic attacks to burnout, and from depression to learning difficulties. Thus, it’s reasonable
to assume that experiential avoidance generally isn’t a form of positive behavior if it’s a broad response pattern.
Ultimately, however, the client’s experience is what determines what’s workable for that individual.
Question: What’s this stuff about “being in the same boat as the client”? You can’t really mean that I’m equally
dysfunctional as a client with schizophrenia.
Answer: ACT promotes nonhierarchical, humanizing relationships between therapists and clients. It doesn’t
deny that differences between therapist and client exist, but does seek to minimize differences that do not serve
the interest of the client. The ACT model assumes that because suffering is ubiquitous, the cause of suffering
must likewise be ubiquitous. ACT and RFT suggest that the main culprit is language itself. So both the therapist
and a client with schizophrenia have the same “language disease.” Although ACT recognizes that specific or
abnormal factors can contribute to the form of a client’s problems (e.g., a genetic predisposition to schizophre-
nia), that doesn’t preclude general processes based on language (e.g., experiential avoidance and fusion) from
being strongly influential. In fact, two randomized controlled studies have shown that ACT can result in a sig-
nificant reduction in rehospitalization of patients with psychotic disorders, and that this result appears to be
related to changes in ACT’s core flexibility processes (Bach & Hayes, 2002; Gaudiano & Herbert, 2006).
Question: What is the role of psychopharmacology with ACT?
Answer: Some people think ACT calls for not utilizing psychiatric medications. This may arise from a misun-
derstanding of ACT’s assumption that human suffering is a normal part of the human condition, in contrast to
the view that suffering is a sign of an abnormal disease process, which is typical of the medical model. However,
the ACT stance on medications is fully pragmatic and recognizes that psychiatric medications are mind-altering
drugs that have both benefits and risks. When using psychiatric medication aligns with a client’s values and a
cost-benefit analysis suggests that taking them is workable, then using medication would be supported as a form
of committed action. This is especially the case in situations where strong research support indicates that medi-
cation is helpful, as for opiate replacement therapy (see Hayes et al., 2012, pp. 342–344).
However, the ACT perspective also acknowledges that psychiatric medications seldom eliminate distressing
thoughts and feelings. While medications may sometimes moderate their impact, no medication can teach
people how to live well. We recommend that all clinicians educate themselves on the current science surround-
ing psychiatric medications and use this information when making decisions about treatment and referral.
For clients who enter treatment while taking psychiatric medications and want to talk about the role of those
medications, a statement along these lines might be helpful.
Therapist: As you know, medications don’t completely solve the problem for everyone. If they did, you wouldn’t
be in here today. But they can give us a peek at what it might be like to be less entangled with our
thoughts and feelings. In our work together, we’ll help you develop other ways to relate to your difficult
thoughts and feelings. And, at some point, we may want to discuss the costs and benefits of medica-
tions for you and your life. But I think it would be helpful to make some progress in here before we
move on to that. Does that sound okay to you?
Be aware that there are some situations in which medications can limit progress (e.g., the anxiety-blocking
effect of benzodiazepines can decrease the benefits of exposure). In such cases, it’s best to deal with the issue at
the appropriate time, which is not necessarily at the beginning of therapy. In ACT, it’s rare to start a course of
therapy by trying to eliminate medication use; continuing to look at workability, based on the client’s direct
experience, is all that’s needed.
Question: I don’t like experiential exercises. Why can’t I just explain to clients what they need to do?
Answer: Therapists can indeed do some good with ACT-based psychoeducation. However, following verbal
rules is not the same as behavior born from experience, which tends to be more flexible. How clients learn can
make a big difference. The needs and values of the client, and the evidence regarding their condition, should be
your primary guides. As the therapist, whether you like or dislike certain approaches is worth noting. Accepting
discomfort and still doing what needs to be done is exactly what ACT is all about, so feeling uncomfortable with
certain elements of ACT is not necessarily bad. Indeed, it can greatly inform therapy.
Question: Can you use creative hopelessness with hopeless or suicidal clients?
Answer: A clarification of terminology is probably in order: creative hopelessness isn’t about making clients feel
hopeless; it’s is about validating clients’ direct experience, enabling them let go of what doesn’t work, and helping
them prepare for real change. The result is typically hopeful and empowering, not depressing and hopeless.
Question: Is ACT inappropriate for some clients?
Answer: Because ACT is an evidence-based approach, the best answer is to follow what the current evidence
suggests. However, we can be more specific. Sometimes this question is a way of asking, “What syndromes was
ACT developed to treat?” The idea behind this question is usually that any treatment that isn’t targeted at spe-
cific syndromes isn’t empirically based. This isn’t the case. The syndromal model is one way to do clinical
science, but not the only way. Indeed, we believe that the syndromal model has been relatively unhelpful, despite
the enormous resources poured into it. ACT has its roots in behavior analysis, an inductive, principle-focused
tradition that’s had a huge impact on empirically supported treatments, despite the fact that it’s had only a tiny
fraction of the research resources devoted to the syndromal model. So another way to answer the question is
this: ACT is not appropriate for clients who don’t experience difficulties due to ACT-relevant processes, such as
experiential avoidance, cognitive fusion, entanglement with a conceptualized self, psychological rigidity, and so
on. Who are these people? We have yet to meet anyone who fits this description. Clients with simple skills acqui-
sition problems could be one example, but because cognitive and verbal processes often impede people in learn-
ing new skills and ACT is useful with verbal and cognitive barriers, ACT should be of value even for a simple
skills acquisition issue.
Question: How can ACT be combined with other treatments?
Answer: ACT is a model aimed at developing psychological flexibility. Any technique that fits with the model
can be used. Many approaches that may seem ACT inconsistent can actually be integrated. For example, relax-
ation training can work well within ACT, as long as it’s presented as training in letting go, not as a tool to for
fighting anxiety. One exception is direct cognitive disputation; however, there isn’t much evidence indicating
that this technique is helpful.
When techniques from other models or traditions work well with ACT, we believe that the combination can
be called ACT—provided that the workability has been tested. That’s not to say it must be called ACT; the
ACT approach isn’t about politics or branding. It’s more worthwhile to open the right doors than to build the
right fences. This attitude, which is widely held throughout the ACT and RFT community, allows ACT to
benefit from a wide array of effective approaches.
Question: What is the evidence supporting ACT?

