Counselling Applications

of
The Mindfulness &
Acceptance Workbook
for Anxiety
Forsyth. J. P., & Eifert, G. H. (2007).

Robyn Polsfut & Molly Hayes

 What we want you to know by the time we’re done

Counselling- Additional ACT

specific
The theoretical theory, research,
applications of the perspective of & application
techniques ACT resources
outlined in the
workbook

Hot
topics in
The feel of
ACT & each chapter
anxiety the field
 Acceptance & Commitment Therapy
• Third-wave approach that seeks to change the function of psychological events
and individual’s relationship to them through strategies such as mindfulness, Click here for
acceptance, or cognitive defusion, rather than changing events directly a brief
• Psychological inflexibility results from dominance of past & feared future/weak
overview
self-knowledge, lack of clarity of values, inaction/impulsivity/avoidance,
(Blonnar, 2010)
attachment to conceptualized self, experiential avoidance, and cognitive fusion
and aims to improve psychological flexibility through the following 6 functions:
1. Acceptance: active awareness and embracing of psychological experiences
2. Cognitive defusion: change the way one interacts with or relates to
thoughts by creating contexts that downplay the power of negative
thoughts
3. Being present: non-judgmental contact with psychological and physical
environments to promote flexible behaviour and direct connections with
the world
4. Self as context: click on the soup can to view a video that describes this
concept (you only need to watch the first two minutes)
5. Values: chosen qualities of purposeful action
6. Committed action: short, medium, and long term change goals

(Rhinewine, 2013)

(Hayes, Luoma, Bond, Masuda, & Lillis, 2006)

1 Choose a New Approach to Get a Different Outcome
ACT as “accept, choose, take action”

Choose
• “Acceptance will help you • Realize your
make anxiety just a part of • Choose a “valued life
your larger life” (p. 13) direction for goals” (p. 14)
• Don’t change your your life • Do something
thoughts, watch them with • Live to be about it
non-judgment well, rather
than living
to feel & Take Action Hot topic,
Accept think well check at the
end for more
information &
• Why choose ACT over other CBT practices? “Because research shows that anxiety watch for
more hot t
management and control efforts are unnecessary” (p.14)
• What kind of commitment does ACT ask for?
• To look at and relate to anxieties differently, not to overcome big adversities
• To take action (by doing the activities)
• To do something differently (because without doing something different,
everything stays the same)
• What if commitment is broken?
• Be gentle, breaking commitment isn’t a failure, it is simply a fall of the bike

(Forsyth & Eirfert, 2007)

2 You Are Not Alone: Understanding Anxiety & Its
Disorders
“anxiety tends to be fueled more by what your mind says than by real sources of danger or threat”
• Anxiety tends to be: (p.32)
• Non-discriminatory and rampant
• Chronic
• Requires action to prevent it from getting worse
• Fear versus Anxiety:
• Fear = the present-oriented basic emotion – it’s protective, causes your body to do things to
make sure you take care of yourself (i.e. somatic nervous responses)
• Anxiety = the future-oriented emotion – body sensations are less obvious but the feelings
associated can last longer than fear
• Provides psychoeducation on types of disordered anxiety by using symptom checklists
and provides additional information on depression, alcohol abuse, and medical
conditions associated with anxiety but discourages searching for answers/diagnosis
• Click on the categories below to view checklists similar to the ones in the workbook

(A list of the URLs for the checklists can be found in the “Notes” section of this slide)
Panic
Disorder Panic Social PTSD GAD
Attack Phobias anxiety OCD

(Forsyth & Eirfert, 2007)

3 Confronting the Core Problem: Living to Avoid Fear &
Anxiety
Thoughts, feelings of anxiety are not the real enemy, the rigid avoidance of fear and
anxiety is the real enemy.

Click on the monster head to view a short (4 minute) video that explains this ACT
perspective shift in a metaphor.

(Oliver, 2011)

• The problem isn’t that an unwanted party guest can arrive at anytime, the
problem is the kinds of behaviours, thoughts, and feelings that the unwanted
guest elicits in the host.

