In plain words
Many people try hard to get rid of painful thoughts and feelings, and find their lives getting smaller as a result. Acceptance and commitment therapy (ACT) helps people make room for difficult inner experiences and take steps toward what matters to them.
ACT is grounded in a behavioral philosophy and a theory of language. It asks whether a way of responding works for the person’s values, rather than whether a thought is true.1
Core ideas
Where this approach came from
Acceptance and commitment therapy (ACT, said as the word "act") was developed in the 1980s and 1990s by Steven Hayes, an American psychologist at the University of Nevada, Reno, with Kirk Strosahl, Kelly Wilson, and colleagues. It comes from the behavioral tradition, which studies how behavior is shaped by circumstances and consequences. ACT added a particular interest in how language and thinking change the way we respond to the world.
ACT is often grouped with mindfulness-based therapies developed around the same time. The research community built around it calls itself contextual behavioral science, and its professional home is the Association for Contextual Behavioral Science (ACBS). ACT didn't invent its core ideas, many of which are old. It organized them into one model that can be taught and tested.123
Source 2Book
The problem ACT focuses on: fighting your own experience
ACT starts from an observation: much suffering comes not from painful thoughts and feelings themselves, but from the struggle to get rid of them. Trying not to feel anxious can mean turning down invitations, drinking, or staying home, and life gets smaller. ACT calls this experiential avoidance: trying to avoid, escape, or control unwanted inner experiences such as thoughts, feelings, memories, or body sensations, even when doing so costs the person things they care about.
A second problem is getting tangled up in thoughts, treating them as literal truths or orders. "I'll embarrass myself" stops being a thought and becomes a reason not to go. ACT calls this fusion.
The goal: psychological flexibility
ACT's goal is psychological flexibility: being able to stay in contact with whatever you're experiencing, including painful thoughts and feelings, and still choose actions that fit what matters to you. ACT describes six processes that build flexibility. Trainers often draw them as a six-sided diagram nicknamed the "hexaflex."
- Acceptance (or willingness): letting unwanted feelings be there without fighting them, when fighting is costing you.
- Defusion: noticing a thought as a thought, so it has less automatic control over what you do.
- Present-moment attention: paying flexible attention to what is happening now.
- Self-as-context: a sense of yourself as the one who notices your thoughts and feelings, rather than being defined by them.
- Values: freely chosen qualities you want your actions to have, such as being caring, curious, or honest.
- Committed action: taking concrete steps guided by those values, even when it's uncomfortable.
These aren't six lessons to complete in order. They overlap, and the therapist works with whichever ones are most relevant at the moment.14
Acceptance and willingness
Acceptance in ACT doesn't mean liking a feeling, giving up, or tolerating mistreatment. It means being willing to feel what is there when trying to control it has become costly. A person afraid of speaking up might notice the heat in their face and the racing thoughts, let them be there, and ask their question anyway.
Defusion: noticing a thought without obeying it
Defusion means loosening a thought's grip on what you do. The thought may still be believable or painful. The change is in how the person relates to it: as something passing through their mind, not as an instruction or a complete description of reality.
Exercises can be simple: noticing "I'm having the thought that I'll fail," saying a thought slowly, or naming a familiar worry ("there's the 'not good enough' story again"). Being clever isn't the point. An exercise has worked if the person can pause and choose a response while the thought is still present. The therapist also checks that an exercise doesn't make the person feel mocked or brushed off.25
Present-moment attention and the noticing self
Present-moment attention means flexible contact with what is happening now: bodily sensations, another person's words, the room, the task at hand. It isn't a demand to feel calm or to monitor yourself constantly. Someone so absorbed in predicting rejection that they stop hearing the other person can practice coming back to the actual conversation.
Self-as-context is the related idea that there is a part of you that notices your thoughts, feelings, and roles without being identical to them. "I'm noticing I feel like a failure" is different from "I am a failure." Exercises should suit the person. Eyes-open attention, movement, or an outward focus may work better than long inward meditation.23
Values and committed action
A value is a chosen quality of action, such as being dependable, curious, or kind. A goal is an outcome you can finish. You can complete a course, but curiosity can carry on through many situations. Values give direction even when an outcome is uncertain or out of your control.
Committed action means taking concrete steps in a valued direction, often small ones, and learning from what happens. Someone who values connection but waits to feel confident before calling a friend might make the call while still feeling unsure. Jenna LeJeune and Jason Luoma, psychologists who train ACT therapists, emphasize that values are discovered through conversation and action, not picked from a list of admirable words.67
Source 6Book
Workability: does it help in the long run?
Workability asks whether a way of coping helps the person over time and in the direction they care about. Pushing grief away may get someone through a meeting but make closeness hard for months. The question isn't whether a strategy is good or bad in general, but what it does in this person's life.
Therapists sometimes help clients look honestly at how much effort they've spent trying to control feelings, and what it has cost. ACT calls this creative hopelessness: not hopelessness about life, but letting go of hope in a strategy that hasn't worked. The client's own goals and observations are the standard, and the question "How has that worked for you?" should be curious, not a rebuke.16
Function: asking what a behavior does
ACT looks at behavior in terms of its function: what it does for the person in a particular situation. The same action can do different things. Taking a walk might be enjoyable exercise one day and a way to put off a difficult phone call the next. You can't tell from the outside which it is. You have to ask what led up to it and what followed.
The philosophy behind this is called functional contextualism: understanding behavior through its context and consequences, and judging ideas by whether they are useful rather than whether they are "true" in the abstract. Practically, it means ACT therapists don't keep a list of healthy and unhealthy behaviors. They get curious about what each one is doing.13
Why words have so much power: relational frame theory
Relational frame theory (RFT) is the research on language behind ACT. It studies how people learn to relate things to each other (this is bigger than that, this means that, this causes that) and how those learned links change how events affect us. That's why the word failure can bring on real distress when nothing has failed, and why knowing a thought is exaggerated doesn't stop it from steering behavior.
Language isn't the enemy. It lets us plan, learn from others, and imagine. But it can also extend an old lesson into new places. If asking questions once got linked with looking stupid, every meeting can start to feel risky. RFT is still a developing research program. Not every ACT metaphor or exercise has its own proven mechanism.148
How change happens
In ACT, change means more freedom of action, not fewer unpleasant feelings. The person learns to notice their inner experience, make room for it, and still take steps toward what matters. This happens through experiential exercises in session, clarifying values, and repeated committed action between sessions. Feeling better often follows, but it isn't the main target.123
Current emphases
- The relationship: Robyn Walser, a psychologist and senior ACT trainer, emphasizes the therapy relationship as a place where flexibility can happen live. For example, the therapist might notice and explore a client's tendency to give the answer they think the therapist wants.
- Language in conversation: Matthieu Villatte, Jennifer Villatte, and Steven Hayes show how the therapist's own wording can be used deliberately to help clients see their thoughts differently.
- Process-based therapy: Hayes, Stefan Hofmann, and colleagues are now placing ACT's processes inside a wider map of how people change, which can draw on other therapies too.
Meet the case
Reason for referral
Ari is a 29-year-old laboratory technician at a hospital research lab who uses they/them pronouns. They contact the clinic after realizing they have turned down every social invitation for six weeks. The moment that tipped them was standing outside a café where a friend was waiting, hearing the thought “They’ll see I’m dull,” and walking home. Later that night they sent an apology that said they felt unwell, which was partly true and partly not.
Presenting concerns
Ari describes strong anxiety in the hours before social plans: a racing heart, a tight stomach, and a stream of predictions about saying something boring or awkward. They try to manage it by rehearsing replies, searching online for reassurance, doing breathing exercises, and waiting until they feel calm enough to go. Usually the calm doesn’t arrive in time, and canceling brings immediate relief followed by loneliness later in the evening. When they do attend, they spend much of the time monitoring how each remark sounded and remember little of what friends said.
In their words: “Once I feel normal, I’ll go.” In early sessions Ari is warm, precise, and self-deprecating. They call themselves “the awkward one” as if it were a job title, while describing being confident and well regarded at the lab bench.
Background and history
Ari describes being left out by a group of peers in middle school, including a period when a former friend mocked them in front of others. They coped by becoming quiet and observant and by putting effort into schoolwork, where they felt competent. In college they had a small group of close friends and felt more at ease, though large gatherings were always tiring. Social anxiety rose again over the past year, after a move across town put them farther from friends and a new schedule of rotating shifts made plans harder to keep. Ari has not had therapy before.
Current life and strengths
Ari lives alone and works rotating shifts, including some overtime, which leaves them tired and occasionally brings on migraines. Their closest friend is Sam, whom they’ve known since college and who keeps inviting them despite cancellations. Another friend in the same group often makes jokes at Ari’s expense, which Ari laughs off but finds hurtful. Ari enjoys quiet evenings alone, reading, and cooking, and doesn’t want therapy to turn them into someone who goes out every night.
Strengths include genuine care for friends, curiosity, careful listening, and a scientist’s willingness to treat ideas as hypotheses. Ari also notices patterns in their own behavior quickly, which helps once the patterns are named without judgment.
Assessment
The therapist asks about mood, sleep, alcohol, health, and safety alongside the anxiety. Ari reports lower mood on lonely evenings but continued interest in work and hobbies. They drink one or two glasses of wine on some evenings when anxious and agree to keep an eye on this. Sleep is disrupted by shift changes. They deny thoughts of suicide or self-harm. The therapist also asks about the quality of the friendships themselves, because some withdrawal might be a reasonable response to being treated badly rather than avoidance.
Working conceptualization
A conceptualization is a working explanation of the person’s difficulties and a plan for what therapy will focus on. The person and clinician review it together and change it as they learn more.
ACT looks at what a behavior does in a person’s life, not just at what it looks like. Many of Ari’s responses, such as rehearsing, reassurance seeking, waiting to feel ready, and canceling, work in the short term because they lower anxiety. Over weeks, the same responses make Ari’s life smaller and move them away from the friendships they care about. ACT calls this pattern experiential avoidance: efforts to get rid of uncomfortable feelings and thoughts that end up costing what matters.
Several processes seem to keep the pattern going. Ari treats thoughts such as “They’ll see I’m dull” as warnings that must be obeyed (fusion), and holds onto the label “the awkward one” as their real identity. Attention during social time goes inward to self-monitoring rather than to the conversation. And calm has become a condition for acting, so values wait for feelings to change.
The aim is psychological flexibility: being able to notice anxiety and self-critical thoughts, stay in contact with what is happening, and choose actions that fit Ari’s values, such as being an interested and dependable friend. Context matters. Staying home after overtime and a migraine may be good self-care, and stepping back from a friend who mocks them may be a healthy boundary. The same outward behavior can serve different purposes, so each one is looked at on its own.
Goals and treatment plan
- Clarify what kind of friend Ari wants to be, in their own words
- Accept or decline invitations as choices rather than as escapes from anxiety
- Stay with a conversation while anxious thoughts are present
- Set a boundary with the friend whose jokes are hurtful
- Keep enough rest to manage shift work
Weekly 50-minute individual sessions, scheduled around Ari’s shifts. Sessions combine short experiential exercises (with Ari free to decline), conversation about specific recent situations, and small committed actions chosen by Ari. Progress is reviewed through what Ari is doing, how connected they feel, distress, and whether choices feel more their own, not by counting events attended.
What would change the picture
The formulation needs revising if exhaustion, migraines, or alcohol explain more than avoidance does, if the friendship group is less safe than it first appeared, or if ACT language itself becomes another set of rules Ari has to obey.
The illustrated course of therapy
The story below follows five moments in this fictional course of therapy. Each scene names the interventions and shows the conversation and clinical reasoning. Session numbers show when events happen; they are not a schedule to copy.
How a clinician thinks
An ACT formulation asks: what inner experiences does the person struggle with, what do they do to avoid or control them, what do those strategies cost, what matters to them, and which flexibility processes are weakest?
Early ACT work often includes what is called creative hopelessness: compassionately noticing that control strategies have not delivered what the person wants.1
What this illustrates: The clinician asks what Ari’s coping strategies help with immediately and what they cost over time.
Ari lists distraction, rehearsing conversations, a drink before parties, and cancelling. Each helps for a while.
List strategies with their short-term and long-term effects.
Note the drink before parties: assess alcohol use carefully.
Identify the value: being a present, caring friend.
Identify weakest processes: acceptance of anxiety, defusion from “they’ll find me boring.”
Plan: small committed actions with willingness and defusion.1
A specific social anxiety disorder treatment, depression, or alcohol use may need direct attention. ACT can integrate these, but the formulation should name them.
Examples of the core ideas
These moments from Ari’s therapy illustrate different concepts. One case across sessions follows the course of therapy in order.
What this illustrates: Ari treats a prediction about being boring as a fact. The example shows the problem of becoming caught up in a thought.
Ari says, “The thought is, ‘They’ll find me boring.’ It’s probably true.”
In the room
Choose what you want to work on. Each intervention includes an explanation and three worked examples with Ari. Meet the case gives the background. These groups are options, not a treatment sequence.
Understand what matters and what gets in the way
Explore chosen directions, the function of behavior, and conflicts between important priorities before choosing an experiential task.
Find a direction that belongs to the person
Intervention
Find a direction that belongs to the person
Values are freely chosen qualities of ongoing action: how a person wants to relate, contribute, or care. A value is not an outcome that can be completed or a rule that guarantees approval. Ari might value being an interested and dependable friend; attending a dinner is one possible goal serving that direction. Values clarification asks what matters and makes room for ambivalence, including pressures from family or culture. The therapist should not decide that sociability is better than solitude. A chosen direction can guide action while discomfort remains, but values must not become a new demand to behave correctly. Practical constraints matter. Naming connection does not create time, access, or welcoming relationships. The next question is how this quality might appear in an attainable action, and whether that action feels owned rather than assigned.
What you do or say
- Ask about moments that felt meaningful.
- Ask how Ari wants to act in the relationships or activities that matter to them.
- Ask which direction Ari wants and which expectations come from other people.
- Name a value in Ari’s own language.
- Find several possible actions serving it.
- Check that Ari wants the action and has the time, resources, and support to try it.
One possible response: What would you want your friend to experience from you?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 4 Ari says they ought to become outgoing because that is what normal people are like. The therapist asks what kind of friend Ari wants to be, rather than how many events they should attend. Ari remembers listening carefully when a colleague was having a hard week and says being interested matters more than seeming impressive. They also enjoy quiet evenings alone, and worry that valuing connection will mean giving those up. The therapist distinguishes an ongoing direction from a social quota. Ari considers sending a thoughtful reply to one friend instead of forcing a crowded party. When asked whose standard the plan serves, Ari notices that it feels different from proving normality. They agree to keep examining whether future actions express chosen care or another demand for approval.
When to use it, and when not
Use when action is organized around avoidance or external approval. Don't prescribe values or assume connection means a high volume of social activity.
What the clinician is tracking
Track ownership, cultural context, and whether a value is being turned into a rule. Distinguish a direction from a goal and from an outcome controlled by others.
Three example exchanges
- Ari
- I should seem outgoing.
- Therapist
- What would you want your friend to experience from you?
- Ari
- That I'm interested.
- Therapist
- How could you express interest in one manageable interaction?
Values are framed as chosen qualities rather than an identity performance.
More examples
- Ari
- I don't want every evening full.
- Therapist
- Connection doesn't require that. What balance would feel yours?
- Ari
- One thoughtful meeting and time alone.
- Therapist
- Let's explore that pattern rather than a social quota.
The therapist asks what friendship means to Ari instead of deciding how sociable they should be.
- Ari
- You keep saying friendship matters.
- Therapist
- I've treated your earlier answer as permanent. What matters now?
- Ari
- I need more space this week.
- Therapist
- We can choose how to honor space and care without forcing a meeting.
Values remain open to the person's present choice and context.
Common slips
- Choosing the client’s values for them.
- Using a value as a moral demand.
- Confusing approval, outcomes, and ongoing qualities of action.
Map what the behavior is doing
Intervention
Map what the behavior is doing
Case conceptualization means developing an explanation of the problem that can guide treatment. In ACT, the therapist asks what an action does for the person in a particular situation. Cancelling dinner might briefly relieve Ari’s anxiety, allow necessary rest, or protect them from an unkind friend. Those possibilities suggest different next steps. Functional analysis is the name for examining what happened before the action and what followed it, both immediately and later. The therapist includes health, relationships, resources, and past learning in this account. Ari helps check whether it fits. The explanation guides which ACT skill might help now. As they try a change, the therapist reviews what happened and revises the account when it fails to explain the result.
What you do or say
- Describe a concrete sequence of behavior.
- Ask what each action accomplished immediately.
- Examine longer-term effects on chosen directions.
- Include contextual risks, health, and resources.
- Suggest which response may be keeping Ari stuck and ask whether that matches their experience.
- Choose a small way to test that understanding, then review the result.
One possible response: What was cancelling doing for you that evening?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 6 Ari says they cancelled Saturday and expects the therapist to call it avoidance. The week included overtime, a migraine, and repeated worries about conversation. The therapist asks what happened in sequence. Ari initially declined because they were exhausted, then spent the evening checking the phone and imagining the friend's disappointment. One decision may have protected rest, while later reassurance seeking restricted it. Ari has successfully met a colleague in a quiet setting, so social contact is not uniformly avoided. The therapist draws a provisional map showing context, anxious language, short-term relief, and longer-term disconnection. Ari corrects two assumptions and adds that the friend often makes jokes at Ari's expense. The next intervention must consider that relationship, not merely increase tolerance of anxiety.