Answer: Research in this area is developing rapidly. As of this writing, almost two hundred randomized trials
on ACT have been published. The latest comprehensive review is by A-Tjak et al. (2015), but you can periodi-
cally check the website of the Association for Contextual Behavioral Science for more recent data (www.contex
tualscience.org/state_of_the_act_evidence).
Question: How does ACT case conceptualization differ from traditional behavioral approaches?
Answer: ACT is a form of behavior therapy, so it isn’t surprising that almost any traditional behavior therapy
technique can be used (with some adaptation) as part of ACT. Stimulus control strategies aimed at controlling
external triggers, contingency management, problem-solving skills, behavioral parenting skills, psychoeducation,
exposure, and social skills training all can be used. The difference is that ACT uses traditional behavioral
change strategies in the service of clients’ most dearly held values and in a context of acceptance and defusion.
Question: Do behavior therapy procedures conflict with ACT?
Answer: A few behavior therapy procedures are commonly thought to conflict with ACT. The most common
example is relaxation training, which seems oriented toward direct emotional change as a method of dealing
with anxiety. But relaxation training was originally presented as training in learning to let go, in which case no
conflict exists. So if relaxation is presented as a way to practice letting go of control and fully experiencing the
present moment, it can be used in ACT.
We can think of no instance in which ACT is incompatible with empirically validated behavior therapy
methods, but at times an ACT model may add only a little to existing approaches.
Skills training provides an example of how an ACT model fits with behavior therapy. Skills training is called
for when a client simply does not know how to do something and needs to learn. An ACT therapist who sees
poor functioning that could be due to a skills deficit (e.g., lack of social engagement or lack of assertive behavior)
can examine two possible etiologies. One scenario would be that the person has the basic skill, but it is at least
partly suppressed by such factors as avoidance of fear or of other unpleasant emotional reactions, which assertive
behavior can occasion. In this case, the problem is linked to experiential avoidance, and ACT work would
involve identifying internal barriers to action and engaging in defusion, acceptance, and committed action. In a
second scenario, the client’s behavior is unskillful due to a lack of learning or practice. Despite the straightfor-
ward etiology, when the client begins to practice, difficult emotions and thoughts may arise because the deficit
will lead to socially awkward behavior. In this case, once again, the ACT model is relevant. If the behavioral
deficit is due to a lack of skill and no barriers impede its acquisition, an ACT model will not add anything to
straightforward skills training, but probably will not interfere either.
Question: Can I integrate ACT with traditional CBT?
Answer: ACT shares a number of attributes with traditional CBT, such as emphasis on learning processes in the
development of problems, focus on a goal-directed active therapy style, use of traditional behavioral strategies,
emphasis on developing a collaborative therapy relationship, respect for empiricism, and considerable emphasis
on the role of human cognition in psychopathology and on its alleviation (Herbert & Forman, 2005). The dif-
ference is in the model of cognition itself. As a result, ACT is not compatible with traditional CBT techniques
that attempt to “modify dysfunctional beliefs and faulty information processing” (Beck, 1993, p. 194), especially
through cognitive restructuring techniques such as disputation.
A therapist who is attempting to integrate ACT with CBT needs to be careful of messages (consistent with
CBT but not with ACT) that imply a need to modify, control, or reduce particular thoughts, feelings, memories,
or sensations. Any message implying that a client needs to think more rationally, logically, or adaptively in order
to live well is going to be inconsistent with ACT. Messages such as these can be confusing to clients and also
reduce the effectiveness of both approaches.
The second major area of difference between CBT and ACT pertains to the goals of treatment and the defi-
nition of a good outcome. CBT tends to be oriented toward helping clients feel better and think more clearly,
with the assumption that they will live better if this can be achieved. In contrast, ACT is directly aimed at
helping clients to live better, fuller, and deeper lives, which sometimes results in better feelings and sometimes
does not. In studies conducted so far, ACT has done as well as or better than CBT, even in terms of clients
feeling better, although that is not its goal. A life well lived is the primary outcome of interest, is defined in the
context of the client’s chosen values, and is based on evidence that the client is acting on those values in his or
her life.
References
A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J., & Emmelkamp, P. M. G. (2015). A meta-
analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental health prob-
lems. Psychotherapy and psychosomatics, 84, 30–36.
Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization
of psychotic patients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 70,
1129–1139.
Beck, A. T. (1993). Cognitive therapy: Past, present, and future. Journal of Consulting and Clinical Psychology, 61,
194–198.
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary
psychometric properties of the Acceptance and Action Questionnaire—II: A revised measure of psychologi-
cal inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688.
Gaudiano, B. A., & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using accep-
tance and commitment therapy: Pilot results. Behaviour Research and Therapy, 44, 415–437.
Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. Oakland, CA:
New Harbinger.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and prac-
tice of mindful change. New York: Guilford.
Herbert, J., & Forman, E. (2005, July). ACT versus traditional CBT. Paper presented at the ACT Summer Institute,
La Salle University, Philadelphia, PA.
Learning ACT, 2d edition How to Be More Experiential in Session
How to Be More Experiential in Session

