Acceptance and Commitment Therapy

A simple tool for assessing the client's willingness to experience uncomfortable sensations, thoughts or feelings in the service of values. In ACT, willingness is not desire or comfort; it is an active choice to stay in contact with inner experience while moving toward what matters. The technique helps shift from "first the pain must go away, then I will live" to "I can live with pain present."

• Identify the specific feeling, thought or sensation the client is avoiding.
• Ask: "From 0 to 10, how willing are you to make room for this anxiety, without fighting it, in order to move toward [value]?"
• Accept the number without evaluation and explore what stands behind it.
• Ask: "What would need to happen for you to move one point higher?"
• Emphasize that willingness is a choice, not a feeling.

When to use:

• The client avoids an experience that blocks life.
• You need to motivate acceptance before defusion or exposure.
• The client is waiting to feel fully ready before acting.
• You are exploring the cost of control: what is lost when the client refuses to feel.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Suicide risk: willingness never means consenting to self-harm; clarify this explicitly.
• ⚠️ Active psychosis: the client may not have enough distance from experience.
• ⚠️ Trauma without stabilization: the practice may become overwhelming.

Hayes, S. C. Strosahl, K. D. & Wilson, K. G. (2011). Acceptance and Commitment Therapy

A core ACT acceptance technique. The client learns to create space around an unpleasant bodily sensation: noticing it, allowing it to be there, breathing into it, and not fighting or avoiding it. The emphasis is on breath, imagery and direct contact. The technique changes the relationship to pain from avoidance to observation.

• Locate the sensation: "Where do you feel this in the body? What size, color or temperature does it have?"
• Direct the breath toward the sensation: "Breathe into that place."
• Expand: "Imagine the sensation expanding like a cloud, with space opening around it."
• Observe: "Notice this feeling like a scientist observing an object, without judgment."
• Link to values: "While this is here, what specific action could you take toward what matters?"

When to use:

• Panic or anxiety with strong physiological sensations.
• Depression experienced as emptiness or heaviness in the chest.
• Chronic pain.
• Post-traumatic stress after stabilization.
• Any avoided bodily sensation.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Acute suicidality: the exercise may reveal the full intensity of pain.
• ⚠️ Dissociation or depersonalization: focusing inward may increase detachment.
• ⚠️ PTSD without stabilization: the exercise may be too intense.
• ⚠️ Active addiction: strong sensations may trigger craving or relapse risk.

Forsyth, J. P. & Eifert, G. H. (2016). The Mindfulness and Acceptance Workbook for Anxiety. New Harbinger

A metaphor for separating discomfort from willingness. One dial shows the intensity of pain, fear or anxiety; the other shows willingness to experience it in the service of values. The key discovery is that discomfort can be at 8 and willingness can also be at 7. Both can be true at the same time. Action is possible even when both dials are high.

• Draw or describe two separate dials.
• Dial 1, discomfort: "From 0 to 10, where is your pain or anxiety now?"
• Dial 2, willingness: "From 0 to 10, how willing are you to make room for this sensation?"
• Show independence: "Discomfort can be 8 and willingness can be 7; both are true at the same time."
• Ask: "What matters more right now: reducing pain or moving while pain is present?"

When to use:

• The client believes: "I cannot live until the pain goes away."
• You need to separate psychological state from the capacity to act.
• Perfectionism or the demand for comfort before action.
• Chronic pain or illness.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ The metaphor can be misunderstood as ignoring pain; clarify that the work is about allowing parallel experience, not suppressing or denying it.

Harris, R. (2009). ACT Made Simple. New Harbinger

A core cognitive defusion technique in ACT. Adding the phrase "I notice I'm having the thought that." creates distance between the thought and identification with it. The thought becomes an event in consciousness that can be observed, not a fact about reality or the self. The technique is simple to learn and powerful in practice.

• Identify the original thought: "I am a failure," "This is impossible," or "Nobody loves me."
• Ask the client to say it exactly as it appears.
• Add the prefix: "Now say: I notice I'm having the thought that I am a failure."
• Ask about the difference: "Did you notice a difference? The first sounds like truth; the second sounds like observation."
• Practice two or three times with different thoughts.