When to use it, and when not
Use to choose interventions and revise treatment. Don't infer function from the appearance of an action or reduce context to the client's avoidance.
What the clinician is tracking
Ask what happened before the action, what changed immediately afterward, and what happened later. Compare occasions and invite Ari to correct your account. Include health, work, relationships, and reasons to protect themselves.
Three example exchanges
- Ari
- I cancelled again.
- Therapist
- What was cancelling doing for you that evening?
- Ari
- Letting me rest after overtime.
- Therapist
- Let's include that before deciding whether this was avoidance.
The therapist asks why Ari canceled that evening and learns that they needed rest after overtime.
More examples
- Ari
- Then I checked my phone all night.
- Therapist
- Did that help you rest, or keep you caught in the worry?
- Ari
- It kept me stuck.
- Therapist
- The cancellation and checking may need different responses.
A sequence can contain both protective and restrictive behavior.
- Ari
- You've left out his jokes.
- Therapist
- You're right. The relationship context changes this formulation.
- Ari
- I don't want to practice accepting insults.
- Therapist
- We'll include boundaries and investigate which contacts you actually choose.
The therapist changes the explanation after hearing about mistreatment, allowing practical protection to become part of the plan.
Common slips
- Labeling behavior as avoidance without asking its function.
- Forcing all six processes into every session.
- Ignoring a correction that challenges the therapist’s map.
Keep values alive when priorities conflict
Intervention
Keep values alive when priorities conflict
Applied values work addresses competing directions, external rules, and changing circumstances. Values do not automatically resolve conflict: Ari may care about friendship, rest, and honesty at the same time. The clinician helps identify which qualities matter in the present situation and which actions can express them without promising a cost-free choice. A goal can serve a value at one time and become a rigid obligation later. Returning to chosen qualities prevents a social activity quota from replacing genuine connection. Values language also requires cultural humility; family or collective responsibilities should not be dismissed as merely external pressure. The therapist asks how Ari experiences those commitments and what room for choice exists. A useful discussion results in flexible action, including a boundary when appropriate, rather than a declaration of the correct value.
What you do or say
- Name the competing valued qualities.
- Ask how Ari wants to keep acting over time, alongside any specific goal they choose.
- Explore costs and resources for each option.
- Choose an action expressing the priorities that matter now.
- State a respectful boundary or request where needed.
- Review the action’s effect over time.
One possible response: Is connection a quality you choose, or a rule never to decline?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 8 Ari has accepted two invitations and now feels trapped by the idea that declining would betray connection. An overtime shift has left Ari tired, and one gathering includes the friend who makes unkind jokes. Ari says commitment means going anyway. The therapist asks whether connection has turned into a rule to attend every event. Ari also values being honest about limits and maintaining enough rest to function at work. They explore a chosen reply that acknowledges care and proposes a quieter meeting next week. Ari worries that this is avoidance dressed up as values. The clinician compares the function and consequences of the options rather than declaring one form correct. They agree to review whether the boundary supports a richer life or becomes an automatic way to decline all contact.
When to use it, and when not
Use when a value becomes an inflexible rule or valued directions compete. Don't decide which value must outrank the others without the client's participation.
What the clinician is tracking
Track choice, cultural commitments, and the actual consequences of different actions. Ask whether values language is supporting flexibility or justifying a familiar avoidance pattern.
Three example exchanges
- Ari
- A good friend goes every time.
- Therapist
- Is connection a quality you choose, or a rule never to decline?
- Ari
- It has become a rule.
- Therapist
- What other action could express care this week?
Values clarification restores multiple possible forms of action.
More examples
- Ari
- I care about them and need rest.
- Therapist
- Both can matter. What reply honors that honestly?
- Ari
- I could suggest next week.
- Therapist
- Let's consider how that fits the actual relationship.
The choice includes competing priorities and context.
- Ari
- You've decided friendship comes first.
- Therapist
- I have given it too much weight. What priorities are yours today?
- Ari
- Rest and an honest boundary.
- Therapist
- Then let's explore those without requiring you to defend them.
The therapist recognizes that Ari wants rest and a boundary today, and lets that choice guide the conversation.
Common slips
- Turning values into attendance rules.
- Dismissing collective commitments as inauthentic.
- Ignoring how values language can rationalize avoidance.
Create room to notice and choose
Attention, willingness, defusion, and perspective taking offer different ways to relate to an experience. Check whether each one opens behavioral choice.
Return attention to what is happening now
Intervention
Return attention to what is happening now
Contact with the present moment means flexibly attending to current experience instead of becoming wholly absorbed in prediction or replay. It includes what is happening inside and around the person, and the ability to shift attention as the situation requires. It is not sustained blankness or perfect concentration. Ari may spend a dinner evaluating every sentence while missing the actual conversation. Noticing a friend's current words can create a different basis for responding. Attention exercises should support engagement, not become a ritual that must be completed before participating. External orientation may fit better than an inward body focus for some people. The therapist asks which form is useful and keeps the exercise brief enough to review its function. Attention naturally wanders; recognizing the wandering and returning is part of the skill, not evidence of failure.
What you do or say
- Identify what current experience is being missed.
- Choose external or internal orientation collaboratively.
- Invite Ari to notice one thing they can see, hear, or feel.
- Name wandering as normal and return gently.
- Link attention to the activity that matters.
- Review whether participation became more available.
One possible response: Could you notice her next sentence before deciding what to say?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 3 Ari says that even when attending a gathering, the evening disappears into an internal review of how each remark sounded. Ari remembers almost none of a friend's story about a new job. The therapist invites Ari to notice three things in the room while continuing the conversation. Ari names the sound of traffic, the texture of the chair, and the therapist's last sentence. When asked what happened next, Ari says the monitoring thought returned immediately. The therapist treats noticing that return as useful and practices choosing where attention goes next. Ari does not want a long meditation exercise. They agree to rehearse listening to one complete sentence and asking a genuine follow-up question, without making perfect concentration the new social performance target.
When to use it, and when not
Use when rumination or anticipation prevents contact with the current situation. Don't insist on inward attention if it increases disconnection or distress.
What the clinician is tracking
Notice whether Ari is more able to join the conversation or activity. They do not need to sit still or perform the exercise perfectly. Ask what returning their attention helped them notice.
Three example exchanges
- Ari
- I'm planning my answer while she talks.
- Therapist
- Could you notice her next sentence before deciding what to say?
- Ari
- I heard she's worried about work.
- Therapist
- What response fits that actual sentence?
Ari shifts attention from judging their own performance to hearing what the other person is saying.
More examples
- Ari
- My mind went back to judging.
- Therapist
- You noticed it. Where would you choose to put attention now?
- Ari
- On what she's saying.
- Therapist
- Let's try that return without requiring the judging to stop.
Returning is practiced as flexibility, not concentration perfection.
- Ari
- Now I'm failing mindfulness too.
- Therapist
- I've made it sound like another standard. Let's simplify.
- Ari
- I just want to be there.
- Therapist
- Then noticing one moment of contact is enough to explore.
The clinician removes a new control demand and restores the relational purpose.
Common slips
- Requiring eyes closed or body focus regardless of preference.
- Treating wandering as failure.
- Using attention as a guarantee of calm.
Make room for a feeling without making it the boss
Intervention
Make room for a feeling without making it the boss
Acceptance means allowing an internal experience to be present when trying to eliminate it is restricting life. It is an active, chosen willingness to have thoughts, emotions, and sensations in the service of something important. It does not mean liking anxiety, resigning oneself to mistreatment, or deciding that practical problems cannot change. Experiential avoidance is an effort to escape inner experience that becomes costly or rigid. Ari's cancellation briefly removes anxiety but also removes friendship. The therapist explores that function before proposing any exercise. Acceptance is useful when it makes a valued action more possible; an exercise that becomes another way to force calm has missed its purpose. Start with something tolerable and let the person decide. The clinician watches the effect on behavior rather than assuming willingness can be measured by how much distress someone endures.
What you do or say
- Explore what avoiding the feeling does now and later.
- Connect willingness to a personally chosen direction.
- Offer a brief, manageable noticing experiment.
- Invite Ari to notice the sensations and see whether they can make room for them.
- Check whether more behavioral choice is available.
- Choose a small action and review the effect.
One possible response: Could you reply with some nerves present, if connection matters?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 2 Ari shows an invitation from a friend. Before replying, Ari has tried breathing exercises, searched for reassurance online, and waited for the nervous feeling to settle. The evening has almost passed, and declining now seems easier. Ari says, “Once I feel normal, I'll go.” The therapist asks what waiting has done to friendship over the last month. Ari becomes quiet and admits that anxiety has ended up choosing every evening. The therapist offers a short experiment: notice one manageable sensation while considering a small reply, with permission to stop. Ari is wary that acceptance means putting up with everything. The therapist separates making room for a feeling from accepting harmful circumstances, and asks what Ari would choose if calm weren't a requirement.
When to use it, and when not
Use when attempts to remove inner discomfort block a valued action. Don't use acceptance to discourage protection, medical evaluation, or practical change.
What the clinician is tracking
Check whether making room for the feeling helps Ari do something important to them. Ask whether they feel pressured to endure it or are using the exercise to make it disappear. They can pause or choose another approach.
Three example exchanges
- Ari
- I'll reply when the nerves stop.
- Therapist
- Could you reply with some nerves present, if connection matters?
- Ari
- Maybe a short yes.
- Therapist
- Let's explore that choice without requiring calm first.
The therapist connects making room for the feeling with an action Ari wants to take, so the exercise has a clear purpose.
More examples
- Ari
- So I just put up with it?
- Therapist
- Not mistreatment. We're exploring whether a feeling has to decide your evening.
- Ari
- I still want to choose the plan.
- Therapist
- Exactly. Which part are you willing to carry for that choice?
The clinician preserves autonomy and the distinction between inner experience and external adversity.
- Ari
- You're telling me to suffer.
- Therapist
- I pushed past your choice. Let's stop the exercise.
- Ari
- I wanted help, not a test.
- Therapist
- We'll understand what would make this useful before deciding whether to try again.
When Ari wants to pause, the therapist adjusts the exercise and checks what would help them continue.
Common slips
- Using willingness as a test of toughness.
- Promising acceptance will remove anxiety.
- Confusing accepting emotion with accepting an unsafe situation.
Hear a thought as a thought
Intervention
Hear a thought as a thought
Defusion means noticing a thought without automatically doing what it says. Ari thinks, ‘They’ll find me boring,’ and cancels dinner as though rejection has already happened. ACT calls this cognitive fusion: a thought has begun to control the person’s response. The therapist helps Ari notice the prediction and consider what to do while it is still present. A phrase such as ‘I’m having the thought that…’ can be useful, but the important question is what happens next. If Ari repeats it until they feel reassured, the exercise may become another reason to delay going out. The therapist checks whether it helps Ari choose. Real concerns about the friendship still need discussion, and Ari can decide that a particular invitation is a poor fit.
What you do or say
- Elicit the exact sentence and what Ari does when it appears.
- Ask permission to observe the sentence briefly.
- Try a respectful noticing phrase or another fitting method.
- Check what changed in the thought’s behavioral grip.
- Ask what is happening outside Ari's thoughts, including any real risks or practical concerns.
- Ask whether the exercise helps Ari take a step toward what matters to them.
One possible response: Can you notice that as a thought appearing right now?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 3 Ari remembers standing outside a café, hearing the sentence “They'll see I'm dull,” and going home. Ari describes the sentence as a warning that must be obeyed. The therapist asks whether they can notice it as something the mind produces before deciding what to do. Ari tries saying “I'm noticing the thought that I'm dull,” then immediately asks whether this is supposed to make the thought weaker. The therapist explains that its strength may stay the same. They are interested in whether Ari can hear the warning and still choose how to spend the evening. Ari also recalls one friend making a hurtful joke last month. They keep that event available for practical discussion rather than treating all social concern as only a thought.
When to use it, and when not
Use when a thought functions as a rigid command or identity. Don't use distancing language to dismiss accurate concerns or invalidate a client's experience.
What the clinician is tracking
Check whether Ari can choose an action while the thought is present. If they repeat a phrase to make the thought go away, ask about that. Make sure your metaphor helps with their problem rather than simply sounding clever.
Three example exchanges
- Ari
- They'll think I'm dull.
- Therapist
- Can you notice that as a thought appearing right now?
- Ari
- It's still convincing.
- Therapist
- It can be convincing and still leave a choice about replying.
Defusion does not depend on disproving or weakening the thought.
More examples
- Ari
- Someone actually did mock me.
- Therapist
- That matters. We can address that event while noticing what the broader warning makes you do.
- Ari
- I stopped seeing everyone.
- Therapist
- Let's distinguish this friend's behavior from letting the warning choose every friendship.
The therapist takes the real situation seriously while helping Ari decide how to respond to the thought.
- Ari
- That silly voice feels insulting.
- Therapist
- I chose a method that didn't fit. We can stop it.
- Ari
- I need you to take the thought seriously.
- Therapist
- I do. Let's use ordinary language to notice its influence instead.
The therapist changes the wording after hearing Ari’s response, while keeping the aim of choosing an action with the thought present.
Common slips
- Equating defusion with positive thinking.
- Judging success by how often the thought occurs.
- Using humorous methods without checking fit.
Notice experience without reducing yourself to it
Intervention
Notice experience without reducing yourself to it
Self-as-context describes the ability to notice experiences without letting one description define everything about you. Ari can remember feeling awkward at dinner, interested in a conversation at work, and relaxed with a cousin. Each experience belongs to the same person. Seeing this variety may help Ari question the rule that being ‘the awkward one’ must determine every social decision. The therapist explores a specific example and asks what Ari notices across different situations. This gives the term a practical meaning before introducing further theory. Personal history and social identity remain important parts of the account. If the discussion feels confusing or makes Ari feel detached, the therapist returns to a concrete situation and checks what would help them respond to it.
What you do or say
- Hear the self-label and the choices it excludes.
- Ask Ari about an experience that differs from the label they have given themselves.
- Help Ari notice when the self-description shows up and how it affects their choices.
- Explore perspective across settings and time.
- Check whether the exercise remains understandable and grounding.
- Connect the wider perspective to one chosen response.
One possible response: Can awkwardness be an experience you notice, rather than all of who you are?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 4 Ari calls themselves the awkward one, as if it were a job title. They describe being confident at the laboratory bench but say that competence doesn't count because social failure reveals the real person. The therapist asks whether the Ari who notices competence and the Ari who notices awkwardness must choose one description as the whole identity. Ari smiles briefly, then worries this is a trick to make them say something positive. The therapist clarifies that no flattering replacement label is required. They compare how Ari spoke with a trusted colleague, a new acquaintance, and the therapist. Different experiences are present, and each can be noticed. Ari considers whether a difficult conversation could be an event experienced by a person rather than proof of what that person permanently is.
When to use it, and when not
Use when a rigid self-story constrains action. Don't negate identities, social realities, or meaningful personal descriptions to make an abstract point.
What the clinician is tracking
Ask whether noticing a self-description helps Ari consider another response. If the exercise feels confusing, makes them feel detached, or turns into an abstract discussion, return to the situation they wanted help with.
Three example exchanges
- Ari
- I'm the awkward one.
- Therapist
- Can awkwardness be an experience you notice, rather than all of who you are?
- Ari
- Sometimes I'm fine with colleagues.
- Therapist
- Could both experiences belong to you without deciding your next invitation?
Remembering more than one experience helps Ari see that a single label does not describe everything about them.
More examples
- Ari
- You want me to say I'm confident.
- Therapist
- No. Another fixed label isn't the goal.
- Ari
- Then I don't have to prove anything?
- Therapist
- We can notice both stories and ask what you want to do now.
The method targets rigidity rather than constructing a more flattering identity.
- Ari
- I don't understand this observer talk.
- Therapist
- I've made it too abstract. Let's return to the invitation in your hand.
- Ari
- I know I want to see them.
- Therapist
- Can the awkwardness story come along without being the final decision-maker?
The therapist returns to a familiar situation to explain the idea when theoretical language becomes confusing.
Common slips
- Presenting self-as-context as a hidden essential self.
- Dismissing cultural or social identity.
- Continuing an abstract exercise when it increases disconnection.
Turn flexibility into action
Choose an achievable action, learn from setbacks, and bring openness and attention into the behavior that matters outside the session.
Take a small step and learn from it
Intervention
Take a small step and learn from it
Committed action is flexible behavior guided by values. Commitment means returning to a chosen direction, not guaranteeing a perfect record or pushing through every obstacle. Goals make a direction concrete; behavior-change methods help identify cues, barriers, supports, and consequences. Ari can choose a brief meeting because friendship matters, while planning what to do if anxiety appears. The plan should specify an attainable action and a review, not an intention to become less anxious. If the step is not completed, ACT examines its function and context rather than declaring a failure of character. Practical problem solving belongs alongside acceptance and defusion. Sometimes the next committed action is changing the plan, setting a boundary, or asking for help. Progress is judged by whether life becomes more flexible and connected to chosen purposes, with symptoms and functioning assessed as well.
What you do or say
- Translate a value into a specific attainable action.
- Identify timing, cues, resources, and likely obstacles.