Perspective
Talking about the there and then or Noticing the here and now
generalities
(mostly present tense)
(future or past tense, generalizations)
Out of Quadrant 1 Quadrant 2
session
(nonexperiential quadrant) • “Imagine you’re really in that situation.
What are you seeing, feeling, hearing,
Move toward a more experiential mode by
and so on? What are you doing?”
eliciting specific examples rather than
speaking in generalities. For example, ask • “Imagine that you’ve magically been
the client for a specific example of the transported to that situation and are
behavior or situation at hand, and then looking at yourself. What would you say
conduct a functional analysis. to the person who is there and then?”
• “Imagine looking back ten years from
now. What would you say to the person
you are now?”
• “How old does that feel? Picture
yourself as a child, having that
experience, and interact with that child
Content
as your current self.”

In Quadrant 3 Quadrant 4
session
• “How does that play out in here?” • “What’s showing up for you as we talk
about this?”
• “Have you noticed that happening
here?” • “Where is it in your body?”
• “Does that ever happen with me in our • “Are you okay with doing an exercise
sessions? If so, what brings it up?” right now?” If the client says yes, lead a
defusion, present-moment, acceptance,
• “Would you be willing to notice when
or perspective-taking exercise.
that shows up here?”
• “What thoughts is your mind coming
up with right now? What do they look
like or sound like?”
• “You be X and I’ll be Y. Show me what
you did.” Then role-play the situation.
Learning ACT, 2d edition ACT Case Conceptualization Form
ACT Case Conceptualization Form

1. Presenting problem in the client’s own words:
The client’s initial goals (what the client wants from therapy):
ACT reformulation of the presenting problem:
Assessment measures (including scores and interpretation):
2. Inflexibility: Assess rigidity due to avoidance and fusion related to private experiences. What thoughts,
emotions, memories, and sensations is the client avoiding? What stories or thoughts is the client fused with?
What behaviors is the client engaging in to avoid or escape these experiences? Check those that apply and
give examples from the client’s behavior.
Internal emotional control strategies (e.g., distraction, excessive worry, numbing):
External emotional control strategies (e.g., drugs, self-harm, avoided situations):
In-session avoidance or emotional control patterns (e.g., topic changes, dropout risk):
Pervasiveness of experiential avoidance: Limited 1 2 3 4 5 Very extensive
What do these observed patterns reveal about how to contextualize treatment for this client? What
methods and interventions should I use? What do I need to do differently for this client?
3. Inflexibility: Assess insensitivity to the present moment and limited perspective taking (e.g., dominance
of the conceptualized past and future, limited self-knowledge, or attachment to the conceptualized self).
4. Inflexibility: Assess disengagement (e.g., unclear values or limited committed action as reflected by
inaction, impulsivity, or avoidant persistence).
5. Factors that may limit motivation (e.g., the client’s experience of unworkability, unclear values, or
issues in the therapeutic relationship):
How should these factors affect what I do in treatment?

