Acceptance and Commitment Therapy (ACT) is a “third-wave” cognitive behavioral intervention aimed at enhancing our psychological flexibility (Hayes et al., 2006).
Rather than suppress or avoid psychological events, ACT is based on the belief that acceptance and mindfulness are more adaptive responses to the inevitabilities of life.
By experiencing our thoughts, physical feelings, and emotions in more flexible ways, acceptance commitment therapists argue, we can reduce the negative behaviors they often lead to (Hayes et al., 1996; Bach & Hayes, 2002).
As an intervention, ACT has empirical bases and has become a relatively well-established part of applied positive psychology in recent decades. If you’re hoping to add ACT approaches into your professional practice or your personal life, read on for an extensive collection of ACT worksheets, assessments, questionnaires, and activities.
Before you read on, we thought you might like to download our three Mindfulness Exercises for free. These science-based, comprehensive exercises will not only help you cultivate a sense of inner peace throughout your daily life but will also give you the tools to enhance the mindfulness of your clients, students or employees.
To put things into further context, ACT has 6 central processes (Harris, 2006). If you’re already familiar with these as a helping professional, feel free to skip ahead to the worksheets in this section.
You can read more about how Acceptance and Commitment Therapy works.
With these processes and principles in mind, here are some useful ACT worksheets.
Suppression and avoidance have detrimental effects over time. As maladaptive strategies, they often tend to work against us rather than in our favor—amplifying the psychological experience we’re trying to escape. By eliciting this ‘rebound’ effect, this acceptance exercise allows therapists to help clients recognize this.
This worksheet has two parts. First, however, it helps to explain the role of mindfulness in coping with unwanted thoughts, feelings, and memories. Then, the client is instructed to:
It also helps to debrief your client after this exercise. Some good prompts include:
The full exercise can be found in our Positive Psychology Toolkit.
Emotional avoidance is another ineffective strategy that people tend to use when uncomfortable thoughts or feelings arise. As short-term responses avoidance may seem helpful, but over the longer term it reinforces the seeming intolerability of these mental experiences.
Therapists can work with clients to recognize when they are cognitively trying to escape distress through common habits like distraction or rumination (Moulds et al., 2007; Wolgast & Lundh, 2017).
This exercise is best worked through after you have introduced the concept of emotional (or experiential) avoidance to your client. If you are engaging with this exercise for yourself, you’ll find a helpful theoretical background and examples to get you started.
In the main section of this worksheet, you’ll find some writing space.
After you or your client have filled out the sheet, it is generally useful to reflect on the insights gleaned from the exercise. Can you spot any patterns? Any alternative behaviors or approaches you could have adopted?
The full exercise can be found in our Positive Psychology Toolkit.
‘Being present’ is one of the most difficult yet central facets of mindfulness. In ACT, as noted, the goal is to accept what we’re feeling without over-inflating or over-identifying with it. Being honest about our mental experiences helps us create space for thoughts, memories, and sensations that inevitably arise as a natural part of life.
Starting with some basic mindfulness exercises is a good approach if your client isn’t familiar with the concept. The Five Senses Worksheet offers a simple practical sequence that encourages you to bring your awareness to what’s right here, right now.
Being present is very helpful in appreciating what’s actually taking place in reality rather than simply in our heads. It empowers us to commit to bigger goals rather than getting caught up in past events and internal ongoings while strengthening our ability to accept and overcome our struggles.
We have a huge array of mindfulness exercises that you can browse and draw from if you feel it will help your client or your personal practice.
Cognitive defusion exercises are designed to address the (sometimes overwhelming) perceived credibility of painful cognitions and feelings. Taking thoughts like “I’m terrible” or “I’m useless” too literally makes it much more difficult for us to see them as what they are—to see thoughts as thoughts.
This ACT cognitive defusion worksheet from our Toolkit gives more coverage of how the approach can be used for more adaptive ways of relating to psychological experiences.
More immersive exercises often help with learning to become an observer of yourself. The Observer Meditation is both a guided script and a PDF—use this to help your client transcend memories, emotions, or personal experiences that they might feel absorbed or preoccupied with.
As an example, one instance of becoming an Observer might look like this:
Try The Observer meditation yourself to practice decentering and reappraising your cognitions (Hayes-Skelton & Graham, 2013). The full exercise can be found in our Positive Psychology Toolkit.
Author and ACT practitioner Russ Harris suggests that we can think about two critical categories when we’re aiming to reduce struggle and suffering in our lives. We can also use two equally important categories when thinking about how to create a meaningful, rich life. Using these following four categories, reflect on and write down your thoughts.