- Plan how Ari can respond when uncomfortable thoughts or feelings arise during the action.
- Clarify useful boundaries and supports.
- Ask what Ari did, what happened, and what they learned.
- Adjust the next step while retaining choice.
One possible response: What's one action that would express interest this week?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 5 Ari chooses to meet a friend for coffee on Saturday. Previous plans failed because Ari waited to feel ready, chose crowded venues, and treated arriving late as a reason to cancel entirely. The therapist asks for a smaller version that fits both values and the actual week. Ari selects a quieter café, agrees a brief visit, and sends the invitation while anxiety is present. They discuss transport and what Ari might say if the conversation pauses. Ari asks whether leaving after the planned half hour counts as avoidance. The therapist explores the reason for leaving rather than declaring every short visit suspect. A chosen time limit may make the action feasible; escaping solely to obey anxiety may need a different review. They agree to examine what happens without grading the visit.
When to use it, and when not
Use when a chosen direction needs a concrete action and support. Don't equate commitment with ignoring exhaustion, real risk, or changing priorities.
What the clinician is tracking
Track the action's function, feasibility, and consequences. Notice all-or-nothing rules that make a partial attempt invisible.
Three example exchanges
- Ari
- I'll be a better friend.
- Therapist
- What's one action that would express interest this week?
- Ari
- Ask Sam for coffee.
- Therapist
- When will you send the message, and what might get in the way?
They turn something Ari cares about into an action small enough to try and discuss afterward.
More examples
- Ari
- I was late, so I nearly cancelled.
- Therapist
- Could arriving late still serve connection?
- Ari
- I could apologize once and go.
- Therapist
- Let's include that option in the plan.
Flexibility prevents a perfectionistic rule from erasing a valued action.
- Ari
- You're asking me to push through everything.
- Therapist
- That isn't the choice I want us to make. What limit needs respect?
- Ari
- Half an hour is enough.
- Therapist
- Let's examine whether that limit supports a feasible visit and review its function.
Commitment includes workable limits and contextual judgment.
Common slips
- Making symptom reduction the condition for action.
- Treating partial progress as no progress.
- Calling every boundary avoidance.
Build persistence that can change course
Intervention
Build persistence that can change course
Applied committed action addresses maintenance, setbacks, and barriers after an initial step. Psychological flexibility includes persistence when an action serves a chosen direction and changing course when it no longer does. Ari's plan can become too large, poorly timed, or dependent on someone else's response. The clinician reviews behavior in context, identifies what supported useful action, and adjusts the next step. Reinforcement means a consequence that increases the likelihood of behavior; in ordinary practice, noticing meaningful contact can support further engagement. A lapse is an event to understand, not proof that earlier work was false. The plan includes practical resources and a way to resume without making up for missed activity through an unrealistic burst. The person's own experience determines whether the direction remains meaningful.
What you do or say
- Review each attempted or missed action in context.
- Identify what supported meaningful engagement.
- Ask what made the action difficult: practical obstacles, real risk, or trying to escape an uncomfortable feeling.
- Choose a next step proportional to current resources.
- Plan a flexible restart after foreseeable obstacles.
- Review whether the direction and method remain useful.
One possible response: What did the earlier visits teach you, even with these setbacks?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 9 Ari has attended coffee twice but declined the next three plans. Ari says the improvement was fake and proposes a crowded party to prove commitment. The therapist reviews each week instead. One cancellation followed overtime, another followed a hurtful message, and the third followed an anxious prediction. These events need different responses. Ari notices that a short planned meeting with a respectful friend had been rewarding, but the all-or-nothing rule about setbacks erased that information. They choose one attainable invitation and a separate boundary conversation, not a dramatic test. They plan how to resume if transport fails or anxiety delays the reply. Ari says that treating missed plans as different events makes returning easier than making a large promise to attend everything.
When to use it, and when not
Use when sustaining change or responding to a lapse. Don't prescribe a larger action simply to compensate for missed practice.
What the clinician is tracking
Track specific barriers and natural consequences that support engagement. Separate persistence in a valued direction from rigidity about a particular goal.
Three example exchanges
- Ari
- Three cancellations mean nothing changed.
- Therapist
- What did the earlier visits teach you, even with these setbacks?
- Ari
- I enjoyed the quieter one.
- Therapist
- Let's retain that information when choosing the next step.
A lapse does not erase useful learning.
More examples
- Ari
- I need to force myself next time.
- Therapist
- Which cancellation involved fear, which exhaustion, and which a disrespectful situation?
- Ari
- They weren't all the same.
- Therapist
- Then the next responses shouldn't be identical either.
The therapist separates three reasons for canceling so Ari can make a different plan for each situation.
- Ari
- That big plan feels like punishment.
- Therapist
- I suggested too much to compensate for a lapse. Let's change it.
- Ari
- One small invitation is enough.
- Therapist
- We'll plan that and how you can resume if it doesn't happen.
The clinician avoids converting commitment into compensatory pressure.
Common slips
- Erasing progress after a setback.
- Increasing task size to punish missed action.
- Using one explanation for every nonattempt.
Bring openness, attention, and action together
Intervention
Bring openness, attention, and action together
Several ACT skills may be useful during the same decision. Ari receives a brief reply from a friend, thinks it means rejection, feels hurt, and wants to stop replying. The therapist can help Ari notice the thought, allow some hurt to be present, read what the friend actually wrote, and decide how to respond. ACT sometimes groups this work as openness, awareness, and engagement: allowing inner experience, attending to the present, and taking an action that matters. The therapist chooses the part that helps with the immediate difficulty. Practical problem solving may also be needed. After trying a response, Ari and the therapist review its effect on the friendship, distress, and daily life, then decide what would be useful next.
What you do or say
- Identify the current choice and context.
- Notice language or avoidance narrowing it.
- Invite enough openness and attention to examine options.
- Connect to a chosen direction.
- Select a practical action or boundary.
- Ask what changed and which part of the exercise helped.
One possible response: Can we notice that story and read the actual words?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 9 Ari receives a delayed reply during the meeting and immediately calls it rejection. The therapist notices Ari switching between checking the phone, reciting a defusion phrase, and planning an apology. Instead of adding another isolated exercise, they slow the sequence. Ari can hear the old unwanted story, feel the disappointment, and read the actual message: the friend has suggested a different day. Ari then remembers wanting an honest, sustainable friendship. They consider a simple reply rather than a paragraph of reassurance seeking. The therapist also asks whether the proposed day fits Ari's schedule. Openness, attention, and engagement support one ordinary decision; they are not a checklist proving correct ACT. Ari chooses a reply and notes that anxiety remained without needing to determine the action.
When to use it, and when not
Use when several processes operate in one meaningful choice. Don't make integration an elaborate exercise that obscures the actual situation.
What the clinician is tracking
Track which process would open the next useful response. Notice whether theoretical completeness is competing with clinical simplicity.
Three example exchanges
- Ari
- The reply means rejection.
- Therapist
- Can we notice that story and read the actual words?
- Ari
- He suggested Thursday.
- Therapist
- What reply fits your wish for honest connection?
The therapist helps Ari read the message carefully and decide how to reply in a way that supports the relationship.
More examples
- Ari
- I should say yes despite anxiety.
- Therapist
- Does Thursday actually fit your work and rest?
- Ari
- No. Saturday would.
- Therapist
- Then flexibility can include offering Saturday.
Valued action is not automatic exposure or compliance.
- Ari
- There are too many things to do.
- Therapist
- I've turned flexibility into a checklist. Let's simplify.
- Ari
- I just need to answer.
- Therapist
- What would a chosen, respectful answer look like now?
The therapist removes the long list of exercises and helps Ari choose a reply.
Common slips
- Forcing all six processes into a single response.
- Treating integration as exposure regardless of context.
- Adding techniques when a simple choice is available.
Adapt the work to this situation
Choose a process from its function in the person’s current difficulty. An exercise is useful when it supports participation, rather than when it is completed correctly.
Adapt willingness to the function of avoidance
Intervention
Adapt willingness to the function of avoidance
After introducing acceptance, the therapist needs to find out which experience Ari is avoiding. Ari may be able to sit with a racing heart but still avoid telling a friend that they would like more contact. In that situation, another exercise about bodily sensations may miss the difficulty. The therapist asks what feels risky about showing interest and what Ari would like to do. They can then try making room for the feeling during a brief conversation or while planning a message. Ari chooses the amount of practice and can pause. The therapist checks whether the exercise helps with the chosen action. Concerns about an actual harmful relationship need practical attention as well as any work with uncomfortable feelings.
What you do or say
- Identify what remains avoided despite earlier progress.
- Ask what revealing or feeling it is predicted to cost.
- Connect a willingness invitation to a chosen purpose.
- Choose a tolerable, specific exercise or conversation.
- Check experience and consent during the attempt.
- Review whether behavioral options expanded.
One possible response: Then caring openly may be the experience we need to understand.
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 6 Ari can notice a racing heart without leaving the room, but still avoids telling Sam that the friendship matters. Ari says feeling nervous is manageable; showing affection feels humiliating because it might not be returned. The therapist recognizes that the earlier body-focused exercise addressed only part of the avoidance. They ask whether Ari is willing to contact the uncertainty of caring while considering one honest sentence. Ari looks away and says it sounds needy. They explore how hiding interest protects against rejection and also makes friendship harder to sustain. No disclosure is assigned automatically. Ari chooses to practice a modest expression in session first and notices both warmth and fear. The clinician checks that willingness is serving Ari's chosen connection rather than the therapist's idea of emotional openness.
When to use it, and when not
Use when an initial acceptance method has missed the experience actually being avoided. Don't increase intensity merely because a client has learned the beginner exercise.
What the clinician is tracking
Ask what feeling or experience Ari is trying to avoid and what they want to be able to do. Check that the exercise fits that difficulty. Ari does not have to disclose more or tolerate more discomfort to please you.
Three example exchanges
- Ari
- I can handle nerves, not telling him I care.
- Therapist
- Then caring openly may be the experience we need to understand.
- Ari
- It could be embarrassing.
- Therapist
- Would exploring that uncertainty serve the friendship you want?
The therapist finds out that expressing care is what feels frightening to Ari, then asks whether exploring that fear would help the friendship.
More examples
- Ari
- Exercises don't fit this.
- Therapist
- We can try an ordinary sentence instead, if you choose.
- Ari
- I could say I enjoyed seeing him.
- Therapist
- Notice what appears while you consider that, without forcing yourself to send it.
Applied acceptance need not use a formal meditation.
- Ari
- You're making this bigger than I wanted.
- Therapist
- I escalated instead of checking fit. Let's step back.
- Ari
- A simple message is enough.
- Therapist
- Then we can work with that chosen level and its actual uncertainty.
The therapist checks which experience Ari is avoiding and adjusts the exercise. Ari does not have to disclose more to make the work useful.
Common slips
- Repeating the same acceptance script despite poor fit.
- Confusing disclosure with willingness.
- Increasing intensity without a functional reason.
Choose defusion that opens action rather than suppresses thought
Intervention
Choose defusion that opens action rather than suppresses thought
A defusion exercise should fit the particular thought that is restricting action. Ari might worry about one dinner, or follow a broader rule that friendship must never feel awkward. The therapist asks how the thought affects Ari’s decisions and chooses a way to examine that influence. They could notice the words together, compare occasions, or pause when the rule appears during the session. Afterward, the therapist asks what changed. Ari may still have the thought while being more able to send a message or decide whether an invitation suits them. Repeating a phrase until it feels safe to act can become a new obstacle. The therapist reviews that use of the exercise and helps Ari try a different response.
What you do or say
- Ask what the current defusion method is expected to achieve.
- Identify the thought’s behavioral rule or command.
- Ask whether Ari is noticing the thought, trying to push it away, or seeking reassurance.
- Select a fitting, simple alternative if useful.
- Link the shift to a chosen context-sensitive action.
- Ask how Ari responded when the thought showed up and whether that helped them do what mattered.
One possible response: Then it's working as reassurance, rather than noticing.
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 7 Ari says the noticing phrase helped once but now gets repeated dozens of times before sending any message. Ari waits for the phrase to stop the thought, then becomes frustrated when it doesn't. The therapist asks what job the phrase has been given. Ari admits that it has become a way to obtain certainty that the friend won't judge them. They identify a broader rule: a reply is permitted only when embarrassment is impossible. Rather than introduce a more elaborate metaphor, the therapist invites Ari to hear the rule and consider whether living by it serves connection. Ari can see that the rule offers protection but no friendship. They choose a brief reply while the warning remains, preserving the option to reconsider genuine signs of disrespect.
When to use it, and when not
Use when a defusion method becomes ritualized or fails to alter behavior. Don't add more clever techniques before investigating the current method's function.
What the clinician is tracking
Ask what Ari wants the exercise to accomplish. Does it help them notice a thought and act, or has it become a repeated attempt to feel certain or calm before doing anything?
Three example exchanges
- Ari
- I say the phrase until I feel certain.
- Therapist
- Then it's working as reassurance, rather than noticing.
- Ari
- I thought certainty was the goal.
- Therapist
- Let's see whether you can choose without having to earn certainty first.
The therapist asks what the exercise is doing for Ari, rather than assuming that repeating the phrase is helping.
More examples
- Ari
- I mustn't be awkward.
- Therapist
- What does obeying that rule allow, and what does it close off?
- Ari
- It stops every invitation.
- Therapist
- Could you notice the rule while deciding which invitation you want?
The rule's effect is investigated without arguing its truth.
- Ari
- You keep giving me new phrases.
- Therapist
- I've responded with methods instead of asking how you're using them.
- Ari
- They're all another test.
- Therapist
- Let's stop collecting phrases and examine one choice that matters.
The therapist stops adding exercises and asks how the existing advice has affected Ari's choices.
Common slips
- Treating method variety as clinical progress.
- Encouraging repetitive phrases as reassurance.
- Ignoring accurate context while distancing from language.
Practice attention where participation breaks down
Intervention
Practice attention where participation breaks down
Applied present-moment work examines where attention becomes inflexible in a particular activity. Ari may hear a friend's words but then abandon the conversation to score their own response. The target is the shift that removes contact, not a general lack of mindfulness. The therapist can slow a short interaction, identify that shift, and rehearse a return to relevant information. Flexible attention includes internal experience and external cues; selecting one is not a permanent prescription. The method should fit the person's sensory needs, culture, health, and preference. Attention to the present can also reveal that a conversation is unkind or uninteresting, leading to a boundary rather than greater endurance. A useful exercise increases responsiveness to what is actually happening. It does not promise freedom from thoughts or make the therapist the judge of correct awareness.
What you do or say
- Reconstruct a short interaction.
- Locate the transition into prediction or self-review.
- Name the shift with permission.
- Practice returning to one relevant external or internal cue.
- Try returning attention during another short conversation and ask what Ari noticed.
- Link the cue to participation and assess context.
One possible response: Can we notice that exact shift in a brief exchange here?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 7 Ari reports attending coffee but repeatedly losing the thread after speaking. The therapist asks Ari to reenact a short, ordinary exchange rather than summarize the whole visit. After one answer, Ari's eyes move away and they begin silently reviewing whether the answer sounded stupid. The clinician pauses at that exact transition. Ari notices the review and can return to the therapist's last words, then ask a follow-up. They try once more with a deliberately imperfect sentence. Ari says the return is possible but not automatic. The therapist also asks whether anything in Sam's response actually felt dismissive. They distinguish missing contact because of self-monitoring from choosing not to remain in a disrespectful exchange, and plan a brief listening cue for the next chosen meeting.
When to use it, and when not
Use when a specific attentional transition blocks engagement. Don't require a sensory exercise that conflicts with accessibility needs or intensifies distress.
What the clinician is tracking
Track the moment attention shifts away and what the shift accomplishes. Check whether returning reveals information the person can use.
Three example exchanges
- Ari
- After I answer, I review every word.
- Therapist
- Can we notice that exact shift in a brief exchange here?
- Ari
- I did it just then.
- Therapist
- Where would you choose to place attention next?
A specific transition is more actionable than a general instruction to be mindful.
More examples
- Ari
- My answer sounded clumsy.
- Therapist
- Can the clumsy answer be present while you hear my next sentence?
- Ari
- I heard you ask about the weekend.
- Therapist
- What response follows from that?
Attention supports continued participation despite self-evaluation.
- Ari
- You're monitoring whether I pay attention.
- Therapist
- That has become another performance demand. Let's change it.
- Ari
- I want a cue I choose.
- Therapist
- Which cue helps you reconnect without needing my approval?
The person owns the attention practice and its purpose.
Common slips
- Giving a general mindfulness instruction without identifying the breakdown.
- Policing attention.
- Assuming present contact means staying in every interaction.
Use perspective taking when identity becomes rigid
Intervention
Use perspective taking when identity becomes rigid
A strong self-description can shape which experiences a person notices. Ari sees themself as ‘the unwanted friend,’ remembers unanswered messages, and overlooks occasions when someone sought their company. The therapist first asks how this description developed and what has made it convincing. They then look together at a recent situation and at other experiences across time. This is an application of self-as-context: noticing a description as one part of experience while considering other ways to respond. The work respects real rejection and discrimination. The therapist also checks their own assumptions about Ari; choosing solitude may sometimes be sensible or enjoyable. A useful discussion helps Ari make a current decision, and stays concrete enough for them to explain in their own words.