6. Cultural, social, environmental, and other contextual variables that may influence treatment:
7. Client strengths and how they might be used in treatment:
8. Integrate the information from all of the previous sections to develop a comprehensive treatment
plan.
Learning ACT, 2d edition Experiential Exercise: Therapist Flexibility
Experiential Exercise: Therapist Flexibility

Many of the places therapists get stuck when working with clients involve their own emotional and cognitive
reactions that lead to inflexibility. Each therapist brings a unique history to therapy, and at times, this history
makes particular clients more difficult on a personal level, which can potentially trigger psychological inflexibil-
ity. This exercise will help you help build awareness of situations in which you may get caught in inflexible
responding with a client who’s difficult for you. In it, you’ll take inventory of the kinds of situations in which you
tend to get stuck with clients. Consider using it any time you find yourself at an impasse in a case and suspect
that part of the reason might be your own inflexibility.
Start by identifying a client you’re working with whom you find challenging. For example, you might choose
a client who elicits uncomfortable emotions for you, for whom you feel like therapy isn’t progressing, or whom
you feel distant from or uncaring toward. Then take a few moments to think about what you experience during
sessions with this client. What are the different thoughts, feelings, evaluations, and urges that arise? See if you
can identify the situations in which you most seem to get stuck. Below are some questions to help you reflect.
Take the time to write out your answer to each question, and consider bringing the psychological flexibility
processes to bear where appropriate.
What are some topics you avoid with this client?
What difficult feelings arise for you when you’re with this client? What do you do in session in response to these
feelings?
What thoughts or stories about the client do you struggle with when you’re with this client? (For example, She’s
hopeless or I’m not incompetent.)
What’s typically going on in session when these thoughts come up?
Do you ever disengage, give up, or zone out with this client? If so, when? What does this tell you?
Do you ever find yourself wanting to argue with the client or, conversely, trying to avoid arguments? If so, what
seems to trigger this?
How might the stories or behavior you identified in response to the previous questions affect this client?
What might it look like if you could remain present during these moments and be most fully who you want to
be for this client? How might your presence be of service to this client?
When you’re struggling with this client, what kind of relationship do you have with yourself? What kind of quali-
ties would describe that relationship?
What qualities do you want to bring to your relationship with this client and with yourself?
If you could see five years into the future, what is the main thing you hope this client would have taken away
from your work together?

What might it mean both to you and to your client if you could more fully bring the qualities you hope for into
your sessions?
What kind of actions do you need to take to be the kind of therapist you want to be with this client (including
toward yourself when with this client)?
If you find yourself turning away from these directions and possibilities, how can you gently return to them?
What would that look like for you?

Learning ACT, 2d edition Learning ACT in Classrooms and Peer Groups and via Peer Supervision
Learning ACT in Classrooms and Peer Groups

and via Peer Supervision
In this appendix, we provide guidance on using Learning ACT in classrooms, peer supervision, practicums, or
any other cooperative learning setting. We discuss how classes can be structured, share tips about forming effec-
tive peer consultation groups, explore ideas about using experiential exercises and role-plays in learning ACT,
and provide advice about reviewing video or audio recordings of sessions or learning from recorded models. A
few controlled studies have examined the process of learning ACT (several are mentioned below), but most of
them haven’t broken down the learning processes into specific components, so in this section we rely primarily
on our history of using these training methods.
General Issues in Using This Book in Group Learning Settings

