'Leaves on a Stream' Worksheet
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Looking for a “leaves on a stream” worksheet to share with clients? Therapists can use this “leaves on a stream” exercise to help clients practice mindfulness.
Mental health clinicians can pull from several modalities—such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT)—to best support each client’s individual treatment needs.
Acceptance and commitment therapy (ACT) is a mindfulness-based type of psychotherapy that equips individuals with skills to move through difficult emotions and accept their present circumstances.
ACT can be used to treat anxiety, depression, obsessive-compulsive disorder (OCD), psychosis, stress, and even chronic pain.
This article provides an overview of the ACT “leaves on a stream” exercise, a mindfulness technique that you can use with clients in your practice. You can also download a free “leaves on a stream” worksheet to save to your electronic health record (EHR) for repeated use with clients.
What is the 'leaves on a stream' exercise?
The “leaves on a stream” exercise is one of several techniques that teach cognitive defusion, which aims to reduce attachment to thought patterns that cause distress and prevent action.
The exercise can be used for anyone struggling with their thoughts, like clients with anxiety, depression, or even clients in psychosis recovery.
Cognitive defusion exercises involve mindfully observing thoughts and emotions, without judgment, and noticing the impact of those thoughts.
Like a thought distortion, cognitive defusion exercises teach the importance of defusing a thought and developing more helpful ways of thinking, which promotes psychological flexibility.
The “leaves on a stream” exercise helps clients observe the flow of their thoughts using a visualization of leaves floating on a flowing stream. The leaves represent their thoughts and feelings, and the practice involves “placing” thoughts and feelings on the leaves and observing them float on by.
You can use the “leaves on a stream” script below to guide your client through the exercise, or you could use our downloadable “leaves on a stream” worksheet to provide to your client as a handout to practice at home.
Is the 'leaves on a stream' exercise suitable for everyone?
Many mindfulness practices involve closing your eyes and sitting still, including the “leaves on a stream” exercise.
This practice may not be suitable for everyone, especially clients with a history of trauma, people who struggle to visualize, and individuals who experience dissociation.
In this instance, trauma-focused ACT expert Russ Harris recommends an alternative exercise like “Hearing Your Thoughts,” in which your eyes are open but focused on a fixed place.
'Leaves on a stream' script
You may use the following script to illustrate the exercise to clients in session. Take a pause for a few seconds between each step.
1. To prepare for the exercise, find a quiet place that is free from distractions.
2. Find a comfortable position. This can be seated, laying down, or standing.
3. You can either close your eyes or practice a relaxed gaze by focusing on a spot in the room.
4. I want you to imagine sitting by a gently flowing stream with leaves floating on the surface of the water. This stream can look however you would like. For the next few seconds, observe what the stream looks like, how the ground feels beneath you, and what the water sounds like as it flows by.
5. You may have noticed thoughts popping into your mind, certain feelings, or sensations. They may be pleasurable, painful, or neutral. Imagine putting those thoughts, feelings, or sensations onto a leaf and observing them floating down the stream.
6. More of these thoughts and feelings will pop up, and each time they do, put them on another leaf and watch them float by—even if they are thoughts like, “I wish this exercise was over” or “I wish I could turn my brain off.” These thoughts count, too.
7. If your feelings are intense or you become frustrated, acknowledge your emotions by saying, “I notice I am feeling X.” Then, place that feeling on a leaf.
8. You may notice feeling distracted. That's normal. Mindfulness is the practice of noticing. Try to continue for another few minutes.
9. Now, imagine the stream dissolving in front of you and gently bring your attention back to the room. You might want to stretch, take a deep breath, or sigh. Do whatever feels good to you.
Other cognitive defusion and mindfulness exercises
Some other cognitive diffusion and mindfulness exercises you may find helpful include:
Using a silly or singing voice
This cognitive defusion technique involves adapting thoughts into a silly voice, trying to sing them, or repeating them in a funny accent. The idea is to defuse their intensity and gain detachment from them.
Labeling or naming thoughts
Naming thoughts as “just thoughts” or saying “I’m having a critical thought” helps to create distance from the feelings about these thoughts and their intensity.
Thought bubbles
This technique uses visualization to imagine the thought in an animated thought bubble, creating distance and separation from the thoughts.
Mindful observation
This exercise involves focusing on an item for a few minutes, and noticing how it feels, looks, smells, tastes, or sounds. This increases the capacity for mindful awareness.
Thanking the mind
This practice involves observing your thoughts without judgment, reminding yourself that thoughts are not facts, and then thanking the mind and letting the thought go.
How to use the ‘leaves on a stream’ worksheet
This free “leaves on a stream” worksheet can be used in several ways:
- In-session, as a script to guide your client through the exercise
- You can download the ‘leaves on a stream’ script PDF and email it to clients or share it during a virtual telehealth session
- Provide the worksheet to clients to practice the exercise at home between sessions
Sources
- Harris, R. (2021). Trauma-focused ACT. A practitioner's guide to working with mind, body & emotions using acceptance and commitment therapy. Context Press.
- Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.
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