What you do or say
- Ask Ari how they describe themselves and which experiences support or challenge that description.
- Ask when Ari began using this self-description and how it has helped them cope.
- Invite a perspective across time or another chosen viewpoint.
- Keep history and current experience both available.
- Check grounding and personal meaning.
- Translate the wider view into a context-sensitive choice.
One possible response: What does the unwanted story allow to count?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 8 Ari describes a delayed reply as confirmation of always being unwanted. Earlier, Ari had felt welcomed at coffee, but says that experience was an exception and this delay reveals the truth. The therapist asks how the unwanted story decides which evidence counts. Ari remembers that it began after exclusion during school and still appears even with caring people. They consider the perspective of Ari now noticing that old learning, without denying its origin. The therapist asks what Ari would say to a friend facing the same uncertainty, then checks whether that perspective fits rather than using it to force reassurance. Ari can hold hurt, history, and a wish for connection together. They choose to wait without sending repeated checking messages and to evaluate the relationship over time.
When to use it, and when not
Use when a self-story filters all experience into one conclusion. Don't use perspective work to erase the history or culture that gives the story meaning.
What the clinician is tracking
Ask whether Ari can see more than one way to respond while respecting what the self-description means to them. Keep the discussion tied to a current decision instead of arguing about who they really are.
Three example exchanges
- Ari
- The good visit didn't count.
- Therapist
- What does the unwanted story allow to count?
- Ari
- Mostly delays and awkwardness.
- Therapist
- Can we notice that filtering without deciding your whole identity?
The client observes a self-story's operation rather than receiving a replacement verdict.
More examples
- Ari
- I really was excluded.
- Therapist
- Yes. The history matters even when the story appears in a different relationship.
- Ari
- I want to remember without obeying it everywhere.
- Therapist
- Let's explore what today's situation permits that school didn't.
Perspective distinguishes contexts without denying harm.
- Ari
- You make it sound like none of it happened.
- Therapist
- I've blurred noticing a story with denying your history. That was wrong.
- Ari
- I need both to matter.
- Therapist
- We'll hold what happened and your present choices together.
The therapist acknowledges that the earlier wording dismissed Ari's history and makes room to discuss both the past and present choices.
Common slips
- Treating identity as an error.
- Using another person’s viewpoint to compel reassurance.
- Ignoring the client’s history to make a philosophical point.
Use and repair the working relationship
The encounter itself can provide a place to notice avoidance, choice, and impact. Repair a method or interaction that is getting in the way.
Use the relationship as a place to practice flexibility
Intervention
Use the relationship as a place to practice flexibility
The therapeutic relationship is a current context in which openness, awareness, and chosen action can be observed. Ari may conceal disagreement with the therapist just as they conceal preferences with friends. The clinician notices that pattern tentatively and explores it without assuming every in-session behavior represents life outside. An ACT-informed alliance includes agreement on goals and tasks, care in the working bond, and permission for correction. The therapist's own anxiety, attachment to a method, or wish to be helpful can narrow responsiveness. Modeling flexibility may include acknowledging uncertainty, slowing down, and receiving feedback without defense. Clinician self-disclosure is judged by its purpose, boundaries, and effect, not by whether it demonstrates authenticity. The relationship serves Ari's needs and treatment goals; it does not become a demand for closeness or disclosure.
What you do or say
- Notice an in-session pattern tentatively.
- Ask how the current task and relationship feel.
- Consider your contribution before interpreting the client.
- Invite a chosen alternative response if useful.
- Respond consistently with consent and professional boundaries.
- Ask what Ari learned from the exchange and which questions remain unanswered.
One possible response: Would a different focus be more useful today?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 7–9: flexibility is not a new performance rule): They retire the repetitive phrase, practice one attentional return during dialogue, and choose a manageable invitation. Ari plans an honest rest boundary and a flexible restart if transport or work interferes. Prior learning is retained rather than erased by the lapse.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 10 Ari agrees to a values exercise and then gives short, polished answers. The therapist notices a familiar pattern of trying not to disappoint. Asked how the exercise feels, Ari says it is fine, then admits they had wanted to discuss the hurtful friend instead. The clinician considers that their enthusiasm may have made disagreement seem unwelcome. They ask whether Ari would be willing to practice saying a preference in this room, with an explicit option to decline. Ari says they want less exercise and more ordinary conversation. The therapist thanks them and changes the focus, then checks how receiving that response feels. Ari is surprised that disagreement did not threaten the relationship. The experience is explored as one piece of learning, not proof that all relationships will respond the same way.
When to use it, and when not
Use when an in-session interaction can illuminate a relevant pattern. Don't pressure the client to disclose or rehearse closeness for the therapist's benefit.
What the clinician is tracking
Track the shared goals, task fit, and the therapist's own rigidity. Consider whether your delivery makes correction genuinely possible.
Three example exchanges
- Ari
- The exercise is fine.
- Therapist
- Would a different focus be more useful today?
- Ari
- I wanted to discuss the friend.
- Therapist
- Let's change the focus and see what you need there.
Actual task adjustment demonstrates that feedback is welcome.
More examples
- Ari
- I don't want to disappoint you.
- Therapist
- Could you tell me a preference while that worry is here, if you choose?
- Ari
- Less exercise, more talking.
- Therapist
- Thank you. We can do that and notice what happens between us.
The relationship offers a consensual opportunity for flexibility.
- Ari
- Your story took over the session.
- Therapist
- I disclosed too much and lost your focus. I'll return it to you.
- Ari
- I needed help with my situation.
- Therapist
- What part do you want us to understand now?
A boundary-aware repair prioritizes the client's work over the therapist's self-expression.
Common slips
- Assuming every in-session response generalizes outside.
- Using authenticity to justify burdensome self-disclosure.
- Inviting feedback without changing anything when it is reasonable to do so.
Repair when the method or relationship misses
Intervention
Repair when the method or relationship misses
Relationship rupture is a strain in the working bond or disagreement about treatment goals and tasks. Ari may withdraw into agreement, challenge an exercise, or say the therapist feels dismissive. ACT processes can support repair, but they cannot replace listening and accountability. The clinician notices their own urge to defend the method, stays open to discomfort, attends to the client's actual words, and chooses a response serving the relationship and agreed goals. This does not mean asking Ari to accept the therapist's error. Repair includes acknowledging a contribution, clarifying intention only when useful, and changing the interaction. Professional boundaries remain in place and can be explained respectfully. The effectiveness of repair is checked in subsequent engagement and feedback, not merely a statement that everything is fine.
What you do or say
- Name the strain and invite the client’s account.
- Pause the impulse to defend the approach.
- Acknowledge the impact and your contribution.
- Clarify the practical or relational issue that was missed.
- Negotiate an observable change in the work.
- Check the repair now and in later sessions.
One possible response: What did I leave out when I suggested it?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 7–9: flexibility is not a new performance rule): They retire the repetitive phrase, practice one attentional return during dialogue, and choose a manageable invitation. Ari plans an honest rest boundary and a flexible restart if transport or work interferes. Prior learning is retained rather than erased by the lapse.
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 11 Ari says acceptance language makes the therapist sound indifferent to being treated badly. Earlier, the therapist had suggested noticing hurt before exploring the friend's repeated jokes. Ari felt the practical problem disappeared behind an exercise. The clinician initially wants to explain that ACT includes values and boundaries, then recognizes that this would defend the model before hearing the impact. Ari says they nearly cancelled because they thought the therapist would call leaving the friendship avoidance. The therapist acknowledges having moved too quickly and asks for a fuller account of the relationship. They agree that the next work will consider boundaries and choice, with experiential methods used only when their purpose is clear. Ari begins asking questions again, but the therapist plans to check the repair rather than assuming one apology settles it.
When to use it, and when not
Use when trust, goals, or task agreement are strained. Don't prescribe acceptance of a rupture instead of addressing what happened.
What the clinician is tracking
Track both direct disagreement and withdrawal. Notice defensive use of theory and whether an agreed change actually appears in the work.
Three example exchanges
- Ari
- Acceptance sounded like putting up with him.
- Therapist
- What did I leave out when I suggested it?
- Ari
- That he keeps insulting me.
- Therapist
- That needed attention. Let's address the relationship itself.
Repair begins with what the method missed.
More examples
- Ari
- I don't want another exercise today.
- Therapist
- Then we won't use one. What would help us examine the boundary?
- Ari
- Talk through what I want to say.
- Therapist
- We'll do that and keep checking whether this focus fits.
Repair is made concrete through task renegotiation.
- Ari
- You're explaining ACT instead of listening.
- Therapist
- I am. I've defended the model and missed your experience again.
- Ari
- I want you to hear why it hurt.
- Therapist
- I'll listen first, then we can decide together what needs to change.
The clinician applies openness to their own discomfort rather than instructing the client to absorb an error.
Common slips
- Using acceptance language to bypass accountability.
- Defending theory before hearing impact.
- Assuming a polite response means trust is restored.
One case across sessions
Follow Ari through the sessions below. Return to the case background and treatment plan.
Sessions 1–2: waiting for calm costs connection
What happened
Ari has declined three invitations while waiting for anxiety to settle. Each cancellation brings short relief and later loneliness. They expect therapy to remove the feeling before they can socialize, and worry that acceptance means surrendering to distress.
Interventions in this scene
- Make room for a feeling without making it the boss
- Map what the behavior is doing
- Find a direction that belongs to the person
- Therapist
- What does waiting for calm make possible, and what does it close off?
- Ari
- I feel safer at home, but I stop seeing people.
- Therapist
- Would you choose a small reply with some anxiety present?
- Ari
- Maybe, if I still get to decide the plan.
What the clinician is thinking
Functional analysis asks what behavior accomplishes now and later. Experiential avoidance is not every attempt to feel better; it becomes clinically relevant when a rigid control pattern restricts a valued life. The therapist must also assess health, workload, and relationship context rather than treating all cancellation as avoidance.
How the clinician applies the intervention
They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Where it goes next
They will choose one meaningful direction and an attainable action, observing whether the practice expands choice rather than judging it by immediate calm.
Sessions 3–4: a warning is not the whole decision
Before this scene: Sessions 1–2 (waiting for calm costs connection).
What happened
Ari stands outside a café, hears “They will see I am dull,” and returns home. During a later gathering, internal evaluation prevents listening. Ari calls awkwardness the real identity beneath competence at work, and expects the therapist to replace that label with reassurance.
Interventions in this scene
- Hear a thought as a thought
- Return attention to what is happening now
- Notice experience without reducing yourself to it
- Find a direction that belongs to the person
- Ari
- The thought feels like a warning I have to obey.
- Therapist
- Can we notice the warning and also attend to what is actually happening?
- Ari
- Sam was asking about my week.
- Therapist
- What response would fit that conversation and the friendship you choose?
What the clinician is thinking
Defusion concerns a thought’s control over behavior, not proof that it is false. Present-moment attention provides current information, and perspective taking allows Ari to notice an identity story without reducing the whole person to it. None of these processes should dismiss real exclusion or demand a positive replacement identity.
How the clinician applies the intervention
They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Where it goes next
Next they will plan a quiet meeting and review the actual experience, including whether the relationship itself feels respectful.
Sessions 5–6: the same cancellation can have different functions
Before this scene: Sessions 3–4 (a warning is not the whole decision).
What happened
Ari attends one brief coffee and cancels another after overtime and a migraine. They expect criticism for not being committed. Later that evening, repeated phone checking prevents rest, and a hurtful joke from another friend raises a separate question about boundaries.
Interventions in this scene
- Map what the behavior is doing
- Take a small step and learn from it
- Adapt willingness to the function of avoidance
- Ari
- You will call cancelling avoidance.
- Therapist
- What was cancelling doing in that particular situation?
- Ari
- Letting me rest. Then I checked messages all night.
- Therapist
- Those actions may need different responses. Let us map each one.
What the clinician is thinking
The form of an action does not establish its function. Rest after illness may be protective, while reassurance seeking can narrow life. ACT case conceptualization includes the environment and consequences, so practical support and boundaries may be more appropriate than asking for more emotional tolerance.
How the clinician applies the intervention
They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Where it goes next
They will review whether the invitation was chosen, whether the rest plan worked, and what boundary Ari wants with the other friend.
Sessions 7–9: flexibility is not a new performance rule
Before this scene: Sessions 5–6 (the same cancellation can have different functions).
What happened
Ari repeats a defusion phrase until certain, treats every invitation as a values obligation, and calls three missed plans proof that progress was fake. The clinician recognizes that helpful language has become another system of demands. Ari still remembers enjoying the quieter meeting.
Interventions in this scene
- Choose defusion that opens action rather than suppresses thought
- Practice attention where participation breaks down
- Use perspective taking when identity becomes rigid
- Keep values alive when priorities conflict
- Build persistence that can change course
- Bring openness, attention, and action together
- Therapist
- What job has the noticing phrase been given?
- Ari
- Making sure I cannot embarrass myself.
- Therapist
- Then it is seeking certainty. What choice matters even without certainty?
- Ari
- A small meeting I actually want, not a party to prove something.
What the clinician is thinking
A method can look like ACT while functioning as control. Values describe chosen qualities, not a quota, and committed action includes adjusting goals after different barriers. The therapist investigates function before adding techniques or increasing the size of the next task.
How the clinician applies the intervention
They retire the repetitive phrase, practice one attentional return during dialogue, and choose a manageable invitation. Ari plans an honest rest boundary and a flexible restart if transport or work interferes. Prior learning is retained rather than erased by the lapse.
Where it goes next
They will examine actual consequences and whether the action expresses Ari’s priorities, bringing openness, attention, and engagement together only as needed.
Sessions 10–11: disagreement belongs in the relationship
Before this scene: Sessions 7–9 (flexibility is not a new performance rule).
What happened
Ari gives polished answers to an exercise and finally says acceptance sounded like putting up with insults. They nearly cancelled because they expected the therapist to label leaving the friendship avoidance. The clinician notices an urge to defend the model and instead asks what was missed.
Interventions in this scene
- Use the relationship as a place to practice flexibility
- Repair when the method or relationship misses
- Keep values alive when priorities conflict
- Ari
- You explained acceptance before hearing what he does.
- Therapist
- I moved too quickly and left the relationship problem out.
- Ari
- I wanted a conversation, not an exercise.
- Therapist
- We can change the task and talk through the boundary you choose.
What the clinician is thinking
An alliance rupture concerns strain in the bond or agreement about goals and tasks. ACT processes can support the therapist’s openness to feedback, but cannot replace accountability. Asking the client to accept an error would repeat the mismatch. In-session disagreement can provide learning, though it does not prove other relationships will respond similarly.
How the clinician applies the intervention
The therapist acknowledges the impact and changes the focus to an ordinary boundary conversation. Ari practices expressing a preference and remains engaged when the clinician receives it. They agree to check the repair at the next visit.
Where it goes next
The next plan includes chosen relationships, realistic limits, and a way to return after setbacks. The clinician will continue assessing fit, functioning, and whether Ari’s life has become less narrowed.
Common mistakes and misconceptions
- ACT is not about giving up on change; it is about changing what you do.
- Acceptance does not mean approving of harm or tolerating changeable situations.
- The six processes are facets of one capacity, not a checklist of exercises.
- Defusion is not pretending thoughts are unimportant.
- ACT includes behavioral methods such as exposure and skills training.
Evidence: the best current read
Reviews include ACT studies for pain, depression, anxiety and other concerns. Results vary by condition and comparator. Some pooled comparisons found no significant difference from CBT; this does not demonstrate equivalence or establish which condition has the strongest evidence.121314
Source 12Review
Source 13Review
How to read this section
- Randomized trial: people are assigned by chance to different treatments, so differences in results are more likely due to the treatment.
- Meta-analysis: a study that combines the results of many trials. An umbrella review is a review of several reviews.
- Control condition: what a treatment is compared with, such as a waitlist, usual care, or another therapy. Beating a waitlist is a lower bar than matching another active treatment.
- Effect size (g or d): how big the difference between groups is. As a rough guide, about 0.2 is small, 0.5 medium, and 0.8 large.
- 95% CI (confidence interval): the range the true result probably falls in. If it crosses zero, the study can't rule out no difference.
- Equivalence or noninferiority: a formal test that one treatment is about as good as another, within a margin set in advance. It is stronger than simply finding no significant difference.
- Heterogeneity: how much results differ from study to study. High heterogeneity makes an average less trustworthy.