When to use:

• Any self-evaluative belief.
• Social anxiety: "People think I am strange."
• Depressive thoughts.
• As a first defusion technique for clients new to ACT.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ There are no specific contraindications; it is usable in most contexts.
• ⚠️ Do not use it mechanically; the client needs to feel the shift, not merely repeat words.

Hayes, S. C. & Smith, S. (2005). Get Out of Your Mind and Into Your Life. New Harbinger

A reframe of thinking as an attempt to help. Even intrusive or badly timed thoughts are framed as the mind trying to protect. The client learns to thank the mind for the thought, acknowledge it, and still not follow it. This creates respect for the mind while preserving choice: not hostility, but distance.

• Identify the thought and its function: "What is your mind trying to prevent or protect you from?"
• Normalize the mind's function: "Its job is to look for threats."
• Offer the formula: "Thank you, mind, for that thought. You are trying to keep me safe. And I can handle this."
• Say it aloud several times.
• Ask: "How does the thought sound now?"

When to use:

• Anxiety or phobias where the mind signals danger.
• Self-criticism where the mind tries to motivate through attack.
• Obsessive-compulsive thoughts.
• The client is hostile toward the mind and fights thoughts.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ The technique can be heard as not taking a real problem seriously; explain the mechanism.
• ⚠️ Highly intellectual clients may dismiss it as naive; clarify that it changes the relationship to thought, not the facts of the situation.

Harris, R. (2009). ACT Made Simple. New Harbinger

Instead of following the content of a thought, the client notices that it is part of a familiar story, a narrative the mind tells again and again. Stories receive names: "the abandonment story," "the failure story." This creates a meta-position: "Oh, here is that story again," and loosens automatic obedience to it.

• Identify a recurring thinking pattern: "Do you notice that this thought comes often?"
• Name the story together: "Let's give it a name. What shall we call this story?"
• Practice recognition: "When it appears, can you say: Oh, here is the story about. again?"
• Add lightness: "You might even smile at it; it is a familiar visitor."
• Explore function: "What does this story do for you? What does it protect you from?"

When to use:

• Recurring thinking patterns.
• Trauma narratives that replay the past again and again.
• Depressive cyclic stories about the self.
• Teaching the client to recognize intrusive patterns.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ The intervention can sound like minimizing real pain; clarify that the story matters, but that does not mean it must be obeyed.

Hayes, S. C. & Smith, S. (2005); Harris, R. (2009). ACT Made Simple

A classic ACT metaphor. You are the bus driver. Thoughts, feelings and memories are loud passengers. You choose where the bus goes, but the passengers ride with you. The key is that they do not have to be defeated or thrown out; you can keep driving in the chosen direction while hearing their voices.

• Define the direction: "Where do you want to drive? What values matter?"
• Identify the passengers: "Which voices are shouting? What do they say?"
• Show the driver's position: "You hear the passengers, and you still choose the direction."
• Explore the trap: "What happens when you turn the bus around to calm them down?"
• Practice: "Can you sit with these voices and keep driving?"

When to use:

• There are multiple conflicting inner voices: thoughts and feelings.
• You are teaching the distinction between contents of consciousness and direction of action.
• Anxiety, depression and contradictory emotions.
• The main ACT question is control versus direction.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ The metaphor may be too abstract for very concrete thinkers; explain it more literally if needed.

Hayes, S. C. (1987); Harris, R. (2009). ACT Made Simple

A classic ACT visualization meditation. The client imagines a calm stream and places each arriving thought, emotion or sensation on a leaf, watching it float away. There is no need to push leaves away and no need to stop them. The practice trains an observer position toward inner experience.

• Introduce the visualization: "Close your eyes and imagine sitting by a calm stream."
• Explain the rule: "Every thought or feeling that appears is a leaf."
• Practice: "Place each experience on a leaf and watch it float by."
• Normalize getting caught: "Sometimes leaves get stuck; that is normal. Just notice it."
• Practice for five to seven minutes, then ask: "What did you notice?"