(Forsyth & Eirfert, 2007)

4 Myths About Anxiety & Its Disorders
Anxiety Myths ACT Truths
Anxiety problems are biological and Genes make you more vulnerable to anxiety problems but
hereditary don’t give you anxiety problems.
Intense anxiety is abnormal Intense anxiety is not the problem, it’s what you do with it.
Anxiety is a sign of weakness We tend to make inferences on ourselves and others based on
limited information, we say we are weak when we feel weak –
this is only a small piece of information. The only thing you
need is a capacity for change and this is within everyone.

Anxiety can must be managed to live a “Anxiety management and avoidance leave you feeling safe
vital life and less anxious in the short term and greatly limit what you
can do. This inaction is the problem” (p.63).

(Forsyth & Eirfert, 2007)

5 Letting Go of Old Myths Opens Up New Opportunities
FEAR = False Evidence Appearing Real (p. 69) becomes a mind trap where worries,
anxieties, and fears (WAFs) limit us from doing what we want

Instead of reacting to FEAR and allowing WAFs to be the reasons

we avoid living well, we can observe them, and step out of the
mind trap.
Strategies for observing experiences:
Click below to learn how to
practice “mindful walking”
Click here to view a (URL is in notes section)
cognitive defusion
technique called “mind
watching” or “leaves on a
stream”
(Artofmindfulliving, 2012)

(Forsyth & Eirfert, 2007)

6 Facing the Costs to Take Charge of Your Life
Managing anxiety has costs: interpersonal, career, health, energy, emotional, financial,
and freedom.
Awareness worksheets that help draw attention to facing the costs of anxiety:
Take stock of anxiety management history (what have I given up?)
(p. 89)
Situation/Event Anxiety/Conce Anxiety Coping Effects on Costs
rn Behaviour You

Take stock of your coping strategies (what are the short and long term costs and
benefits of my anxiety management?) (p.91)

WAF coping Costs Benefits

strategy
Short-Term Long-Term Short-Term Long-Term

(Forsyth & Eirfert, 2007)

7 What Matters More to You: Managing Your Anxiety or
Living a Good Life?
Helping you to connect with what you want from this life
through a few activities:
Anxiety Click here for
Management Living in Full
Epitaph (what would Experience – The
Funeral Meditation
(imagine attending your own
your gravestone say
about your anxiety
Life Form: A Life
funeral. What did people say
management?) & My Enhancement
about you? What did you want to
hear them say?) Valued Life Exercise
(URL is in notes
Epitaph (what would section)
your gravestone say if
you were free from
WAFs?)

(Forsyth & Eirfert, 2007)

8 Ending Your Struggle With Anxiety is the Solution

Dropping the tug-of-war rope with

anxiety management actually gives
you more control because it allows
you to exert control over your
actions rather than exhausting it
with thoughts and feelings.

Image retrieved from

http://www.scientificmindfulness.com/2011/04/living-with-your-
fears.html

(Forsyth & Eirfert, 2007)

9 You Control Your Choices, Actions, & Destiny

• Learning what the difference between what I can and cannot

control
• You can control your actions but you can’t control your feelings,
thoughts, or other people’s…

• How willing are you to have WAFs but not act on them?

• How willing are you to make growth possible by turning your

attention to what you can control and away from things you can’t?

(Forsyth & Eirfert, 2007)

10 Getting Into Your Life With Mindful Acceptance

Four qualities of mindful acceptance:

1. Paying attention
2. On purpose
3. In the present moment
4. Nonjudgmentally

Click below to view a video that explains mindfulness in ACT

(Rhinewine, 2013)

(Forsyth & Eirfert, 2007)

11 Learning Mindful Acceptance

• We cannot choose what comes into our minds

• We can only choose what we pay attention to and
how we pay attention (p. 148)
• Becoming an Impartial Observer:
• Plant yourself in the present moment
• Listen to your body
• DO NOT feed self judgments, instead observe the
judgment and let it be (no judging judgments)
• Engage your “wise mind” or observing self and recognize
your separate thoughts, feelings, and actions

(Forsyth & Eirfert, 2007)

12 Taking Control of Your Life
• Engage your values – Values refer to actions, not morals,
beliefs, or philosophies
• Values act as a map guiding what is important in your life
through ups and downs
• Valued living + mindful acceptance = compassion in action (p.
168)
• Values are a wise and vital alternative to WAFs (p. 169)
• A mantra to engage your values:
“Does this action I want to take move me closer or further away
from my values?”
(p. 169)