- Risk of bias and certainty (GRADE): ratings of how much the study design could have skewed results, and how much confidence the overall evidence deserves.
| Question and design | Finding | Limitation |
|---|---|---|
| Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis (opens in a new tab) How do flexibility and inflexibility relate to chronic-pain outcomes? Three-level meta-analysis of cross-sectional associations. | Associations varied by construct and outcome; the abstract reports generally meaningful links with functioning and distress. | No causal direction or mediation can be inferred; measure and country differences contributed heterogeneity.Full appraisalWho was studied: 36 cross-sectional studies, 7,779 participants. Treatment: Measured psychological flexibility and inflexibility; not an assigned therapy. Compared with: Associations with pain, function, quality of life, distress. Outcomes measured: Pain intensity, impairment, quality of life, anxiety and depression. Follow-up: Cross-sectional, not treatment follow-up. |
| The empirical status of acceptance and commitment therapy: A review of meta-analyses (opens in a new tab) What do existing meta-analyses show about ACT’s efficacy? Review of meta-analyses. | ACT was generally superior to inactive controls, treatment as usual, and most active comparators except CBT, with which it was comparable. | Author allegiance; overlapping trials across meta-analyses; quality of the underlying trials.Full appraisalWho was studied: 20 meta-analyses, 100 controlled effect sizes, 12,477 participants; anxiety, depression, substance use, pain, and transdiagnostic groups. Treatment: ACT. Compared with: Inactive controls, treatment as usual, and active treatments. Outcomes measured: Condition-specific outcomes. Follow-up: As reported. |
| A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems (opens in a new tab) How effective is ACT for clinically relevant mental and physical health problems? Meta-analysis. | Overall against controls g = 0.57; waitlist g = 0.82; psychological placebo g = 0.51; treatment as usual g = 0.64. No significant difference from CBT (p = 0.14). | Mixed populations; no-difference results do not establish equivalence; quality varied.Full appraisalWho was studied: 39 randomized trials, 1,821 patients with mental disorders or somatic health problems. Treatment: ACT. Compared with: Waitlist, psychological placebo, treatment as usual, and CBT. Outcomes measured: Primary and secondary outcomes, life satisfaction, process measures. Follow-up: Post-treatment and follow-up combined. |
| The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis (opens in a new tab) What is the efficacy and methodological quality of ACT trials? Systematic review and meta-analysis with quality ratings. | Mean effect 0.42; against other cognitive or behavioral treatments 0.16 (non-significant). Rated probably efficacious for chronic pain and tinnitus; possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and work stress. | Disputed: a 2017 response reported numerous factual and interpretive errors in the quality ratings.Full appraisalWho was studied: 60 randomized trials, 4,234 participants with psychiatric or somatic disorders or work stress. Treatment: ACT. Compared with: Various controls and other cognitive behavioral treatments. Outcomes measured: Primary outcomes. Follow-up: As reported. |
| Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators (opens in a new tab) How did ACT and CBT compare for social phobia? Three-arm randomized trial with moderator analyses. | Both active therapies outperformed waiting list; no group difference observed on the reported main outcomes. | Modest sample, exploratory moderators, one research context. Absence of a significant difference does not establish equivalence.Full appraisalWho was studied: Abstract reports 87 participants with DSM-IV social phobia. Treatment: 12 sessions of ACT. Compared with: 12 sessions of CBT and 12-week waiting list. Outcomes measured: Self-report, independent clinician ratings, public-speaking task. Follow-up: Posttreatment plus 6 and 12 months after baseline for active groups. |
Practice with a partner
Practice with fictional scenarios and take turns responding. Agree on a word either person can use to pause the exercise. Keep crisis scenarios and intensive personal exercises out of peer practice. These exercises support learning; they do not replace clinical supervision.
Choose an intervention below. Each rehearsal reminds you what it is, sets the scene, and offers three rounds with feedback.
Understand what matters and what gets in the way
Find a direction that belongs to the person
Intervention
Find a direction that belongs to the person
Values are freely chosen qualities of ongoing action: how a person wants to relate, contribute, or care. A value is not an outcome that can be completed or a rule that guarantees approval. Ari might value being an interested and dependable friend; attending a dinner is one possible goal serving that direction. Values clarification asks what matters and makes room for ambivalence, including pressures from family or culture. The therapist should not decide that sociability is better than solitude. A chosen direction can guide action while discomfort remains, but values must not become a new demand to behave correctly. Practical constraints matter. Naming connection does not create time, access, or welcoming relationships. The next question is how this quality might appear in an attainable action, and whether that action feels owned rather than assigned.
Read the full intervention and worked examples
What you do or say
- Ask about moments that felt meaningful.
- Ask how Ari wants to act in the relationships or activities that matter to them.
- Ask which direction Ari wants and which expectations come from other people.
- Name a value in Ari’s own language.
- Find several possible actions serving it.
- Check that Ari wants the action and has the time, resources, and support to try it.
One possible response: What would you want your friend to experience from you?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 4 Ari says they ought to become outgoing because that is what normal people are like. The therapist asks what kind of friend Ari wants to be, rather than how many events they should attend. Ari remembers listening carefully when a colleague was having a hard week and says being interested matters more than seeming impressive. They also enjoy quiet evenings alone, and worry that valuing connection will mean giving those up. The therapist distinguishes an ongoing direction from a social quota. Ari considers sending a thoughtful reply to one friend instead of forcing a crowded party. When asked whose standard the plan serves, Ari notices that it feels different from proving normality. They agree to keep examining whether future actions express chosen care or another demand for approval.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Move from image to quality
Intervention: Find a direction that belongs to the person
Opening line in this scene: I should seem outgoing.
See one possible exchange and why it helps
- Ari
- I should seem outgoing.
- Therapist
- What would you want your friend to experience from you?
- Ari
- That I'm interested.
- Therapist
- How could you express interest in one manageable interaction?
Values are framed as chosen qualities rather than an identity performance.
Retain legitimate solitude
Intervention: Find a direction that belongs to the person
Opening line in this scene: I don't want every evening full.
See one possible exchange and why it helps
- Ari
- I don't want every evening full.
- Therapist
- Connection doesn't require that. What balance would feel yours?
- Ari
- One thoughtful meeting and time alone.
- Therapist
- Let's explore that pattern rather than a social quota.
The therapist asks what friendship means to Ari instead of deciding how sociable they should be.
Repair imposed values
Intervention: Find a direction that belongs to the person
Opening line in this scene: You keep saying friendship matters.
See one possible exchange and why it helps
- Ari
- You keep saying friendship matters.
- Therapist
- I've treated your earlier answer as permanent. What matters now?
- Ari
- I need more space this week.
- Therapist
- We can choose how to honor space and care without forcing a meeting.
Values remain open to the person's present choice and context.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Find a direction that belongs to the person? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track ownership, cultural context, and whether a value is being turned into a rule. Distinguish a direction from a goal and from an outcome controlled by others.
- Try again with one change. Check this common slip: Choosing the client’s values for them.
Try this with a partner
Map what the behavior is doing
Intervention
Map what the behavior is doing
Case conceptualization means developing an explanation of the problem that can guide treatment. In ACT, the therapist asks what an action does for the person in a particular situation. Cancelling dinner might briefly relieve Ari’s anxiety, allow necessary rest, or protect them from an unkind friend. Those possibilities suggest different next steps. Functional analysis is the name for examining what happened before the action and what followed it, both immediately and later. The therapist includes health, relationships, resources, and past learning in this account. Ari helps check whether it fits. The explanation guides which ACT skill might help now. As they try a change, the therapist reviews what happened and revises the account when it fails to explain the result.
Read the full intervention and worked examples
What you do or say
- Describe a concrete sequence of behavior.
- Ask what each action accomplished immediately.
- Examine longer-term effects on chosen directions.
- Include contextual risks, health, and resources.
- Suggest which response may be keeping Ari stuck and ask whether that matches their experience.
- Choose a small way to test that understanding, then review the result.
One possible response: What was cancelling doing for you that evening?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 6 Ari says they cancelled Saturday and expects the therapist to call it avoidance. The week included overtime, a migraine, and repeated worries about conversation. The therapist asks what happened in sequence. Ari initially declined because they were exhausted, then spent the evening checking the phone and imagining the friend's disappointment. One decision may have protected rest, while later reassurance seeking restricted it. Ari has successfully met a colleague in a quiet setting, so social contact is not uniformly avoided. The therapist draws a provisional map showing context, anxious language, short-term relief, and longer-term disconnection. Ari corrects two assumptions and adds that the friend often makes jokes at Ari's expense. The next intervention must consider that relationship, not merely increase tolerance of anxiety.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Ask the function
Intervention: Map what the behavior is doing
Opening line in this scene: I cancelled again.
See one possible exchange and why it helps
- Ari
- I cancelled again.
- Therapist
- What was cancelling doing for you that evening?
- Ari
- Letting me rest after overtime.
- Therapist
- Let's include that before deciding whether this was avoidance.
The therapist asks why Ari canceled that evening and learns that they needed rest after overtime.
Notice mixed functions
Intervention: Map what the behavior is doing
Opening line in this scene: Then I checked my phone all night.
See one possible exchange and why it helps
- Ari
- Then I checked my phone all night.
- Therapist
- Did that help you rest, or keep you caught in the worry?
- Ari
- It kept me stuck.
- Therapist
- The cancellation and checking may need different responses.
A sequence can contain both protective and restrictive behavior.
Repair a simplistic map
Intervention: Map what the behavior is doing
Opening line in this scene: You've left out his jokes.
See one possible exchange and why it helps
- Ari
- You've left out his jokes.
- Therapist
- You're right. The relationship context changes this formulation.
- Ari
- I don't want to practice accepting insults.
- Therapist
- We'll include boundaries and investigate which contacts you actually choose.
The therapist changes the explanation after hearing about mistreatment, allowing practical protection to become part of the plan.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Map what the behavior is doing? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Ask what happened before the action, what changed immediately afterward, and what happened later. Compare occasions and invite Ari to correct your account. Include health, work, relationships, and reasons to protect themselves.
- Try again with one change. Check this common slip: Labeling behavior as avoidance without asking its function.
Try this with a partner
Keep values alive when priorities conflict
Intervention
Keep values alive when priorities conflict
Applied values work addresses competing directions, external rules, and changing circumstances. Values do not automatically resolve conflict: Ari may care about friendship, rest, and honesty at the same time. The clinician helps identify which qualities matter in the present situation and which actions can express them without promising a cost-free choice. A goal can serve a value at one time and become a rigid obligation later. Returning to chosen qualities prevents a social activity quota from replacing genuine connection. Values language also requires cultural humility; family or collective responsibilities should not be dismissed as merely external pressure. The therapist asks how Ari experiences those commitments and what room for choice exists. A useful discussion results in flexible action, including a boundary when appropriate, rather than a declaration of the correct value.
Read the full intervention and worked examples
What you do or say
- Name the competing valued qualities.
- Ask how Ari wants to keep acting over time, alongside any specific goal they choose.
- Explore costs and resources for each option.
- Choose an action expressing the priorities that matter now.
- State a respectful boundary or request where needed.
- Review the action’s effect over time.
One possible response: Is connection a quality you choose, or a rule never to decline?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 8 Ari has accepted two invitations and now feels trapped by the idea that declining would betray connection. An overtime shift has left Ari tired, and one gathering includes the friend who makes unkind jokes. Ari says commitment means going anyway. The therapist asks whether connection has turned into a rule to attend every event. Ari also values being honest about limits and maintaining enough rest to function at work. They explore a chosen reply that acknowledges care and proposes a quieter meeting next week. Ari worries that this is avoidance dressed up as values. The clinician compares the function and consequences of the options rather than declaring one form correct. They agree to review whether the boundary supports a richer life or becomes an automatic way to decline all contact.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Untie value and quota
Intervention: Keep values alive when priorities conflict
Opening line in this scene: A good friend goes every time.
See one possible exchange and why it helps
- Ari
- A good friend goes every time.
- Therapist
- Is connection a quality you choose, or a rule never to decline?
- Ari
- It has become a rule.
- Therapist
- What other action could express care this week?
Values clarification restores multiple possible forms of action.
Hold a conflict
Intervention: Keep values alive when priorities conflict
Opening line in this scene: I care about them and need rest.
See one possible exchange and why it helps
- Ari
- I care about them and need rest.
- Therapist
- Both can matter. What reply honors that honestly?
- Ari
- I could suggest next week.
- Therapist
- Let's consider how that fits the actual relationship.
The choice includes competing priorities and context.
Repair value ranking
Intervention: Keep values alive when priorities conflict
Opening line in this scene: You've decided friendship comes first.
See one possible exchange and why it helps
- Ari
- You've decided friendship comes first.
- Therapist
- I have given it too much weight. What priorities are yours today?
- Ari
- Rest and an honest boundary.
- Therapist
- Then let's explore those without requiring you to defend them.
The therapist recognizes that Ari wants rest and a boundary today, and lets that choice guide the conversation.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Keep values alive when priorities conflict? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track choice, cultural commitments, and the actual consequences of different actions. Ask whether values language is supporting flexibility or justifying a familiar avoidance pattern.
- Try again with one change. Check this common slip: Turning values into attendance rules.
Try this with a partner
Create room to notice and choose
Return attention to what is happening now
Intervention
Return attention to what is happening now
Contact with the present moment means flexibly attending to current experience instead of becoming wholly absorbed in prediction or replay. It includes what is happening inside and around the person, and the ability to shift attention as the situation requires. It is not sustained blankness or perfect concentration. Ari may spend a dinner evaluating every sentence while missing the actual conversation. Noticing a friend's current words can create a different basis for responding. Attention exercises should support engagement, not become a ritual that must be completed before participating. External orientation may fit better than an inward body focus for some people. The therapist asks which form is useful and keeps the exercise brief enough to review its function. Attention naturally wanders; recognizing the wandering and returning is part of the skill, not evidence of failure.
Read the full intervention and worked examples
What you do or say
- Identify what current experience is being missed.
- Choose external or internal orientation collaboratively.
- Invite Ari to notice one thing they can see, hear, or feel.
- Name wandering as normal and return gently.
- Link attention to the activity that matters.
- Review whether participation became more available.
One possible response: Could you notice her next sentence before deciding what to say?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 3 Ari says that even when attending a gathering, the evening disappears into an internal review of how each remark sounded. Ari remembers almost none of a friend's story about a new job. The therapist invites Ari to notice three things in the room while continuing the conversation. Ari names the sound of traffic, the texture of the chair, and the therapist's last sentence. When asked what happened next, Ari says the monitoring thought returned immediately. The therapist treats noticing that return as useful and practices choosing where attention goes next. Ari does not want a long meditation exercise. They agree to rehearse listening to one complete sentence and asking a genuine follow-up question, without making perfect concentration the new social performance target.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Listen to the current sentence
Intervention: Return attention to what is happening now
Opening line in this scene: I'm planning my answer while she talks.
See one possible exchange and why it helps
- Ari
- I'm planning my answer while she talks.
- Therapist
- Could you notice her next sentence before deciding what to say?
- Ari
- I heard she's worried about work.
- Therapist
- What response fits that actual sentence?
Ari shifts attention from judging their own performance to hearing what the other person is saying.
Allow wandering
Intervention: Return attention to what is happening now
Opening line in this scene: My mind went back to judging.
See one possible exchange and why it helps
- Ari
- My mind went back to judging.
- Therapist
- You noticed it. Where would you choose to put attention now?
- Ari
- On what she's saying.
- Therapist
- Let's try that return without requiring the judging to stop.
Returning is practiced as flexibility, not concentration perfection.
Repair a performance test
Intervention: Return attention to what is happening now
Opening line in this scene: Now I'm failing mindfulness too.
See one possible exchange and why it helps
- Ari
- Now I'm failing mindfulness too.
- Therapist
- I've made it sound like another standard. Let's simplify.
- Ari
- I just want to be there.
- Therapist
- Then noticing one moment of contact is enough to explore.
The clinician removes a new control demand and restores the relational purpose.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Return attention to what is happening now? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Notice whether Ari is more able to join the conversation or activity. They do not need to sit still or perform the exercise perfectly. Ask what returning their attention helped them notice.
- Try again with one change. Check this common slip: Requiring eyes closed or body focus regardless of preference.
Try this with a partner
Make room for a feeling without making it the boss
Intervention
Make room for a feeling without making it the boss
Acceptance means allowing an internal experience to be present when trying to eliminate it is restricting life. It is an active, chosen willingness to have thoughts, emotions, and sensations in the service of something important. It does not mean liking anxiety, resigning oneself to mistreatment, or deciding that practical problems cannot change. Experiential avoidance is an effort to escape inner experience that becomes costly or rigid. Ari's cancellation briefly removes anxiety but also removes friendship. The therapist explores that function before proposing any exercise. Acceptance is useful when it makes a valued action more possible; an exercise that becomes another way to force calm has missed its purpose. Start with something tolerable and let the person decide. The clinician watches the effect on behavior rather than assuming willingness can be measured by how much distress someone endures.
Read the full intervention and worked examples
What you do or say
- Explore what avoiding the feeling does now and later.
- Connect willingness to a personally chosen direction.
- Offer a brief, manageable noticing experiment.
- Invite Ari to notice the sensations and see whether they can make room for them.
- Check whether more behavioral choice is available.
- Choose a small action and review the effect.
One possible response: Could you reply with some nerves present, if connection matters?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 2 Ari shows an invitation from a friend. Before replying, Ari has tried breathing exercises, searched for reassurance online, and waited for the nervous feeling to settle. The evening has almost passed, and declining now seems easier. Ari says, “Once I feel normal, I'll go.” The therapist asks what waiting has done to friendship over the last month. Ari becomes quiet and admits that anxiety has ended up choosing every evening. The therapist offers a short experiment: notice one manageable sensation while considering a small reply, with permission to stop. Ari is wary that acceptance means putting up with everything. The therapist separates making room for a feeling from accepting harmful circumstances, and asks what Ari would choose if calm weren't a requirement.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Change the condition for acting
Intervention: Make room for a feeling without making it the boss
Opening line in this scene: I'll reply when the nerves stop.
See one possible exchange and why it helps
- Ari
- I'll reply when the nerves stop.
- Therapist
- Could you reply with some nerves present, if connection matters?
- Ari
- Maybe a short yes.