When to use:

• Rumination and repetitive thoughts.
• Future-oriented anxiety.
• Obsessive thoughts.
• Introducing the idea that thoughts are not facts.
• Any avoidance of thinking.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ For clients with dissociation, keep eyes open or use a shorter version.
• ⚠️ Do not use the exercise as a way to remove thoughts; it is about observing, not suppression.

Hayes, S. C. Strosahl, K. D. & Wilson, K. G. (2011). Acceptance and Commitment Therapy

A brief grounding protocol developed in ACT for moments of emotional storm. The client acknowledges inner experience, reconnects with the body and engages with the world around them. The aim is not to calm down instantly, but to become steady enough to choose the next action.

• Acknowledge what is present: "I am noticing anxiety, tightness and the thought that I cannot cope."
• Come back into the body: press feet into the floor, straighten the spine, breathe, move fingers or shoulders.
• Engage with the environment: name what you see, hear and touch.
• Repeat the cycle slowly two or three times.
• Ask: "Now that the storm is still here but you are anchored, what is one useful next step?"

When to use:

• Panic or intense anxiety.
• Flashbacks or intrusive memories.
• Emotional flooding.
• The client is lost in thoughts and needs present-moment contact quickly.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No specific contraindications.
• ⚠️ If the client is highly dissociated, keep instructions concrete, external and short.

Harris, R. (2019). ACT Made Simple, 2nd ed. New Harbinger

A self-as-context metaphor. The sky holds all weather: sun, clouds, rain and storms. The sky is not damaged by the weather. Likewise, awareness can hold thoughts, feelings and sensations without being identical to them. The technique helps the client experience a stable observing position.

• Introduce the image: "Imagine the mind like weather moving through the sky."
• Identify current weather: thoughts, emotions, body sensations.
• Ask: "What is the sky in this metaphor?"
• Invite the client to notice that awareness contains experience without being the experience.
• Connect to action: "From the position of the sky, what step toward values is possible?"

When to use:

• The client is fused with emotions: "I am anxiety," "I am depression."
• Shame and self-judgment.
• Introducing self-as-context.
• The client benefits from imagery and contemplative work.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ For clients with dissociation, avoid overemphasizing detachment; keep the practice embodied and grounded.
• ⚠️ Do not use the metaphor to bypass real emotion.

Hayes, S. C. Strosahl, K. D. & Wilson, K. G. (2011). Acceptance and Commitment Therapy

A self-as-context exercise. The client recalls different life stages and notices that thoughts, roles, body and circumstances have changed, while the perspective from which experience is noticed has a continuity. This does not prove a metaphysical self; it helps the client loosen fusion with current roles or stories.

• Ask the client to remember themselves at age five, fifteen and today.
• Notice what changed: body, roles, worries, beliefs, relationships.
• Ask: "Was there a sense of 'I' noticing life then and now?"
• Separate observer from content: "You have had many stories; you are also the one who notices them."
• Link to current difficulty: "Can this current story also be noticed, rather than obeyed?"

When to use:

• Identity fusion: "I am broken," "I am my diagnosis."
• Life transitions and role loss.
• Shame and rigid self-concepts.
• Deepening self-as-context after simpler defusion work.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Use cautiously with dissociation or depersonalization.
• ⚠️ Do not turn the exercise into philosophical debate; keep it experiential.

Hayes, S. C. Strosahl, K. D. & Wilson, K. G. (2011). Acceptance and Commitment Therapy

A visual values clarification tool. The client marks how close current behavior is to values in major life domains. The target makes the gap visible without moralizing: not "good or bad," but "closer or farther from what matters." It becomes a basis for committed action.

• Draw a target with concentric circles.
• Choose domains such as relationships, work, health and personal growth.
• Ask the client to mark where they currently are in each domain.
• Explore one domain with the largest gap or strongest importance.
• Choose one small action that moves one step closer to the center.

When to use:

• The client is unclear about values.
• Life has narrowed around symptom control.
• You need a practical bridge from values to action.
• Reviewing progress across therapy.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Perfectionistic clients may treat the target as a scorecard; explicitly frame it as orientation, not evaluation.
• ⚠️ Do not move to action before values are named in the client's own words.