One way this book can be used is as a core text in a course or study group (including online formats) focused
on developing knowledge, skills, and competency in ACT. In contrast with ongoing supervision in ACT, which
typically incorporates experiential work with the therapist’s barriers into the supervision process and includes a
focus on case conceptualization, courses and study groups tend to focus more on learning the theoretical and
conceptual background of ACT and understanding what constitutes an effective and ACT-consistent therapist
response. There are ACT and RFT study groups around the world, in both online and in-person formats, and
some communities where English is not the dominant language have used such study groups to create a core of
ACT-trained professionals fluent in the community’s primary language.
In a course focusing on ACT, we recommend including at least one other comprehensive ACT text that is
more theoretically and philosophically oriented, such as Acceptance and Commitment Therapy: The Process and
Practice of Mindful Change (Hayes, Strosahl, & Wilson, 2012). In classroom-based study groups, about three
hours of class time per chapter usually suffice to develop an introductory understanding of the material in this
book. For this approach to be effective, each participant needs to read the relevant chapter for the week and
engage in the exercises before coming to class. Instructors will ideally check on this or test for it to increase the
likelihood that students actually engage in the practices. An obvious way to do this is to ask students to submit
their responses to the core competency exercises each week (for example, via a survey created for that purpose
using Google Forms) so that specific examples can be discussed in class. We recommend restricting this to the
core competency exercises, as the experiential exercises may include personal material that students may not
want to share in a classroom context. However, this might also allow students to document questions or issues
that emerged as they read the chapter and complete the exercises.
Here’s an example of how a weekly session or class might be structured:
1. Open with an experiential exercise, such as a mindfulness exercise. For example, each week the class
might open with a mindfulness exercise that touches upon the flexibility process that session centers on.
2. Briefly discuss any reactions to the opening exercise.
3. Discuss the readings that were assigned for the week, set an agenda for what will be reviewed in the class,
and create an opportunity for students to ask questions.
4. Review specific student responses or do role-plays to make the learning process more experiential.
5. Assign readings and perhaps take time to engage in an ACT-related values-based action (e.g., listen to an
ACT podcast or read an article linked to the science of ACT or RFT).
Here are some specific tips to consider when reviewing specific example responses in class. Often partici-
pants want feedback on responses that don’t appear to be similar to the model responses in form but may be
functionally coherent with the targeted competency. When reviewing such responses, the key is to assess whether
they fit the competency in a functional way, even if the form differs from that of the samples. One potential
approach is to look for other student responses that also demonstrate the competency while seeming different
from the models in form. Highlighting these examples can help with abstracting the essential function, as sepa-
rate from the form. In addition, we recommend reviewing examples that partially achieve the competency with
the goal of shaping more effective responses. Finally, low-quality responses can be reviewed as exemplars of
common pitfalls or misunderstandings about ACT.
We’ve noticed that if participants have read the ACT, RFT, and functional contextualist literature more
widely, this tends to prevent gross misunderstandings of the model and leads to more sensible and coherent
comprehension and application of ACT, even if for people who are not yet experts. A similar effect is achieved
when study group participants work together to arrive at consensus on whether a particular response represents
a coherent application of the model, as idiosyncratic understandings are moderated by the group.
We also suggest that you look for opportunities to conduct role-plays as a way to respond to questions or
issues brought up in class. Below, we will discuss role-plays specifically. Here, we’ll just offer that if participants
don’t seem to understand a particular competency, the leader can illustrate that competency via role-play. Role-
plays conducted by experts are usually best for teaching less experienced therapists, while role-plays conducted
by trainees are often more illuminating for more experienced therapists. Alternatively, participants who express
uncertainty about a competency can try to role-play it as best they can and get feedback and help with their
delivery.
We caution against turning classroom discussions into entirely verbal enterprises (e.g., how is defusion
defined, rather than how to use defusion) because this misses the opportunity for experiential learning, which is
as crucial to learning the model as working with it in session. Another potential error is allowing a single right
answer to emerge, especially if this happens quickly. Getting at the heart of ACT and RFT requires some loosen-
ing of language at one level (e.g., less technical clinical ways of speaking focused on changing normal language
functions) and tightening at another (e.g., RFT principles and philosophical assumptions). In addition, the
model makes more sense when all of its elements are integrated. Thus, especially early on, participants need to
live with some degree of ambiguity as they develop familiarity with the model.
Study groups can also be conducted online. If done on a Listserv or Facebook group, members can take turns
summarizing the chapters to set the context for an online discussion of the material. If done through an Internet
or phone-based conference calls, study groups are run in the same manner as in-person groups. Internet-based
ACT courses are commercially available.
Issues Specific to Peer Consultation Groups

Peer consultation groups are an important part of the ACT approach to training and dissemination, which
tends to be open, functional, and nonhierarchical. It truly is possible for a group of people to collaboratively learn
ACT even if none of them are expert in it. Based on experience with starting and participating in such groups,
we have a few tips for those considering starting an ACT peer consultation groups.
We’ve found that groups as small as two people can meet effectively and do useful work. Some peer consulta-
tion groups are more personal and tend to include experiential aspects in their training, while others are more
focused on building skills and function more as a study group.
In order for a group to succeed, we recommend having at least one person take responsibility for organizing
meetings and doing the necessary coordinating to make sure the group meets regularly. If experiential compo-
nents are to be included, it’s imperative to spend some time during early meetings discussing how this will be
structured and members’ hopes and fears regarding expressing personal material. We highly recommend that
participation in experiential aspects of the group process be completely voluntary, and that this be acknowledged
up front. In addition, developing a sense of trust is necessary for good experiential work, so confidentiality must
be assured.
A variety of different peer consultation models exist. In this section, we’ll briefly describe one example of
how group members might help each other learn. The Portland model of ACT peer consultation (Thompson et
al., 2015) outlines several specific roles that define and structure the group, with the roles of group leader and
process facilitator being central. Both help keep the group on track in terms of following the agenda and staying
functionally consistent with ACT principles. Each meeting lasts two hours and begins with an experiential exer-
cise, followed by a period of open discussion. The last hour or so is reserved for focused experiential learning.
During this time, a volunteer “skill builder” is asked to identify an ACT skill, process, or method that she wants
to learn. She then works on practicing this skill with another participant, who takes the role of the “case pre-
senter,” often in the form of a “real-play” (as opposed to a role-play) in which the presenter uses personal struggles
to provide material for the skill builder to work on during a fifteen- to twenty-minute practice period. Alternatively,
the case presenter may role-play a client whose situation calls for the skill the person wants to develop. Additional
roles are the “assistant to the skill builder,” who is available to help should the skill builder need input, and the
“hexaflex monitor,” who observes use of the flexibility processes in the interaction and provides feedback after
the exercise is completed. After the skills practice has concluded, the hexaflex monitor provides input. This is
followed by an experiential discussion involving the entire group, ending with a technical discussion. The final
activity in the meeting is identifying roles for the next meeting. This format could easily incorporate the present
volume into its structure. Each week could focus on a single chapter, with the person who volunteers as skill
builder practicing the content in that chapter.
Experiential Work in Supervision, Practicums, and Training Settings