- Therapist
- Let's explore that choice without requiring calm first.
The therapist connects making room for the feeling with an action Ari wants to take, so the exercise has a clear purpose.
Distinguish acceptance from resignation
Intervention: Make room for a feeling without making it the boss
Opening line in this scene: So I just put up with it?
See one possible exchange and why it helps
- Ari
- So I just put up with it?
- Therapist
- Not mistreatment. We're exploring whether a feeling has to decide your evening.
- Ari
- I still want to choose the plan.
- Therapist
- Exactly. Which part are you willing to carry for that choice?
The clinician preserves autonomy and the distinction between inner experience and external adversity.
Repair pushing willingness
Intervention: Make room for a feeling without making it the boss
Opening line in this scene: You're telling me to suffer.
See one possible exchange and why it helps
- Ari
- You're telling me to suffer.
- Therapist
- I pushed past your choice. Let's stop the exercise.
- Ari
- I wanted help, not a test.
- Therapist
- We'll understand what would make this useful before deciding whether to try again.
When Ari wants to pause, the therapist adjusts the exercise and checks what would help them continue.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Make room for a feeling without making it the boss? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Check whether making room for the feeling helps Ari do something important to them. Ask whether they feel pressured to endure it or are using the exercise to make it disappear. They can pause or choose another approach.
- Try again with one change. Check this common slip: Using willingness as a test of toughness.
Try this with a partner
Hear a thought as a thought
Intervention
Hear a thought as a thought
Defusion means noticing a thought without automatically doing what it says. Ari thinks, ‘They’ll find me boring,’ and cancels dinner as though rejection has already happened. ACT calls this cognitive fusion: a thought has begun to control the person’s response. The therapist helps Ari notice the prediction and consider what to do while it is still present. A phrase such as ‘I’m having the thought that…’ can be useful, but the important question is what happens next. If Ari repeats it until they feel reassured, the exercise may become another reason to delay going out. The therapist checks whether it helps Ari choose. Real concerns about the friendship still need discussion, and Ari can decide that a particular invitation is a poor fit.
Read the full intervention and worked examples
What you do or say
- Elicit the exact sentence and what Ari does when it appears.
- Ask permission to observe the sentence briefly.
- Try a respectful noticing phrase or another fitting method.
- Check what changed in the thought’s behavioral grip.
- Ask what is happening outside Ari's thoughts, including any real risks or practical concerns.
- Ask whether the exercise helps Ari take a step toward what matters to them.
One possible response: Can you notice that as a thought appearing right now?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 3 Ari remembers standing outside a café, hearing the sentence “They'll see I'm dull,” and going home. Ari describes the sentence as a warning that must be obeyed. The therapist asks whether they can notice it as something the mind produces before deciding what to do. Ari tries saying “I'm noticing the thought that I'm dull,” then immediately asks whether this is supposed to make the thought weaker. The therapist explains that its strength may stay the same. They are interested in whether Ari can hear the warning and still choose how to spend the evening. Ari also recalls one friend making a hurtful joke last month. They keep that event available for practical discussion rather than treating all social concern as only a thought.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Name the sentence
Intervention: Hear a thought as a thought
Opening line in this scene: They'll think I'm dull.
See one possible exchange and why it helps
- Ari
- They'll think I'm dull.
- Therapist
- Can you notice that as a thought appearing right now?
- Ari
- It's still convincing.
- Therapist
- It can be convincing and still leave a choice about replying.
Defusion does not depend on disproving or weakening the thought.
Keep real events in view
Intervention: Hear a thought as a thought
Opening line in this scene: Someone actually did mock me.
See one possible exchange and why it helps
- Ari
- Someone actually did mock me.
- Therapist
- That matters. We can address that event while noticing what the broader warning makes you do.
- Ari
- I stopped seeing everyone.
- Therapist
- Let's distinguish this friend's behavior from letting the warning choose every friendship.
The therapist takes the real situation seriously while helping Ari decide how to respond to the thought.
Repair an ill-fitting method
Intervention: Hear a thought as a thought
Opening line in this scene: That silly voice feels insulting.
See one possible exchange and why it helps
- Ari
- That silly voice feels insulting.
- Therapist
- I chose a method that didn't fit. We can stop it.
- Ari
- I need you to take the thought seriously.
- Therapist
- I do. Let's use ordinary language to notice its influence instead.
The therapist changes the wording after hearing Ari’s response, while keeping the aim of choosing an action with the thought present.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Hear a thought as a thought? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Check whether Ari can choose an action while the thought is present. If they repeat a phrase to make the thought go away, ask about that. Make sure your metaphor helps with their problem rather than simply sounding clever.
- Try again with one change. Check this common slip: Equating defusion with positive thinking.
Try this with a partner
Notice experience without reducing yourself to it
Intervention
Notice experience without reducing yourself to it
Self-as-context describes the ability to notice experiences without letting one description define everything about you. Ari can remember feeling awkward at dinner, interested in a conversation at work, and relaxed with a cousin. Each experience belongs to the same person. Seeing this variety may help Ari question the rule that being ‘the awkward one’ must determine every social decision. The therapist explores a specific example and asks what Ari notices across different situations. This gives the term a practical meaning before introducing further theory. Personal history and social identity remain important parts of the account. If the discussion feels confusing or makes Ari feel detached, the therapist returns to a concrete situation and checks what would help them respond to it.
Read the full intervention and worked examples
What you do or say
- Hear the self-label and the choices it excludes.
- Ask Ari about an experience that differs from the label they have given themselves.
- Help Ari notice when the self-description shows up and how it affects their choices.
- Explore perspective across settings and time.
- Check whether the exercise remains understandable and grounding.
- Connect the wider perspective to one chosen response.
One possible response: Can awkwardness be an experience you notice, rather than all of who you are?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 1–2: waiting for calm costs connection): They map short relief and longer disconnection, and try a brief, consensual noticing exercise. Ari can feel nervousness while considering a reply. The therapist makes clear that willingness does not require accepting mistreatment or completing a larger activity.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 4 Ari calls themselves the awkward one, as if it were a job title. They describe being confident at the laboratory bench but say that competence doesn't count because social failure reveals the real person. The therapist asks whether the Ari who notices competence and the Ari who notices awkwardness must choose one description as the whole identity. Ari smiles briefly, then worries this is a trick to make them say something positive. The therapist clarifies that no flattering replacement label is required. They compare how Ari spoke with a trusted colleague, a new acquaintance, and the therapist. Different experiences are present, and each can be noticed. Ari considers whether a difficult conversation could be an event experienced by a person rather than proof of what that person permanently is.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Distinguish person and event
Intervention: Notice experience without reducing yourself to it
Opening line in this scene: I'm the awkward one.
See one possible exchange and why it helps
- Ari
- I'm the awkward one.
- Therapist
- Can awkwardness be an experience you notice, rather than all of who you are?
- Ari
- Sometimes I'm fine with colleagues.
- Therapist
- Could both experiences belong to you without deciding your next invitation?
Remembering more than one experience helps Ari see that a single label does not describe everything about them.
Avoid a replacement label
Intervention: Notice experience without reducing yourself to it
Opening line in this scene: You want me to say I'm confident.
See one possible exchange and why it helps
- Ari
- You want me to say I'm confident.
- Therapist
- No. Another fixed label isn't the goal.
- Ari
- Then I don't have to prove anything?
- Therapist
- We can notice both stories and ask what you want to do now.
The method targets rigidity rather than constructing a more flattering identity.
Repair abstraction
Intervention: Notice experience without reducing yourself to it
Opening line in this scene: I don't understand this observer talk.
See one possible exchange and why it helps
- Ari
- I don't understand this observer talk.
- Therapist
- I've made it too abstract. Let's return to the invitation in your hand.
- Ari
- I know I want to see them.
- Therapist
- Can the awkwardness story come along without being the final decision-maker?
The therapist returns to a familiar situation to explain the idea when theoretical language becomes confusing.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Notice experience without reducing yourself to it? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Ask whether noticing a self-description helps Ari consider another response. If the exercise feels confusing, makes them feel detached, or turns into an abstract discussion, return to the situation they wanted help with.
- Try again with one change. Check this common slip: Presenting self-as-context as a hidden essential self.
Try this with a partner
Turn flexibility into action
Take a small step and learn from it
Intervention
Take a small step and learn from it
Committed action is flexible behavior guided by values. Commitment means returning to a chosen direction, not guaranteeing a perfect record or pushing through every obstacle. Goals make a direction concrete; behavior-change methods help identify cues, barriers, supports, and consequences. Ari can choose a brief meeting because friendship matters, while planning what to do if anxiety appears. The plan should specify an attainable action and a review, not an intention to become less anxious. If the step is not completed, ACT examines its function and context rather than declaring a failure of character. Practical problem solving belongs alongside acceptance and defusion. Sometimes the next committed action is changing the plan, setting a boundary, or asking for help. Progress is judged by whether life becomes more flexible and connected to chosen purposes, with symptoms and functioning assessed as well.
Read the full intervention and worked examples
What you do or say
- Translate a value into a specific attainable action.
- Identify timing, cues, resources, and likely obstacles.
- Plan how Ari can respond when uncomfortable thoughts or feelings arise during the action.
- Clarify useful boundaries and supports.
- Ask what Ari did, what happened, and what they learned.
- Adjust the next step while retaining choice.
One possible response: What's one action that would express interest this week?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 5 Ari chooses to meet a friend for coffee on Saturday. Previous plans failed because Ari waited to feel ready, chose crowded venues, and treated arriving late as a reason to cancel entirely. The therapist asks for a smaller version that fits both values and the actual week. Ari selects a quieter café, agrees a brief visit, and sends the invitation while anxiety is present. They discuss transport and what Ari might say if the conversation pauses. Ari asks whether leaving after the planned half hour counts as avoidance. The therapist explores the reason for leaving rather than declaring every short visit suspect. A chosen time limit may make the action feasible; escaping solely to obey anxiety may need a different review. They agree to examine what happens without grading the visit.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Choose an action
Intervention: Take a small step and learn from it
Opening line in this scene: I'll be a better friend.
See one possible exchange and why it helps
- Ari
- I'll be a better friend.
- Therapist
- What's one action that would express interest this week?
- Ari
- Ask Sam for coffee.
- Therapist
- When will you send the message, and what might get in the way?
They turn something Ari cares about into an action small enough to try and discuss afterward.
Allow an imperfect attempt
Intervention: Take a small step and learn from it
Opening line in this scene: I was late, so I nearly cancelled.
See one possible exchange and why it helps
- Ari
- I was late, so I nearly cancelled.
- Therapist
- Could arriving late still serve connection?
- Ari
- I could apologize once and go.
- Therapist
- Let's include that option in the plan.
Flexibility prevents a perfectionistic rule from erasing a valued action.
Repair pressure disguised as commitment
Intervention: Take a small step and learn from it
Opening line in this scene: You're asking me to push through everything.
See one possible exchange and why it helps
- Ari
- You're asking me to push through everything.
- Therapist
- That isn't the choice I want us to make. What limit needs respect?
- Ari
- Half an hour is enough.
- Therapist
- Let's examine whether that limit supports a feasible visit and review its function.
Commitment includes workable limits and contextual judgment.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Take a small step and learn from it? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the action's function, feasibility, and consequences. Notice all-or-nothing rules that make a partial attempt invisible.
- Try again with one change. Check this common slip: Making symptom reduction the condition for action.
Try this with a partner
Build persistence that can change course
Intervention
Build persistence that can change course
Applied committed action addresses maintenance, setbacks, and barriers after an initial step. Psychological flexibility includes persistence when an action serves a chosen direction and changing course when it no longer does. Ari's plan can become too large, poorly timed, or dependent on someone else's response. The clinician reviews behavior in context, identifies what supported useful action, and adjusts the next step. Reinforcement means a consequence that increases the likelihood of behavior; in ordinary practice, noticing meaningful contact can support further engagement. A lapse is an event to understand, not proof that earlier work was false. The plan includes practical resources and a way to resume without making up for missed activity through an unrealistic burst. The person's own experience determines whether the direction remains meaningful.
Read the full intervention and worked examples
What you do or say
- Review each attempted or missed action in context.
- Identify what supported meaningful engagement.
- Ask what made the action difficult: practical obstacles, real risk, or trying to escape an uncomfortable feeling.
- Choose a next step proportional to current resources.
- Plan a flexible restart after foreseeable obstacles.
- Review whether the direction and method remain useful.
One possible response: What did the earlier visits teach you, even with these setbacks?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 9 Ari has attended coffee twice but declined the next three plans. Ari says the improvement was fake and proposes a crowded party to prove commitment. The therapist reviews each week instead. One cancellation followed overtime, another followed a hurtful message, and the third followed an anxious prediction. These events need different responses. Ari notices that a short planned meeting with a respectful friend had been rewarding, but the all-or-nothing rule about setbacks erased that information. They choose one attainable invitation and a separate boundary conversation, not a dramatic test. They plan how to resume if transport fails or anxiety delays the reply. Ari says that treating missed plans as different events makes returning easier than making a large promise to attend everything.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Keep prior learning
Intervention: Build persistence that can change course
Opening line in this scene: Three cancellations mean nothing changed.
See one possible exchange and why it helps
- Ari
- Three cancellations mean nothing changed.
- Therapist
- What did the earlier visits teach you, even with these setbacks?
- Ari
- I enjoyed the quieter one.
- Therapist
- Let's retain that information when choosing the next step.
A lapse does not erase useful learning.
Differentiate barriers
Intervention: Build persistence that can change course
Opening line in this scene: I need to force myself next time.
See one possible exchange and why it helps
- Ari
- I need to force myself next time.
- Therapist
- Which cancellation involved fear, which exhaustion, and which a disrespectful situation?
- Ari
- They weren't all the same.
- Therapist
- Then the next responses shouldn't be identical either.
The therapist separates three reasons for canceling so Ari can make a different plan for each situation.
Repair escalation
Intervention: Build persistence that can change course
Opening line in this scene: That big plan feels like punishment.
See one possible exchange and why it helps
- Ari
- That big plan feels like punishment.
- Therapist
- I suggested too much to compensate for a lapse. Let's change it.
- Ari
- One small invitation is enough.
- Therapist
- We'll plan that and how you can resume if it doesn't happen.
The clinician avoids converting commitment into compensatory pressure.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Build persistence that can change course? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track specific barriers and natural consequences that support engagement. Separate persistence in a valued direction from rigidity about a particular goal.
- Try again with one change. Check this common slip: Erasing progress after a setback.
Try this with a partner
Bring openness, attention, and action together
Intervention
Bring openness, attention, and action together
Several ACT skills may be useful during the same decision. Ari receives a brief reply from a friend, thinks it means rejection, feels hurt, and wants to stop replying. The therapist can help Ari notice the thought, allow some hurt to be present, read what the friend actually wrote, and decide how to respond. ACT sometimes groups this work as openness, awareness, and engagement: allowing inner experience, attending to the present, and taking an action that matters. The therapist chooses the part that helps with the immediate difficulty. Practical problem solving may also be needed. After trying a response, Ari and the therapist review its effect on the friendship, distress, and daily life, then decide what would be useful next.
Read the full intervention and worked examples
What you do or say
- Identify the current choice and context.
- Notice language or avoidance narrowing it.
- Invite enough openness and attention to examine options.
- Connect to a chosen direction.
- Select a practical action or boundary.
- Ask what changed and which part of the exercise helped.
One possible response: Can we notice that story and read the actual words?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 9 Ari receives a delayed reply during the meeting and immediately calls it rejection. The therapist notices Ari switching between checking the phone, reciting a defusion phrase, and planning an apology. Instead of adding another isolated exercise, they slow the sequence. Ari can hear the old unwanted story, feel the disappointment, and read the actual message: the friend has suggested a different day. Ari then remembers wanting an honest, sustainable friendship. They consider a simple reply rather than a paragraph of reassurance seeking. The therapist also asks whether the proposed day fits Ari's schedule. Openness, attention, and engagement support one ordinary decision; they are not a checklist proving correct ACT. Ari chooses a reply and notes that anxiety remained without needing to determine the action.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Connect processes to one choice
Intervention: Bring openness, attention, and action together
Opening line in this scene: The reply means rejection.
See one possible exchange and why it helps
- Ari
- The reply means rejection.
- Therapist
- Can we notice that story and read the actual words?
- Ari
- He suggested Thursday.
- Therapist
- What reply fits your wish for honest connection?
The therapist helps Ari read the message carefully and decide how to reply in a way that supports the relationship.
Include practical fit
Intervention: Bring openness, attention, and action together
Opening line in this scene: I should say yes despite anxiety.
See one possible exchange and why it helps
- Ari
- I should say yes despite anxiety.
- Therapist
- Does Thursday actually fit your work and rest?
- Ari
- No. Saturday would.
- Therapist
- Then flexibility can include offering Saturday.
Valued action is not automatic exposure or compliance.
Repair process overload
Intervention: Bring openness, attention, and action together
Opening line in this scene: There are too many things to do.
See one possible exchange and why it helps
- Ari
- There are too many things to do.
- Therapist
- I've turned flexibility into a checklist. Let's simplify.
- Ari
- I just need to answer.
- Therapist
- What would a chosen, respectful answer look like now?
The therapist removes the long list of exercises and helps Ari choose a reply.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Bring openness, attention, and action together? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track which process would open the next useful response. Notice whether theoretical completeness is competing with clinical simplicity.