Tobias Lundgren's Bull's Eye values exercise; Harris, R. (2009). ACT Made Simple

A deep values exercise. The client imagines how they would want to be remembered at the end of life. The aim is not morbidity, but contact with what truly matters and with the gap between current living and desired direction.

• Create safety: "This is an unusual exercise, and it can feel deep."
• Invite visualization: "Imagine many years have passed and people have gathered at your funeral."
• Ask: "What would you want to hear? What was the most important value of your life?"
• Invite written or spoken response: "How would you want to be remembered?"
• Bridge to now: "What does this tell us about what matters this week?"

When to use:

• Deep values clarification when surface methods do not work.
• The client is living on autopilot or according to someone else's life.
• Existential crisis can become a catalyst for change.
• The client is mature enough and ready for deeper work.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Suicidal ideation: do not use with active suicide risk.
• ⚠️ Acute grief: stabilize first.
• ⚠️ Do not use before trust and safety are established.

Existential therapy traditions (Yalom, I.); Hayes, S. C. et al. (2011). ACT integration

A model by Russ Harris. At any moment there is a choice point: move toward values or move away from discomfort. The technique helps the client see this point in concrete situations and consciously choose direction. It is simple, practical and applicable to relationships, procrastination, crisis moments and everyday behavior.

• Identify the value: "What matters to you in this situation?"
• Identify the obstacle: "What pulls you away from the value? Which thoughts, feelings or sensations?"
• Name the avoidance pattern: "What do you usually do when this shows up?"
• Offer an alternative: "What could you do toward the value, even with discomfort present?"
• Anchor the choice: "Right now, in this moment, which path do you choose?"

When to use:

• The client is stuck in avoidance.
• Impulsive decisions.
• Showing how freedom of choice works.
• Crisis moments.
• Everyday situations where a quick ACT map is useful.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No specific contraindications.
• ⚠️ Do not turn the model into moral pressure; it is a tool for awareness of choice.

Harris, R. (2009). ACT Made Simple. New Harbinger

Kevin Polk's four-quadrant model that makes the client's movements visible. The horizontal axis is toward values versus away from discomfort. The vertical axis is inner experience versus external behavior. The matrix shows how much life energy goes into avoidance and how much remains available for valued action.

• Draw four quadrants on paper.
• Lower right, away from discomfort externally: "What do you do to get away from pain? Avoid, postpone, withdraw?"
• Lower left, toward values externally: "What do you do in the direction of what matters?"
• Upper right, away from discomfort internally: "How do you try to get away inside? Suppress, distract, argue?"
• Upper left, toward values internally: "Which thoughts and images support movement toward values?"

When to use:

• You need a structured view of the problem.
• You want to show that moving toward values requires willingness to feel discomfort.
• The client needs to see an avoidance pattern.
• Visual restructuring of a session is useful.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No specific contraindications.
• ⚠️ Do not overload the client; the matrix can be filled gradually, one quadrant at a time.

Polk, K. L. & Schoendorff, B. (2014). The ACT Matrix: A New Approach to Building Psychological Flexibility. New Harbinger

The ACT version of exposure: not simply entering the feared situation, but entering while holding the value at the center. Values become the anchor during exposure. This shifts the task from "endure until anxiety disappears" to "do this for what matters." Motivation becomes internal rather than external.

• Identify the value: "Why is this important to you?"
• Build a hierarchy from easier to harder situations.
• Prepare the anchor: "When anxiety rises, remember the value. Why are you here?"
• Enter the situation while practicing acceptance of anxiety rather than fighting it.
• Debrief afterward: "What did you notice? How did anxiety change?"

When to use:

• Phobias and panic disorder.
• Social anxiety.
• Avoidance that maintains or worsens the problem.
• Exposure needs meaning, not just endurance.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ PTSD without stabilization: do not use until there is enough stability.
• ⚠️ Suicidal ideation: exposure can increase despair in acute states.

Twohig, M. P. & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Obsessive-Compulsive Spectrum Disorders

A key Hayes metaphor for the paradox of struggle. On one side of the rope is the client; on the other is the monster: anxiety, pain, depression. The harder the client pulls, the harder the monster pulls back. The more life is spent fighting pain, the more pain occupies life. The exit is to drop the rope: the monster may remain nearby, but the client leaves the struggle and moves toward values.