Traditionally, ACT training includes experiential work that focuses on the development of psychological
flexibility in the therapist. This aspect of training is fairly unique to ACT, compared to other CBT approaches.
The difference comes from the model. In ACT, it’s assumed that therapists swim in the same verbal soup as their
clients, and that they struggle with the same basic issues of nonacceptance, entanglement with difficult thoughts,
lack of values clarity, and lack of committed action. In chapter 9, we discussed how flexibility processes can be
understood at the level of the client, the therapist, and the therapeutic relationship. In a parallel fashion, super-
vision can focus these same three levels: trainee skill and knowledge related to working with clients, working on
the trainee’s own psychological flexibility, and the trainee’s interpersonal behavior in the room with the
supervisor.
An experiential focus on the therapist’s flexibility and interpersonal behavior is included in training for two
major reasons. First, addressing psychological flexibility in therapists should help them be more committed,
engaged, flexible, and effective in their work with clients. For example, if therapists aren’t accepting of their clients
or their reactions to clients, it can be difficult for them to guide clients to be accepting of themselves. Similarly, it
would be inconsistent for therapists to fluently practice defusion with clients if therapists themselves are fused
with their own ideas about the right way to practice defusion or if they are attached to a particular idea about what
a client needs to do. In fact, several studies (e.g., Brinkborg, Michanek, Hesser, & Berglund, 2011; Luoma &
Vilardaga, 2013; Varra, Hayes, Roget, & Fisher, 2008) have already shown experiential training for ACT thera-
pists helps produce more flexibility, less entanglement, less burnout, and a greater ability to learn new behaviors.
Second, experiential training is thought to provide a metric for a functional understanding of the flexibility
processes. For example, when therapists learn to be more sensitive to the signs of their own cognitive fusion or
defusion, it may be easier for them to sense these processes in clients. If they are better able to observe flexibility
processes in clients’ behavior, then they can use that feedback to detect the difference between topographical
adherence to the ACT model and functional competence in implementing it.
ACT supervision targets clinician inflexibility by engaging the trainee in the same processes that are used
with clients. This can take the form of helping trainees contact their present-moment reactions to clients or to
supervision, or helping them contact a sense of self-as-context while observing harsh self-judgments. Trainees
who feel stuck with clients can be guided through a physicalizing exercise or other cognitive defusion technique
with their own sense of stuckness and any other thoughts or feelings that arise. Trainees can be asked to notice
the sense of struggle in the room with a client (or supervisor) and then be supported in developing a more
accepting and willing stance toward their own reactions. Trainees who are unclear about what they are working
for with clients can be guided to identify their own therapy-relevant values through a values exercise such as
imagining their clients attending their retirement party. Finally, trainees can be coached to commit to engaging
in a discussion or exercise with a client while simultaneously making room for their own anxious or uncomfort-
able reactions. When working in this kind of experiential mode, supervisors will, of course, work to shape the
trainee’s behavior, but more importantly, they must establish the conditions that allow learning.
In order for experiential work to be part of the supervision process, the supervisor needs to explicitly discuss
the role of this work and how it aligns with the experiential focus of ACT. Supervision that includes experiential
techniques must be built around an agreement with trainees that discussion of their internal experiences and
struggles in the therapy room and in the supervision process will be part of supervision. Of course, the trainee’s
level of willingness to disclose and desire for privacy are to be respected. Just as it isn’t appropriate to coerce a
client, it isn’t appropriate to coerce a trainee. Fortunately, some of the experiential processes that are key to ACT
can be done without a great deal of self-disclosure, allowing cautious trainees to see what they can gain by
opening up to this level of engagement, even though dealing directly with emotional reactions, struggles, and
concerns can be anxiety provoking and challenging.
For both supervisors and trainees, a focus on experiential approaches in supervision may feel artificial,
uncomfortable, or constraining at first. The supervisor usually needs to work hard early during supervision,
whether in a group or with individuals, to focus on experiential approaches until a norm of experiential work has
been established. Thereafter, supervision sessions generally flow fairly smoothly between experiential and con-
ceptual learning. Importantly, the supervisor must be part of the experiential process. This model is not one of
enlightened experts sitting in judgment of others. The model is recursive and horizontal; thus, if supervisors are
closed, defended, or attached to being right, they won’t be able to create a sense of open exploration with
trainees.
One way to foster an experiential focus in supervision is to begin each meeting with an experiential exercise.
Exercises can be selected to focus on a specific flexibility process if that’s called for. Another way to foster this
focus is to periodically ask trainees (and the supervisor) to put their values and barriers on the table. For example,
at the start of an ACT training group or after a transition in membership, participants can take turns reporting
one thing they want the group to be about for them, and one psychological barrier that could prevent that from
happening. Participants might also be asked to explore how that barrier could manifest in the group. For example,
one person might say, “What I want to accomplish within the group this semester is to learn to be bolder in
trying new things with my clients. A barrier to doing that is that I get afraid and start having the thought, ‘The
people in my group will see how incompetent I am.’ The way that would manifest in here is that I’d start making
jokes and trying to find a way to change the subject if the discussion gets too close to areas that are difficult for
me.” As each person puts these kinds of aspirations, fears, and avoidance moves on the table, the group tends to
come together as everyone sees that many of their barriers are shared.
One common barrier to developing the kind of trusting, open, and exploratory group process needed for
effective experiential supervision is when members compete to give the most insightful or correct responses in
regard to the matter at hand. Although this attempt to look good and be right may lead to modeling of effective
responses that can be useful for the group at large, it can also stifle important experiential work if it’s function-
ally attached to avoiding fears around being less knowledgeable or capable. To prevent this, it may be helpful to
create a context in which sharing about internal emotional experiences and not knowing are as important as
being right or being smart. The supervisor can foster such an atmosphere by modeling and instigating this
stance. If the group becomes entangled in this process, the supervisor can simply ask each member to put a dif-
ficult thought or feeling that’s currently present on the table without attempting to change it. This can help
ground the process in the present moment.
Reviewing Audio and Video Recordings of Sessions