- Try again with one change. Check this common slip: Forcing all six processes into a single response.
Try this with a partner
Adapt the work to this situation
Adapt willingness to the function of avoidance
Intervention
Adapt willingness to the function of avoidance
After introducing acceptance, the therapist needs to find out which experience Ari is avoiding. Ari may be able to sit with a racing heart but still avoid telling a friend that they would like more contact. In that situation, another exercise about bodily sensations may miss the difficulty. The therapist asks what feels risky about showing interest and what Ari would like to do. They can then try making room for the feeling during a brief conversation or while planning a message. Ari chooses the amount of practice and can pause. The therapist checks whether the exercise helps with the chosen action. Concerns about an actual harmful relationship need practical attention as well as any work with uncomfortable feelings.
Read the full intervention and worked examples
What you do or say
- Identify what remains avoided despite earlier progress.
- Ask what revealing or feeling it is predicted to cost.
- Connect a willingness invitation to a chosen purpose.
- Choose a tolerable, specific exercise or conversation.
- Check experience and consent during the attempt.
- Review whether behavioral options expanded.
One possible response: Then caring openly may be the experience we need to understand.
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 3–4: a warning is not the whole decision): They practice returning to one sentence after noticing self-evaluation. Ari then identifies being interested, rather than appearing outgoing, as a chosen quality. A short, ordinary reply becomes possible while the warning remains.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 6 Ari can notice a racing heart without leaving the room, but still avoids telling Sam that the friendship matters. Ari says feeling nervous is manageable; showing affection feels humiliating because it might not be returned. The therapist recognizes that the earlier body-focused exercise addressed only part of the avoidance. They ask whether Ari is willing to contact the uncertainty of caring while considering one honest sentence. Ari looks away and says it sounds needy. They explore how hiding interest protects against rejection and also makes friendship harder to sustain. No disclosure is assigned automatically. Ari chooses to practice a modest expression in session first and notices both warmth and fear. The clinician checks that willingness is serving Ari's chosen connection rather than the therapist's idea of emotional openness.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Find the actual avoided experience
Intervention: Adapt willingness to the function of avoidance
Opening line in this scene: I can handle nerves, not telling him I care.
See one possible exchange and why it helps
- Ari
- I can handle nerves, not telling him I care.
- Therapist
- Then caring openly may be the experience we need to understand.
- Ari
- It could be embarrassing.
- Therapist
- Would exploring that uncertainty serve the friendship you want?
The therapist finds out that expressing care is what feels frightening to Ari, then asks whether exploring that fear would help the friendship.
Use an ordinary sentence
Intervention: Adapt willingness to the function of avoidance
Opening line in this scene: Exercises don't fit this.
See one possible exchange and why it helps
- Ari
- Exercises don't fit this.
- Therapist
- We can try an ordinary sentence instead, if you choose.
- Ari
- I could say I enjoyed seeing him.
- Therapist
- Notice what appears while you consider that, without forcing yourself to send it.
Applied acceptance need not use a formal meditation.
Repair over-intensifying
Intervention: Adapt willingness to the function of avoidance
Opening line in this scene: You're making this bigger than I wanted.
See one possible exchange and why it helps
- Ari
- You're making this bigger than I wanted.
- Therapist
- I escalated instead of checking fit. Let's step back.
- Ari
- A simple message is enough.
- Therapist
- Then we can work with that chosen level and its actual uncertainty.
The therapist checks which experience Ari is avoiding and adjusts the exercise. Ari does not have to disclose more to make the work useful.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Adapt willingness to the function of avoidance? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Ask what feeling or experience Ari is trying to avoid and what they want to be able to do. Check that the exercise fits that difficulty. Ari does not have to disclose more or tolerate more discomfort to please you.
- Try again with one change. Check this common slip: Repeating the same acceptance script despite poor fit.
Try this with a partner
Choose defusion that opens action rather than suppresses thought
Intervention
Choose defusion that opens action rather than suppresses thought
A defusion exercise should fit the particular thought that is restricting action. Ari might worry about one dinner, or follow a broader rule that friendship must never feel awkward. The therapist asks how the thought affects Ari’s decisions and chooses a way to examine that influence. They could notice the words together, compare occasions, or pause when the rule appears during the session. Afterward, the therapist asks what changed. Ari may still have the thought while being more able to send a message or decide whether an invitation suits them. Repeating a phrase until it feels safe to act can become a new obstacle. The therapist reviews that use of the exercise and helps Ari try a different response.
Read the full intervention and worked examples
What you do or say
- Ask what the current defusion method is expected to achieve.
- Identify the thought’s behavioral rule or command.
- Ask whether Ari is noticing the thought, trying to push it away, or seeking reassurance.
- Select a fitting, simple alternative if useful.
- Link the shift to a chosen context-sensitive action.
- Ask how Ari responded when the thought showed up and whether that helped them do what mattered.
One possible response: Then it's working as reassurance, rather than noticing.
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 7 Ari says the noticing phrase helped once but now gets repeated dozens of times before sending any message. Ari waits for the phrase to stop the thought, then becomes frustrated when it doesn't. The therapist asks what job the phrase has been given. Ari admits that it has become a way to obtain certainty that the friend won't judge them. They identify a broader rule: a reply is permitted only when embarrassment is impossible. Rather than introduce a more elaborate metaphor, the therapist invites Ari to hear the rule and consider whether living by it serves connection. Ari can see that the rule offers protection but no friendship. They choose a brief reply while the warning remains, preserving the option to reconsider genuine signs of disrespect.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Investigate the method
Intervention: Choose defusion that opens action rather than suppresses thought
Opening line in this scene: I say the phrase until I feel certain.
See one possible exchange and why it helps
- Ari
- I say the phrase until I feel certain.
- Therapist
- Then it's working as reassurance, rather than noticing.
- Ari
- I thought certainty was the goal.
- Therapist
- Let's see whether you can choose without having to earn certainty first.
The therapist asks what the exercise is doing for Ari, rather than assuming that repeating the phrase is helping.
Work with a rule
Intervention: Choose defusion that opens action rather than suppresses thought
Opening line in this scene: I mustn't be awkward.
See one possible exchange and why it helps
- Ari
- I mustn't be awkward.
- Therapist
- What does obeying that rule allow, and what does it close off?
- Ari
- It stops every invitation.
- Therapist
- Could you notice the rule while deciding which invitation you want?
The rule's effect is investigated without arguing its truth.
Repair technique collecting
Intervention: Choose defusion that opens action rather than suppresses thought
Opening line in this scene: You keep giving me new phrases.
See one possible exchange and why it helps
- Ari
- You keep giving me new phrases.
- Therapist
- I've responded with methods instead of asking how you're using them.
- Ari
- They're all another test.
- Therapist
- Let's stop collecting phrases and examine one choice that matters.
The therapist stops adding exercises and asks how the existing advice has affected Ari's choices.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Choose defusion that opens action rather than suppresses thought? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Ask what Ari wants the exercise to accomplish. Does it help them notice a thought and act, or has it become a repeated attempt to feel certain or calm before doing anything?
- Try again with one change. Check this common slip: Treating method variety as clinical progress.
Try this with a partner
Practice attention where participation breaks down
Intervention
Practice attention where participation breaks down
Applied present-moment work examines where attention becomes inflexible in a particular activity. Ari may hear a friend's words but then abandon the conversation to score their own response. The target is the shift that removes contact, not a general lack of mindfulness. The therapist can slow a short interaction, identify that shift, and rehearse a return to relevant information. Flexible attention includes internal experience and external cues; selecting one is not a permanent prescription. The method should fit the person's sensory needs, culture, health, and preference. Attention to the present can also reveal that a conversation is unkind or uninteresting, leading to a boundary rather than greater endurance. A useful exercise increases responsiveness to what is actually happening. It does not promise freedom from thoughts or make the therapist the judge of correct awareness.
Read the full intervention and worked examples
What you do or say
- Reconstruct a short interaction.
- Locate the transition into prediction or self-review.
- Name the shift with permission.
- Practice returning to one relevant external or internal cue.
- Try returning attention during another short conversation and ask what Ari noticed.
- Link the cue to participation and assess context.
One possible response: Can we notice that exact shift in a brief exchange here?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 7 Ari reports attending coffee but repeatedly losing the thread after speaking. The therapist asks Ari to reenact a short, ordinary exchange rather than summarize the whole visit. After one answer, Ari's eyes move away and they begin silently reviewing whether the answer sounded stupid. The clinician pauses at that exact transition. Ari notices the review and can return to the therapist's last words, then ask a follow-up. They try once more with a deliberately imperfect sentence. Ari says the return is possible but not automatic. The therapist also asks whether anything in Sam's response actually felt dismissive. They distinguish missing contact because of self-monitoring from choosing not to remain in a disrespectful exchange, and plan a brief listening cue for the next chosen meeting.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Find the shift
Intervention: Practice attention where participation breaks down
Opening line in this scene: After I answer, I review every word.
See one possible exchange and why it helps
- Ari
- After I answer, I review every word.
- Therapist
- Can we notice that exact shift in a brief exchange here?
- Ari
- I did it just then.
- Therapist
- Where would you choose to place attention next?
A specific transition is more actionable than a general instruction to be mindful.
Return after imperfection
Intervention: Practice attention where participation breaks down
Opening line in this scene: My answer sounded clumsy.
See one possible exchange and why it helps
- Ari
- My answer sounded clumsy.
- Therapist
- Can the clumsy answer be present while you hear my next sentence?
- Ari
- I heard you ask about the weekend.
- Therapist
- What response follows from that?
Attention supports continued participation despite self-evaluation.
Repair attentional policing
Intervention: Practice attention where participation breaks down
Opening line in this scene: You're monitoring whether I pay attention.
See one possible exchange and why it helps
- Ari
- You're monitoring whether I pay attention.
- Therapist
- That has become another performance demand. Let's change it.
- Ari
- I want a cue I choose.
- Therapist
- Which cue helps you reconnect without needing my approval?
The person owns the attention practice and its purpose.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Practice attention where participation breaks down? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the moment attention shifts away and what the shift accomplishes. Check whether returning reveals information the person can use.
- Try again with one change. Check this common slip: Giving a general mindfulness instruction without identifying the breakdown.
Try this with a partner
Use perspective taking when identity becomes rigid
Intervention
Use perspective taking when identity becomes rigid
A strong self-description can shape which experiences a person notices. Ari sees themself as ‘the unwanted friend,’ remembers unanswered messages, and overlooks occasions when someone sought their company. The therapist first asks how this description developed and what has made it convincing. They then look together at a recent situation and at other experiences across time. This is an application of self-as-context: noticing a description as one part of experience while considering other ways to respond. The work respects real rejection and discrimination. The therapist also checks their own assumptions about Ari; choosing solitude may sometimes be sensible or enjoyable. A useful discussion helps Ari make a current decision, and stays concrete enough for them to explain in their own words.
Read the full intervention and worked examples
What you do or say
- Ask Ari how they describe themselves and which experiences support or challenge that description.
- Ask when Ari began using this self-description and how it has helped them cope.
- Invite a perspective across time or another chosen viewpoint.
- Keep history and current experience both available.
- Check grounding and personal meaning.
- Translate the wider view into a context-sensitive choice.
One possible response: What does the unwanted story allow to count?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 5–6: the same cancellation can have different functions): They revise the map and separate recovery, checking, and the disrespectful interaction. Ari chooses a quieter invitation with a respectful friend, and they practice expressing interest while allowing uncertainty. The therapist adapts acceptance to vulnerability rather than repeating only a body exercise.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 8 Ari describes a delayed reply as confirmation of always being unwanted. Earlier, Ari had felt welcomed at coffee, but says that experience was an exception and this delay reveals the truth. The therapist asks how the unwanted story decides which evidence counts. Ari remembers that it began after exclusion during school and still appears even with caring people. They consider the perspective of Ari now noticing that old learning, without denying its origin. The therapist asks what Ari would say to a friend facing the same uncertainty, then checks whether that perspective fits rather than using it to force reassurance. Ari can hold hurt, history, and a wish for connection together. They choose to wait without sending repeated checking messages and to evaluate the relationship over time.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Notice a selective story
Intervention: Use perspective taking when identity becomes rigid
Opening line in this scene: The good visit didn't count.
See one possible exchange and why it helps
- Ari
- The good visit didn't count.
- Therapist
- What does the unwanted story allow to count?
- Ari
- Mostly delays and awkwardness.
- Therapist
- Can we notice that filtering without deciding your whole identity?
The client observes a self-story's operation rather than receiving a replacement verdict.
Include history
Intervention: Use perspective taking when identity becomes rigid
Opening line in this scene: I really was excluded.
See one possible exchange and why it helps
- Ari
- I really was excluded.
- Therapist
- Yes. The history matters even when the story appears in a different relationship.
- Ari
- I want to remember without obeying it everywhere.
- Therapist
- Let's explore what today's situation permits that school didn't.
Perspective distinguishes contexts without denying harm.
Repair identity erasure
Intervention: Use perspective taking when identity becomes rigid
Opening line in this scene: You make it sound like none of it happened.
See one possible exchange and why it helps
- Ari
- You make it sound like none of it happened.
- Therapist
- I've blurred noticing a story with denying your history. That was wrong.
- Ari
- I need both to matter.
- Therapist
- We'll hold what happened and your present choices together.
The therapist acknowledges that the earlier wording dismissed Ari's history and makes room to discuss both the past and present choices.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Use perspective taking when identity becomes rigid? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Ask whether Ari can see more than one way to respond while respecting what the self-description means to them. Keep the discussion tied to a current decision instead of arguing about who they really are.
- Try again with one change. Check this common slip: Treating identity as an error.
Try this with a partner
Use and repair the working relationship
Use the relationship as a place to practice flexibility
Intervention
Use the relationship as a place to practice flexibility
The therapeutic relationship is a current context in which openness, awareness, and chosen action can be observed. Ari may conceal disagreement with the therapist just as they conceal preferences with friends. The clinician notices that pattern tentatively and explores it without assuming every in-session behavior represents life outside. An ACT-informed alliance includes agreement on goals and tasks, care in the working bond, and permission for correction. The therapist's own anxiety, attachment to a method, or wish to be helpful can narrow responsiveness. Modeling flexibility may include acknowledging uncertainty, slowing down, and receiving feedback without defense. Clinician self-disclosure is judged by its purpose, boundaries, and effect, not by whether it demonstrates authenticity. The relationship serves Ari's needs and treatment goals; it does not become a demand for closeness or disclosure.
Read the full intervention and worked examples
What you do or say
- Notice an in-session pattern tentatively.
- Ask how the current task and relationship feel.
- Consider your contribution before interpreting the client.
- Invite a chosen alternative response if useful.
- Respond consistently with consent and professional boundaries.
- Ask what Ari learned from the exchange and which questions remain unanswered.
One possible response: Would a different focus be more useful today?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 7–9: flexibility is not a new performance rule): They retire the repetitive phrase, practice one attentional return during dialogue, and choose a manageable invitation. Ari plans an honest rest boundary and a flexible restart if transport or work interferes. Prior learning is retained rather than erased by the lapse.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 10 Ari agrees to a values exercise and then gives short, polished answers. The therapist notices a familiar pattern of trying not to disappoint. Asked how the exercise feels, Ari says it is fine, then admits they had wanted to discuss the hurtful friend instead. The clinician considers that their enthusiasm may have made disagreement seem unwelcome. They ask whether Ari would be willing to practice saying a preference in this room, with an explicit option to decline. Ari says they want less exercise and more ordinary conversation. The therapist thanks them and changes the focus, then checks how receiving that response feels. Ari is surprised that disagreement did not threaten the relationship. The experience is explored as one piece of learning, not proof that all relationships will respond the same way.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Invite task feedback
Intervention: Use the relationship as a place to practice flexibility
Opening line in this scene: The exercise is fine.
See one possible exchange and why it helps
- Ari
- The exercise is fine.
- Therapist
- Would a different focus be more useful today?
- Ari
- I wanted to discuss the friend.
- Therapist
- Let's change the focus and see what you need there.
Actual task adjustment demonstrates that feedback is welcome.
Practice a preference
Intervention: Use the relationship as a place to practice flexibility
Opening line in this scene: I don't want to disappoint you.
See one possible exchange and why it helps
- Ari
- I don't want to disappoint you.
- Therapist
- Could you tell me a preference while that worry is here, if you choose?
- Ari
- Less exercise, more talking.
- Therapist
- Thank you. We can do that and notice what happens between us.
The relationship offers a consensual opportunity for flexibility.
Repair therapist-centered authenticity
Intervention: Use the relationship as a place to practice flexibility
Opening line in this scene: Your story took over the session.
See one possible exchange and why it helps
- Ari
- Your story took over the session.
- Therapist
- I disclosed too much and lost your focus. I'll return it to you.
- Ari
- I needed help with my situation.
- Therapist
- What part do you want us to understand now?
A boundary-aware repair prioritizes the client's work over the therapist's self-expression.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Use the relationship as a place to practice flexibility? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track the shared goals, task fit, and the therapist's own rigidity. Consider whether your delivery makes correction genuinely possible.
- Try again with one change. Check this common slip: Assuming every in-session response generalizes outside.