Problem Emotions and Thoughts: What self-criticisms, worries, thoughts, fears, memories, or other thoughts tend to preoccupy you? List some feelings, sensations, or emotions that you find hard to deal with.
Problem Behaviors: Describe some actions that you engage in which are harmful over time—things that:
Values: List some things that matter personally to you in the long run. Which of your character strengths and qualities would you like to build on? What things do you (or do you want to) represent/stand for? In what ways do you hope to further yourself by tackling your problems? What are some ways you’d like to enhance or boost your relationships?
Goals and Actions: List some of your present behaviors or actions which are designed to enhance your life over the longer term. What are some things you’d like to do more or new things you’d like to begin? Can you think of some steps you want to make to improve your life? Skills you aspire to build on further?
This Values and Problems worksheet is adapted from Russ Harris’ Complete Happiness Trap ACT Worksheets.
This values discussion sheet, resource, or handout offers a framework that clients can use to explore and reflect on their personal values. As well as helping them (or you) get some clarity, they stimulate thinking about potential life goals in ten different areas (Wilson & Murrell, 2004). After the first few examples, you’ll be able to create your own questions along the same lines.
The categories and some example questions are:
Use this free Personal Values Worksheet to help you.
Commitment is about maintaining motivation to the continuing pursuit of a client’s life goals over time. Drawing on goal-setting theory, therefore, it helps to have clear, concrete objectives for positive ‘approach’ goals (Locke, 1968; Locke & Latham, 2002).
Using these three headings, create a 3-column grid like the following:
| Commitment | Potential Obstacles | Strategies for Boosting Commitment |
|---|---|---|
| In this column, your client designs goals that reflect the values from any of the above exercises. | Alongside each commitment from the list, identify the possible roadblocks… | …so that you can come up with potential alternative pathways in this column. |
This Exploring Willingness and Commitment worksheet focuses in on one value that you or your client have identified. Whether it’s being a more patient father or working toward more integrity, single out one commitment and work through the following questions.
After working on these sections, the focus is the personal ‘stuff’. It’s time to reframe these as ‘stuff’—feelings and thoughts—rather than reality, as powerful or unpleasant as they may seem. Even though they exist, we can still accomplish what we commit ourselves to. There is one more question on this worksheet:
If the answer is no, start again with another valued goal. If it’s yes, then go for it.
This worksheet is adapted from Letting a Little Non-verbal Air Into the Room, an academic publication by Ciarrochi & Robb (2005).
Below we discuss a few valuable questionnaires and surveys.
Bond and colleagues’ (2011) Acceptance and Action Questionnaire-II (AAQ-II) was designed to measure various core ACT constructs. This 10-item instrument uses a 7-point Likert Scale to assess psychological flexibility, acceptance, action, and experiential avoidance and can be used as part of therapy.
Especially helpful in interventions that adopt acceptance and mindfulness approaches, the Revised Acceptance and Action Questionnaire is a simple self-report tool to administer and score. With 1 representing “Never True” and 7 for “Always True”, some example items include:
Find the Acceptance and Action Questionnaire in our Positive Psychology Toolkit©.
Avoidance, or more technically experiential avoidance, describes behavior which aims to
“alter the frequency or form of unwanted private events, including thoughts, memories, and bodily sensations, even when doing so causes personal harm” (Hayes et al., 2012: 981).
Developed by Gámez and colleagues (2014), the Brief Experiential Avoidance Questionnaire is one psychometric assessment of experiential avoidance that has demonstrated good internal consistency. It comprises 15 6-point Likert Scale Items and has stronger construct validity than the (perhaps) better-known Acceptance and Avoidance Questionnaire-II (AAQ-II) (Tyndall et al., 2018).
With 1 being “Strongly Disagree” and 6 representing “Strongly Agree,” this self-report measure includes the following example items (Gámez et al., 2014):
The full and original BEAQ is available in this publication.
This personal values questionnaire is similar to the Values Worksheet given above, however, it provides more background theory and uses different domains. Somewhat more structured and extensive, therefore, it’s a useful way to help your client both explore their values and identify any discrepancies with actual valued living.
Throughout the course of ACT therapy, it is a helpful method for tracking progress once a commitment is established.
Part One of this tool introduces four broad domains in which your client can identify personally meaningful ways of living—this is a Values Identification exercise. Included domains are Work/Education, Leisure, Relationships, and Personal Growth/Health. Below this, you and your client can work with a ‘dartboard’ visualization where they mark how they are living their life in relation to the ‘Bulls Eye’; their ideal way of living.