• Introduce the image: "Imagine you are in a tug of war with your anxiety."
• Describe the dynamic: "Every time you pull, the monster pulls harder. You are stuck."
• Show the trap: "All attention is on the struggle. Life is happening at the edge of the pit."
• Offer the exit: "What if you simply dropped the rope?"
• Explore: "The monster may still be there, but you are no longer in the struggle. Where will you go now?"

When to use:

• Showing that struggle worsens the problem.
• The client is stuck trying to control or suppress symptoms.
• First-session introduction to ACT logic.
• Any unsuccessful avoidance pattern: panic, anxiety, pain.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No specific contraindications.
• ⚠️ Do not frame it as giving up to pain; it is stopping the struggle, not becoming passive.

Hayes, S. C. Strosahl, K. D. & Wilson, K. G. (2011). Acceptance and Commitment Therapy

A four-step protocol for accepting difficult emotions: Recognize, Allow, Investigate and Non-identification. Developed in mindfulness contexts and widely used in ACT, it helps deepen contact with experience without automatic avoidance, especially with shame, guilt and perfectionism.

• Recognize: "What is happening inside? Name it: I notice fear, shame or anger."
• Allow: do not fight and do not rush to advise the mind; let the experience be present.
• Investigate: "Like a scientist, where does it live? What texture does it have? Which story comes with it?"
• Non-identification: "This is not you. You are the one noticing it. Shame is here, and you are not shame."

When to use:

• Complex emotions: shame, guilt, perfectionism.
• The client is hooked by an emotion and cannot step out of it.
• Depression where the task is to move through experience rather than avoid it.
• In-session work with presence and a meditative pace.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Significant dissociation: the practice may deepen detachment.
• ⚠️ Acute psychosis: there may not be enough distance from experience.
• ⚠️ Active self-harm: the practice may intensify the acute state.

McDonald, M. (mindfulness traditions); Hayes, S. C. & Smith, S. (2005). Get Out of Your Mind and Into Your Life. New Harbinger

A quick grounding technique. The client names five things they see, four sounds they hear, three bodily sensations, two smells and one taste. This is a full sensory reorientation to the present moment. It is especially useful in panic, flashbacks and dissociation because it returns attention to the here and now.

• Name five things you can see right now, any objects in the visual field.
• Name four sounds you can hear, near or far.
• Name three sensations in the body: contact with the chair, feet on the floor, clothing on the skin.
• Name two smells present in the air.
• Name one taste in the mouth right now.

When to use:

• Panic or dissociation: returning to the body.
• Anxiety: reorientation to the here and now.
• Flashbacks or intrusive memories.
• Any state where the client is not fully present.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ No specific contraindications.
• ⚠️ With very strong panic, begin with an anchor such as feet, body and breath, then move to the five senses.

Adapted from DBT (Linehan, M.); Hayes, S. C. et al. (2011)

An exercise in full presence, often done with a raisin or another small object or food. The client explores the object through all five senses as slowly and fully as possible. The exercise makes the difference between autopilot and full presence visible and opens access to the richness of the present moment.

• Choose an object: a raisin, chocolate, orange, stone or flower.
• Sight: look at it for a minute; notice color, form and surface.
• Touch: feel it with the fingers; notice texture and temperature.
• Smell: bring it to the nose and inhale fully; notice the smell.
• Taste, if appropriate: place it on the tongue and wait; notice how the taste changes.
• Discuss: "When was the last time you were this present? What does this say about life outside autopilot?"

When to use:

• Rumination: moving out of the head and into sensation.
• Anhedonia or depression: restoring contact with pleasure.
• Introducing mindfulness practice.
• The client lives on autopilot and wants to change that.

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Eating disorders: use caution with food; choose a neutral object if needed.
• ⚠️ Excessive self-monitoring may increase body anxiety.

Kabat-Zinn, J. (1990). Full Catastrophe Living. Delta; Hayes, S. C. et al. (2011)