Try this with a partner
Repair when the method or relationship misses
Intervention
Repair when the method or relationship misses
Relationship rupture is a strain in the working bond or disagreement about treatment goals and tasks. Ari may withdraw into agreement, challenge an exercise, or say the therapist feels dismissive. ACT processes can support repair, but they cannot replace listening and accountability. The clinician notices their own urge to defend the method, stays open to discomfort, attends to the client's actual words, and chooses a response serving the relationship and agreed goals. This does not mean asking Ari to accept the therapist's error. Repair includes acknowledging a contribution, clarifying intention only when useful, and changing the interaction. Professional boundaries remain in place and can be explained respectfully. The effectiveness of repair is checked in subsequent engagement and feedback, not merely a statement that everything is fine.
Read the full intervention and worked examples
What you do or say
- Name the strain and invite the client’s account.
- Pause the impulse to defend the approach.
- Acknowledge the impact and your contribution.
- Clarify the practical or relational issue that was missed.
- Negotiate an observable change in the work.
- Check the repair now and in later sessions.
One possible response: What did I leave out when I suggested it?
Vignette: the intervention in context
Fictional case: Ari
Case background and conceptualization
Ari is a 29-year-old lab technician. Close friendships matter to Ari, but anxiety before social plans has led to declining invitations. Ari is the same fictional person as the practice case “Avoiding difficult feelings.”
Working conceptualization
Ari values friendship but often waits for anxiety and self-critical thoughts to disappear before joining in. Canceling can bring immediate relief while making life smaller. ACT asks what a response does in this particular situation: rest can be useful, while the same cancellation can sometimes serve avoidance. The aim is psychological flexibility—having more choice while difficult experiences are present.
Earlier in the illustrated case (Sessions 7–9: flexibility is not a new performance rule): They retire the repetitive phrase, practice one attentional return during dialogue, and choose a manageable invitation. Ari plans an honest rest boundary and a flexible restart if transport or work interferes. Prior learning is retained rather than erased by the lapse.
Case outline, treatment focus, and earlier sessions
Ari is 29 and works as a lab technician. Close friendships matter, but invitations now trigger anxious predictions and withdrawal. In weekly individual ACT, Ari and the therapist are investigating what anxiety-management efforts make possible and what they cost. At Session 11 Ari says acceptance language makes the therapist sound indifferent to being treated badly. Earlier, the therapist had suggested noticing hurt before exploring the friend's repeated jokes. Ari felt the practical problem disappeared behind an exercise. The clinician initially wants to explain that ACT includes values and boundaries, then recognizes that this would defend the model before hearing the impact. Ari says they nearly cancelled because they thought the therapist would call leaving the friendship avoidance. The therapist acknowledges having moved too quickly and asks for a fuller account of the relationship. They agree that the next work will consider boundaries and choice, with experiential methods used only when their purpose is clear. Ari begins asking questions again, but the therapist plans to check the repair rather than assuming one apology settles it.
One partner plays the fictional person in this scene; the other practices the therapist’s response. Choose one round below. Say the opening line, respond once, then pause for feedback and retry before swapping roles. Each round is a different version of the same scene. Choose one to practice.
Choose a round
Hear the mismatch
Intervention: Repair when the method or relationship misses
Opening line in this scene: Acceptance sounded like putting up with him.
See one possible exchange and why it helps
- Ari
- Acceptance sounded like putting up with him.
- Therapist
- What did I leave out when I suggested it?
- Ari
- That he keeps insulting me.
- Therapist
- That needed attention. Let's address the relationship itself.
Repair begins with what the method missed.
Change the task
Intervention: Repair when the method or relationship misses
Opening line in this scene: I don't want another exercise today.
See one possible exchange and why it helps
- Ari
- I don't want another exercise today.
- Therapist
- Then we won't use one. What would help us examine the boundary?
- Ari
- Talk through what I want to say.
- Therapist
- We'll do that and keep checking whether this focus fits.
Repair is made concrete through task renegotiation.
Repair theory-based defense
Intervention: Repair when the method or relationship misses
Opening line in this scene: You're explaining ACT instead of listening.
See one possible exchange and why it helps
- Ari
- You're explaining ACT instead of listening.
- Therapist
- I am. I've defended the model and missed your experience again.
- Ari
- I want you to hear why it hurt.
- Therapist
- I'll listen first, then we can decide together what needs to change.
The clinician applies openness to their own discomfort rather than instructing the client to absorb an error.
Increase difficulty only by agreement. Either partner can pause or choose a simpler response.
Feedback and retry
- Did the response carry out this intervention: Repair when the method or relationship misses? Describe the words or action that did it.
- What did you notice in the fictional person’s response? Compare it with what the clinician is tracking: Track both direct disagreement and withdrawal. Notice defensive use of theory and whether an agreed change actually appears in the work.
- Try again with one change. Check this common slip: Using acceptance language to bypass accountability.
Try this with a partner
Going deeper
Optional topics for when the core ideas feel familiar. Open any that interest you.
A behavioral science lineage
ACT developed within behavior analysis and contextual behavioral science; Hayes, Strosahl, and Wilson’s text presents the model and its philosophical base.1
Beyond six boxes
Process-based approaches emphasize identifying which flexibility processes matter for a particular person, rather than delivering a fixed sequence.13
The field today
A map of selected published perspectives, the people developing them, and questions to compare as you read.
Schools of thought
Psychological flexibility in clinical practice
Hayes, Strosahl, and Wilson organize ACT around flexibility rather than the elimination of difficult inner experience. Harris and Luoma, Hayes, and Walser develop accessible ways to teach and practice it. The six processes are a formulation framework, not a mandatory exercise sequence.1162
Clinical relational frame theory
Törneke and the Villattes connect language research with clinical conversation. This perspective asks how words alter the function of experience and how a therapist’s language can widen possible responses. It offers a more detailed behavioral account than using metaphors alone.89
Process-based and responsive applications
Walser emphasizes flexible, person-responsive clinical work; process-based authors examine how ACT processes fit a broader model of change. These developments invite integration while retaining functional analysis. They do not mean that ACT’s identity or its six-process model has simply disappeared.310
People to know
Steven C. Hayes. ACT, contextual behavioral science, and process-based development.1
Kirk D. Strosahl. ACT formulation and clinical application.1
Kelly G. Wilson. Values and the experiential therapeutic encounter.1
Robyn D. Walser. Responsive ACT practice and clinical training.3
Jason B. Luoma. ACT skills development and values work.2
Russ Harris. Accessible ACT teaching.16
Niklas Törneke. Clinical applications of relational frame theory.8
Matthieu Villatte. Language as clinical intervention.9
Jennifer L. Villatte. Clinical language and relational frame theory.9
Live debates
These questions bring the different clinical priorities above into conversation.
How much RFT should clinicians learn?
A detailed account of language can guide more precise interventions. Pragmatic trainers also want methods clinicians can learn without extensive basic-science study. The question is how much explanation improves responsiveness rather than adding terminology.816
ACT identity and broader process work
A recognizable ACT model gives trainees a coherent starting point. Process-based proposals seek to organize useful interventions across brands and theories. The tradeoff concerns coherence and testability as well as openness to other traditions.110
Values as direction or pressure
Values work can help someone choose a meaningful direction while discomfort remains. It can also become another rule about living correctly if the therapist supplies the values or treats hesitation as avoidance. Flexible practice keeps the person’s authorship central.63
Exercises and function
Memorable metaphors can make an abstract process experiential. A functional account asks what the exercise actually changes for this person; fluency in delivering it is not the same as choosing it well.29
What institute trainees read
A reading route into these traditions. Individual institutes set their own syllabi.
Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed.
The developers’ core text, presenting ACT as a model of psychological flexibility grounded in functional contextualism.1
Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists, Second Edition
A skills-focused companion to process formulation.2
ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy, Second Edition
An accessible introduction, to be read alongside case formulation and supervision rather than as a list of metaphors.16
The Heart of ACT: Developing a Flexible, Process-Based, and Client-Centered Practice Using Acceptance and Commitment Therapy
Connects process work with the relational delivery of treatment.3
Values in Therapy: A Clinician’s Guide to Helping Clients Explore Values, Increase Psychological Flexibility, and Live a More Meaningful Life
Deepens the nuance of values conversations and client choice.6
Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application
Introduces a behavioral account of language and its clinical implications.8
Mastering the Clinical Conversation: Language as Intervention
Connects relational frame theory with clinical conversations and responsive language use.9
Process-Based Therapy: A Common Ground for Understanding and Utilizing Therapeutic Practices
Explore a framework for describing therapeutic processes across different schools.10
Read, watch, listen
Books
Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. (opens in a new tab)
The developers’ core text, presenting ACT as a model of psychological flexibility grounded in functional contextualism.
Paid · Purchase or library. Source details
Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists, Second Edition (opens in a new tab)
A skills-focused companion to process formulation.
Paid · Purchase or library. Source details
The Heart of ACT: Developing a Flexible, Process-Based, and Client-Centered Practice Using Acceptance and Commitment Therapy (opens in a new tab)
Connects process work with the relational delivery of treatment.
Paid · Purchase or library. Source details
Values in Therapy: A Clinician’s Guide to Helping Clients Explore Values, Increase Psychological Flexibility, and Live a More Meaningful Life (opens in a new tab)
Deepens the nuance of values conversations and client choice.
Paid · Purchase or library. Source details
Podcasts
Episode 103: Acceptance and Commitment Therapy with Dr. Steven Hayes (opens in a new tab)
Hear an ACT co-developer explain psychological flexibility and the model’s origins.
Free. Source details
185: Russ Harris, Part 1 (opens in a new tab)
Explore acceptance, values and responses to difficult thoughts in everyday language.
Free. Source details
469. ACT Refresher with Matt Boone (opens in a new tab)
Refresh the relationship between ACT’s processes and clinical practice.
Free. Source details
416. Trauma and PTSD Treatment with Robyn Walser (opens in a new tab)
Explore how an ACT clinician thinks about trauma and PTSD treatment.
Free. Source details
301. Seven Daily ACT Practices for Living Fully with Diana Hill and Debbie Sorensen (opens in a new tab)
Connect ACT processes with concrete daily practices.
Free. Source details
Videos
ACT in Action: 6-Video Series (opens in a new tab)
Study explanations and demonstrations of the ACT model across a six-volume training series.
Paid · Purchase or library. Source details
Psychological Flexibility: How Love Turns Pain into Purpose (opens in a new tab)
Hear Hayes explain psychological flexibility through a public lecture.
Free. Source details
Useful ACT Reframes (opens in a new tab)
Explore the language of workability and getting hooked.
Free. Source details
Understanding Values in ACT (opens in a new tab)
Clarify how values guide choices and committed action.
Free. Source details
Values vs Goals (opens in a new tab)
Distinguish an ongoing direction in life from a goal that can be completed.
Free. Source details
Articles
The empirical status of acceptance and commitment therapy: A review of meta-analyses (opens in a new tab)
Read an overview of ACT meta-analyses and the questions used to assess that literature.
Journal or institutional access. Source details
The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis (opens in a new tab)
Examine a critical systematic review and its assessment of ACT study quality.
Journal or institutional access. Source details
Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement (opens in a new tab)
Read a methodological response to Öst’s review and recommendations for reviewing psychotherapy.
Journal or institutional access. Source details
Acceptance and commitment therapy and the therapeutic relationship: Rupture and repair (opens in a new tab)
Explore ACT’s account of alliance rupture, therapist flexibility and repair.
Free. Source details
Process-Based Therapy: A Common Ground for Understanding and Utilizing Therapeutic Practices (opens in a new tab)
Explore a framework for describing therapeutic processes across different schools.
Free. Source details
More from the training institutes and publishers
Sources
Three Sides is independently produced and is not affiliated with or endorsed by the authors or publishers listed here. These publications are supporting readings; the teaching scenes and partner rehearsals were written for Three Sides. Fictional dialogue and case progress are illustrations, not study results.
Show all 37 references
Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd ed. (opens in a new tab)
Second edition ©2012; hardcover first released in September 2011. Paperback release in 2016 is the same edition.
The developers’ core text, presenting ACT as a model of psychological flexibility grounded in functional contextualism.
Learning ACT: An Acceptance and Commitment Therapy Skills Training Manual for Therapists, Second Edition (opens in a new tab)
A skills-focused companion to process formulation.
The Heart of ACT: Developing a Flexible, Process-Based, and Client-Centered Practice Using Acceptance and Commitment Therapy (opens in a new tab)
Connects process work with the relational delivery of treatment.
About ACT (opens in a new tab)
Official overview of psychological flexibility and the six ACT processes.
Acceptance and Commitment Therapy: Defusion (opens in a new tab)
A short training video on defusion.
Values in Therapy: A Clinician’s Guide to Helping Clients Explore Values, Increase Psychological Flexibility, and Live a More Meaningful Life (opens in a new tab)
Deepens the nuance of values conversations and client choice.
Values + Truffle Hunting in Sessions: An Interview with Jenna LeJeune, PhD (opens in a new tab)
A written interview on values as qualities of action and their role in clinical choices.
Learning RFT: An Introduction to Relational Frame Theory and Its Clinical Application (opens in a new tab)
Introduces a behavioral account of language and its clinical implications.
Mastering the Clinical Conversation: Language as Intervention (opens in a new tab)
Connects relational frame theory with clinical conversations and responsive language use.
Process-Based Therapy: A Common Ground for Understanding and Utilizing Therapeutic Practices (opens in a new tab)
Explore a framework for describing therapeutic processes across different schools.
Acceptance and Commitment Therapy: Deliberate Practice to Develop and Enhance Skills in ACT (opens in a new tab)
A skills-development book for ACT, with exercises for practicing acceptance, flexibility and valued action.
A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems (opens in a new tab)
A widely cited meta-analysis restricted to clinically relevant problems.
The empirical status of acceptance and commitment therapy: A review of meta-analyses (opens in a new tab)
Read an overview of ACT meta-analyses and the questions used to assess that literature.
The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis (opens in a new tab)
Examine a critical systematic review and its assessment of ACT study quality.
Departing from the essential features of a high quality systematic review of psychotherapy: A response to Öst (2014) and recommendations for improvement (opens in a new tab)
Read a methodological response to Öst’s review and recommendations for reviewing psychotherapy.
ACT Made Simple: An Easy-To-Read Primer on Acceptance and Commitment Therapy, Second Edition (opens in a new tab)
An accessible introduction, to be read alongside case formulation and supervision rather than as a list of metaphors.
Episode 103: Acceptance and Commitment Therapy with Dr. Steven Hayes (opens in a new tab)
November 21, 2020.
Hear an ACT co-developer explain psychological flexibility and the model’s origins.
185: Russ Harris, Part 1 (opens in a new tab)
Explore acceptance, values and responses to difficult thoughts in everyday language.
469. ACT Refresher with Matt Boone (opens in a new tab)
Refresh the relationship between ACT’s processes and clinical practice.
416. Trauma and PTSD Treatment with Robyn Walser (opens in a new tab)
Explore how an ACT clinician thinks about trauma and PTSD treatment.
301. Seven Daily ACT Practices for Living Fully with Diana Hill and Debbie Sorensen (opens in a new tab)
Connect ACT processes with concrete daily practices.
ACT in Action: 6-Video Series (opens in a new tab)
Study explanations and demonstrations of the ACT model across a six-volume training series.
Psychological Flexibility: How Love Turns Pain into Purpose (opens in a new tab)
Hear Hayes explain psychological flexibility through a public lecture.
Useful ACT Reframes (opens in a new tab)
Explore the language of workability and getting hooked.
Understanding Values in ACT (opens in a new tab)
Clarify how values guide choices and committed action.
Values vs Goals (opens in a new tab)
Distinguish an ongoing direction in life from a goal that can be completed.
Acceptance and commitment therapy and the therapeutic relationship: Rupture and repair (opens in a new tab)
Explore ACT’s account of alliance rupture, therapist flexibility and repair.
Do we need to challenge thoughts in cognitive behavior therapy? (opens in a new tab)
Explore a conceptual debate about the role of thought challenging in CBT.
Veterans Health Administration ACT Video Series: Acceptance (opens in a new tab)
A process-specific demonstration in the VHA series, listed by ACBS; not proof of treatment efficacy.
Veterans Health Administration ACT Video Series: Observing Self (opens in a new tab)
A process-specific demonstration in the VHA series, listed by ACBS; not proof of treatment efficacy.
Veterans Health Administration ACT Video Series: Presence (opens in a new tab)
A process-specific demonstration in the VHA series, listed by ACBS; not proof of treatment efficacy.
Veterans Health Administration ACT Video Series: Values & Committed Action (opens in a new tab)
A process-specific demonstration in the VHA series, listed by ACBS; not proof of treatment efficacy.
Veterans Health Administration ACT Video Series: Willingness (opens in a new tab)
A process-specific demonstration in the VHA series, listed by ACBS; not proof of treatment efficacy.
Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them (opens in a new tab)
Critically examines measurement, specificity, power, and transparency; valuable against overconfident claims that all six processes are established causal mechanisms.
Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: outcomes and moderators (opens in a new tab)
A relevant comparison for Ari’s fictional situation; no observed difference is not proof that treatments are interchangeable for every client.
Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis (opens in a new tab)
Provides process-outcome associations; cross-sectional findings cannot establish a mechanism or treatment effect.
ACBS podcast and audio resources (opens in a new tab)
Browse the official collection for additional talks, interviews and training resources.