Acceptance and commitment therapy (ACT) worksheets
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For mental health therapists looking for ACT therapy worksheets, this guide to acceptance and commitment therapy worksheets describes this intervention, provides an overview of the ACT hexaflex worksheet, and includes a list of different types of ACT skills.
You can also download free ACT therapy worksheets to save to your electronic health record (EHR) and use in your therapy practice.
What is ACT therapy?
Acceptance and commitment therapy (ACT) is a humanistic type of cognitive behavioral therapy that harnesses mindfulness to help individuals accept difficult emotions and the inevitable conditions of life. It does this by helping people create greater psychological flexibility and commit to values-based actions.
The goal of ACT is not to suppress life experiences, but to reduce suffering and build a meaningful life.
In therapy, ACT and the use of ACT therapy worksheets can help clients to:
- Learn new skills to reduce the impact of difficult emotions
- Get clear on their core values
- Focus their attention on what is meaningful and engage in the present moment
According to well-known ACT trainer, medical practitioner, and psychologist, Russ Harris, ACT is based on a philosophy of science called functional contextualism and a theory of language known as relational frame theory.
What is the ACT hexaflex?
There are six core processes of ACT, referred to as the ACT hexaflex:
1. Contact with the present moment: This practice emphasizes being in the present moment by narrowing, broadening, shifting, and sustaining our attention.
2. Acceptance: This involves making space for thoughts, feelings, emotions, memories, and urges, instead of avoiding them.
3. Defusion: This is the practice of noticing, acknowledging, and stepping back from our thoughts. Cognitive defusion, like acceptance, isn't about avoiding thoughts, but making space for them and holding them less firmly.
4. Self-as context means being able to separate oneself from our experiences.
5. Values: This process involves identifying what matters, such as how you want to be treated, and how you want to treat others. Then, using those values as a basis for motivation, inspiration, and self-guidance.
6. Committed action: The last part of the hexaflex is taking effective action, guided by one’s values, to build a whole and meaningful life.
Types of ACT skills
There are various types of ACT skills included in acceptance and commitment therapy worksheets that teach the core processes of ACT.
However, at their core, they interconnect with the practice of psychological flexibility, described by Harris as the ability to act effectively and mindfully while guided by our values.
ACT psychological flexibility allows us to respond effectively to life, develop a sense of meaning and purpose, and engage fully in the present moment.
Some examples of ACT skills and practices include:
Getting unhooked
This psychological flexibility ACT skill involves recognizing unhelpful cognitions, creating distance between those thoughts and feelings, and learning to observe them instead of reacting to them.
For example, a client might complain about feeling overwhelmed by a new job and dealing with multiple health challenges. The client describes feeling a lot of resistance to these overwhelming demands while in a less-abled body and that they are spending their time comparing themselves to their past self and the energy they used to have.
Unhooking from these thoughts and feelings might include acknowledging, “Oh, this is the ableist story playing,” spending their energy focusing on their goals instead of this unhelpful narrative.
Dropping an anchor
This activity can help clients ground themselves, reduce emotional overwhelm, and respond more calmly and intentionally.
Practicing this exercise involves naming and acknowledging your emotions and feelings, and imagining dropping an anchor to stabilize yourself.
You might suggest a client presses their feet into the ground, takes a few deep breaths, and focuses on things they can observe in the present moment, like their breath, objects in the room, and things they can see or smell.
Thoughts on a stream
This meditation practice uses the cognitive defusion skill of imagining your thoughts as leaves floating down a stream. If you’re looking for meditation-focused acceptance and commitment therapy worksheets, you can download this free “leaves on a stream” worksheet.
Observing thoughts in this way helps clients unhook from unhelpful cognitions, create distance between thoughts and feelings, and reduce the impact of intense emotions.
Connect and reflect
If a client is having difficulty identifying their values, you may encourage them to think about a person they care about. Ask them to reflect on a recent experience they enjoyed with them.
You can prompt their memory by asking them what they did and what they were saying.
Then, you can dig a little deeper by asking how they felt, how they were treating their friend, and how they felt they were being treated. This process can help clients identify values that are important to them.
Benefits of ACT therapy worksheets
Using ACT therapy worksheets is a helpful way for therapists to illustrate ACT skills.
For instance, ACT for anxiety worksheets give clients the ability to visualize and process what you’re saying without focusing on note-taking or forgetting important details of a skill or practice.
ACT has been well-researched and is known as an effective treatment for anxiety, depression, substance use disorder, phobias, and stress-related issues. Research has also demonstrated ACT can reduce psychological distress in people with cancer.
The main benefits of acceptance and commitment therapy worksheets include:
- Increased commitment to value-driven behaviors
- Long-term improvements in behavior
- Enhanced psychological flexibility to adapt to various challenges, situations, and demands
- Improved internal and external awareness
You can download the ACT therapy worksheets at the top of this article to save and use in your therapy practice.
Sources
- Dindo, L., Van Liew, J. R., & Arch, J. J. (2017). Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics:the journal of the American Society for Experimental NeuroTherapeutics.
- Gloster, A, T., Walder, N., Levin, M., E., Twohig, M., P., Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science.
- Harris, R. (2021). Trauma-informed ACT: A practitioner's guide to working with mind, body, emotion using acceptance and commitment therapy. Context Press.
- Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (2nd ed.). New Harbinger Publications.
- Harris, R. (2014). Complete worksheets. The Happiness Trap.
- Li, Z., Shang, W., Wang, C., Yang, K., & Guo, J. (2022). Characteristics and trends in acceptance and commitment therapy research: A bibliometric analysis. Frontiers in psychology.
- Zhang, C. Q., Leeming, E., Smith, P., Chung, P. K., Hagger, M. S., & Hayes, S. C. (2018). Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach.
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