Audio and video recordings of sessions are among the most important training tools and are now common
practice in many training settings. However, for established professionals in a group, recording sessions is often
an uncomfortable experience. They may not have had anyone watch their work for many years and may fear the
judgment of a consultant or peers. They may fear clients’ reactions to recording sessions and be concerned that
those reactions could interfere with the therapy relationship. If not addressed directly, such fears can create a
significant barrier to using this powerful training method. With a bit of willingness and effort, however, most
therapists find that getting feedback on their actual ACT work is extremely valuable. In addition, the vast major-
ity of clients are open to the process of recording sessions, as long as doing so is presented matter-of-factly and
the purpose of the recording and the boundaries of confidentiality are thoroughly explained.
Watching or listening to recordings of sessions is highly recommended for supervision purposes. Recordings
of sessions can keep supervisors and fellow trainees much closer to actual in-session experiences. In addition,
having other eyes and ears paying attention to the content may allow for identification of previously unrecog-
nized aspects of client or therapist behavior that are relevant to moving forward.
Using Role-Plays in Training

Another way to simulate the richness of information present in actual sessions is to use role-plays. These can
be conducted in multiple ways and for multiple purposes. One purpose of role-playing is to unpack an example
of a particularly troubling, difficult, or puzzling interaction with a client. Role-plays can also bring to life concep-
tual issues that, if discussed conceptually, risk turning into a dull, lifeless exercise. Furthermore, conceptual
issues in supervision often reflect a combination of conceptual and experiential barriers. Doing a role-play that
illustrates a conceptual issue can provide a way to work with both types of barriers, along with an opportunity
for modeling alternative in-session responses.
Role-plays can be conducted by having the trainee role-play the client, the therapist, or both, depending
upon the situation and need of the therapist. Often, role-plays are used to experiment with and model alterna-
tive ways of intervening with clients, but not as opportunities for exploring and working with thoughts, feelings,
and sensations related to clinical situations. Trainees may not even think of obtaining supervision relating to
their internal emotional experiences, yet these internal therapist experiences may be the aspect of in-session
work most in need of attention. Role-plays can help re-create trainees’ initial reactions to clinical situations and
thereby allow them to work with material closer to their original behavior. This is particularly helpful when
recordings of sessions are not available.
Role-plays in which trainees play clients may also have the benefit of helping trainees with perspective
taking, resulting in more empathy for clients’ experience. When doing role-plays in a group, it can be helpful to
have multiple trainees take on the role of the therapist. This can help defuse some of the competitiveness or
comparisons that could occur. In addition, it can foster empathy toward the trainee who is currently the primary
focus of supervision.
One way to help role-plays be less artificial is to take trainees through a brief eyes-closed exercise, focusing
on their caring for the client, the values they bring to sessions, and the difficulty of feeling the client’s pain and
not being sure what to do or how to help. Trainees may then be invited to imagine that they are the client, expe-
riencing the client’s particular struggles related to the topic at hand, including the client’s thoughts, feelings,
urges, and imagery. At the end of the eyes-closed exercise, as trainees open their eyes, they can be asked to
picture being that client. In only a few minutes, what might otherwise have been an artificial, highly intellectual
exercise can become a role-play that’s intensely focused on the reality of being with someone who is suffering.
Providing Models
Therapists in training rarely have the opportunity to observe expert models at work. Few supervisors allow
their students to watch them work. However, studies have suggested that watching experts conduct therapy is
one of the most rapid ways to learn new therapy techniques (Baum & Gray, 1992). Thus, we strongly encourage
modeling as a method of learning ACT, for example, by having trainees watch video recordings of the supervi-
sor’s sessions, or having them watch the supervisor engage in role-plays.
If trainees are going to learn by watching a model, they need to have access to the covert behaviors of that
model. If a supervisor is performing as the model, this access can be provided in several ways. Supervisors can