In Part Two, you’ll find space for writing down any perceived barriers between your client’s current and ideal life. In this same space, there is a rating system that can be used to estimate how powerful this barrier is perceived to be, from “Doesn’t prevent me at all” to “Prevents me completely”.
The final part of this survey is a Valued Action Plan—here is a designated space for your client to write down actions that will take them from where they are to the metaphorical Bulls Eye. Work through this space by considering what values-based action your client would willingly take to tackle or overcome the obstacles from Part Two above.
The full exercise can be found in our Positive Psychology Toolkit©.
These detailed, science-based exercises will help you or your clients enjoy the benefits of mindfulness and create positive shifts in their mental, physical, and emotional health.
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There is no one type of ACT intervention—Acceptance and Commitment Therapy can vary from the very-short, lasting a few minutes, to lengthy interventions that span numerous sessions. Typically, they involve techniques based on the six core processes we looked at above.
For instance, expansion and acceptance interventions might include one or more exercises to challenge over-identification; similarly, they may introduce or encourage the client to practice ‘unhooking’ from negative thoughts (Ciarrochi & Robb, 2005). As an intervention, the former could be a single exercise, or it could involve practice over a period of time.
Self as Observer interventions might incorporate any number of defusion exercises, such as The Observer meditation we considered above, or they might involve working with metaphors—perspective shifting exercises for ‘creative hopelessness’ (Hayes et al., 1999).
There are myriad mindfulness techniques that form part of Being Present interventions, and Cognitive Defusion Interventions for reappraising painful thoughts, and the list goes on. It’s impossible to provide an exhaustive list of ACT interventions in this one article, but here are a few that you might find useful as a helping professional.
Both ACT and CBT focus on cognitive distortions—the latter is geared predominantly toward restructuring them, however, while ACT is about creating space for these through acceptance. Without an awareness of cognitive distortions in the first instance, we’re hard-pressed to do either.
This Increasing Awareness of Cognitive Distortions intervention works well in conjunction with mindfulness interventions as part of ACT therapy (Burns, 1980). It begins by introducing the cognitive distortion concept and outlines 11 examples that your client may be able to relate to. Examples include All-or-Nothing Thinking, Personalization, Should Statements, and Jumping to Conclusions.
While this comes as a helpful PDF, therapists will likely find this a very useful step to work through with your client. Being able to answer any questions will be helpful as your client moves to the next stage; filling out a worksheet with cognitive distortions that they can identify.
Three columns, as shown below, provide some structure for a guided awareness intervention that will ideally take place for at least 5 minutes daily over a week. The full exercise can be found in our Positive Psychology Toolkit.
| Feelings | Thoughts | Cognitive Distortion? |
|---|---|---|
| Try to identify and/or label the emotion that’s present in the moment. Is it fear? Unhappiness? Embarrassment? This works for bodily sensations, too. Is it tension? Heaviness? Lethargy? | What thoughts are passing through your head as these feelings are occurring? Ideally, this is a good start to understanding how the two relate to one another. | Use the table if necessary to identify which cognitive distortion might be at work. Are you perhaps discounting the positive in this situation? Or overgeneralizing? |
Adapted from an experiential exercise by Monestès & Villatte (2013), this intervention encourages your client to act independently of their thoughts. It’s a form of exposure in a sense, fostering their ability to behave as per their values rather than reacting instantaneously to their mental processes. So, it’s about developing psychological flexibility.
It’s always good to debrief afterward with some discussion about how it felt, and the salience of independent action which isn’t driven by language. Try not to let your client’s actions become the direct opposite of what you’re doing, however, as this still leaves some link to language rather than encouraging psychological flexibility.
A full version of this appears in Stoddard and Afari’s (2013) Complete Book of ACT Metaphors.
Walking the client mentally through their own funeral is a guided intervention that aims to help them clarify their values. To open the discussion as a therapist, ask your client to imagine that they’ve suddenly passed away. As the universe would have it, they’re able to attend their own funeral, albeit as a ghost of their former self.
The discussion can be used to explore what they’d like their friend’s eulogies to include, as well as their family member’s speeches. They can think about what they’d like on their tombstone, prompting an exploration of questions like:
There are numerous variations of this Values intervention, but the original is from Hayes’ (2004) vignette in A Practical Guide to Acceptance and Commitment Therapy.
A little earlier, I introduced the idea of metaphors. Let’s look at a few examples and how these can be used within your ACT intervention.