review a clinical situation with trainees, for example, by presenting a video recording of a therapy session while
discussing their own internal process and awareness of their own response to that clinical situation. The purpose
of such a review is less about providing model responses and more about giving trainees an opportunity to hear
the internal processes of an expert.
If the model is a video recording of an expert (e.g., the downloadable videos associated with this book), it can
be helpful for supervisors to periodically stop the video and lead a discussion guided by several key questions:
What did the trainees see the client and therapist do? Which client behavior do they think informed what the therapist
did? What purposes and rationales do they see for the therapist’s intervention? The supervisor can also ask trainees
to reconstruct the verbal dialogue central to the intervention. In these ways, the supervisor can help ensure that
trainees have an understanding of how ACT theory is guiding the expert’s behavior. Without such an under-
standing, trainees won’t be able to generalize the modeled behavior to related situations.
References
Baum, B. E., & Gray, J. J. (1992). Expert modeling, self-observation using videotape, and acquisition of basic
therapy skills. Professional Psychology: Research and Practice, 23, 220–225.
Brinkborg, H., Michanek, J., Hesser, H., & Berglund, G. (2011). Acceptance and commitment therapy for the
treatment of stress among social workers: A randomized controlled trial. Behaviour Research and Therapy, 49,
389–398.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and prac-
tice of mindful change. New York: Guilford.
Luoma, J. B., & Vilardaga, J. P. (2013). Improving therapist psychological flexibility while training acceptance
and commitment therapy: A pilot study. Cognitive Behaviour Therapy, 42, 1–8.
Thompson, B. T., Luoma, J. B., Terry, C., LeJeune, J. T., Guinther, P., & Robb, H. (2015). Creating a peer-led
acceptance and commitment therapy consultation group: The Portland model. Journal of Contextual
Behavioral Science, 4, 144–150.
Varra, A. A., Hayes, S. C., Roget, N., & Fisher, G. (2008). A randomized control trial examining the effect of
acceptance and commitment training on clinician willingness to use evidence-based pharmacotherapy.
Journal of Consulting and Clinical Psychology, 76, 449.

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Learning ACT, 2d edition

ACT Core Competency Rating Form

ACT Core Competency Rating Form

Developing Willingness and Acceptance

3 The therapist actively uses the concept of workability in clinical interactions.

8 The therapist helps the client experience the qualities of willingness.

Undermining Cognitive Fusion

Getting in Contact with the Present Moment

Distinguishing the Conceptualized Self from Self-­a s-­Context

Defining Valued Directions

31 The therapist helps the client clarify valued life directions.*

Building Patterns of Committed Action

The ACT Ther apeutic Stance

47 The therapist introduces experiential exercises, paradoxes, or metaphors as appropriate and

Frequently Asked Questions

Question: How do I introduce an experiential exercise or metaphor?

Question: How do I explain ACT to clients and get informed consent?

Client: How is opening up going to help?

Question: Is experiential avoidance always a bad thing?

Question: What is the role of psychopharmacology with ACT?

Question: Is ACT inappropriate for some clients?

Question: How can ACT be combined with other treatments?

Question: What is the evidence supporting ACT?

Question: Do behavior therapy procedures conflict with ACT?

Question: Can I integrate ACT with traditional CBT?

How to Be More Experiential in Session

as your current self.”

ACT Case Conceptualization Form

ACT reformulation of the presenting problem:

Assessment measures (including scores and interpretation):

Internal emotional control strategies (e.g., distraction, excessive worry, numbing):

External emotional control strategies (e.g., drugs, self-­harm, avoided situations):

Pervasiveness of experiential avoidance: Limited 1 2 3 4 5 Very extensive

How should these factors affect what I do in treatment?

7. Client strengths and how they might be used in treatment:

Experiential Exercise: Therapist Flexibility

What are some topics you avoid with this client?

What’s typically going on in session when these thoughts come up?

Learning ACT in Classrooms and Peer Groups

General Issues in Using This Book in Group Learning Settings

Here’s an example of how a weekly session or class might be structured:

2. Briefly discuss any reactions to the opening exercise.

Issues Specific to Peer Consultation Groups

Experiential Work in Supervision, Practicums, and Training Settings

Reviewing Audio and Video Recordings of Sessions

Using Role-Plays in Training

You might also like

Distinguishing the Conceptualized Self from Self-a s-Context

External emotional control strategies (e.g., drugs, self-harm, avoided situations):