(Forsyth & Eirfert, 2007)

13 Finding Your Values
Completing the Valued Directions Worksheet will help you:
1. Focus on life domains that you find important
2. Discover your intentions
3. Highlight if your actions reflect what matters to you
4. Uncover possible roadblocks to living your values

Click the lotus to see the Valued Directions Worksheet

(URL is in note section)

(Forsyth & Eirfert, 2007)

14Getting Ready to Face Anxiety With Mindful Acceptance

First things first, you are in charge! You choose what you do and
attend to.
What to do when you’re anxious or afraid:
• Move with your barriers, you do not need to get rid of your
WAFs in order to live a valued life the key is to accept them
and bring them with you
• Free yourself from mind traps such as “but” ex. I’d like to go to
the mall but I’m afraid of having a panic attack.” Try “and”
instead
• Do not buy into your thoughts, observe them
• Ride the full wave of your emotions

(Forsyth & Eirfert, 2007)

15 Bringing Compassion to Your Anxiety
• Practicing acts of kindness to yourself and others is a
behavioural remedy to anxiety and anger
• TLC Problems: Issues that arise when you feel tired/stressed,
lonely, and craving (p. 203)
– These can be derailed by acting with compassion to yourself.
Compassionate actions include: meditation, reading, walking, etc.
• Practice forgiveness to self, others, and WAFs by
1. Awareness: wake up the hurt and pain without judgment or denial
2. Separation: Use your Wise (observing) Mind and invite healing change
3. Compassionate Witness: Extend compassion to your experience and
others
4. Let Go and Move On: Release grudges and resentment that increase
suffering and then move forward in valued life directions
(p. 208)

(Forsyth & Eirfert, 2007)

16 Developing Comfort in Your Own Skin
Engaging in exercises of bodily
discomfort can help increase your
acceptance and comfort within your own
skin
• See Bodily Discomfort Form and
follow these 7 steps:
1. Identify a valued domain
2. Practice an exercise from the
form
3. Apply your mindful and
acceptance skills
4. Chart your progress
5. Reflect on your practice
6. Repeat exercises
7. Review your rating on your Bodily
Discomfort Form
(p. 219)

(Forsyth & Eirfert, 2007)

17 Developing Comfort With Your Judgmental Mind

The key to unhinging your mind from traps, suffering,

and self-judgment is to engage your wise mind
• The wise mind is able to separate
Wise painful thoughts, feelings, and
Mind actions
• The wise mind is able to extend
compassion and forgiveness
(steps on slide 18) to these
thoughts, feelings, and actions
Thoughts Action • This takes practice writing out
thoughts, feelings, and actions
that are coming to the
judgmental mind help the wise
mind see them for what they are,
(p. 155) accept them, and let them go
Feelings

(Forsyth & Eirfert, 2007)

18 Moving Toward A Valued Life

• Identify well-defined and achievable goals

• Identify necessary steps to achieving the goals then arrange them in a
logical order
• Make a commitment to take a step
• Practice living your values in difficult situations
• Here is a sample chart that might help (p. 253)
My Value:
Goal I want to achieve:
(p. 253)
Steps to goal Barriers Strategies Date(s) achieved

(Forsyth & Eirfert, 2007)

19 Staying the Course

• Tips to Keep On Moving (p. 256-261)

• Recommit to action after breaking a commitment
• Getting back on track is what matters
• Move with barriers and setbacks
• Do not let your mind trap you
• Watch for idleness and fill it with activity
• Practice flexibility
• Emotional discomfort can be your teacher
• Always Remember: A meaningful life is built one step at a
time and the choice is yours!

(Forsyth & Eirfert, 2007)

 Summary
Tools & Counselling Applications
• Disorder Symptoms Checklists (slide 5)
• Mind Watching and Mindful Walking
for observing experiences (slide 8)
• Anxiety Management History and
Anxiety Coping Strategies Costs
Worksheets (slide 9)
• Funeral Meditation, Epitaphs, and
Living in Full Experience Forms (slide
10)
• Mindful Acceptance Introduction
Activities(slide 13 & slide14)
• Valued Directions Worksheet (slide 16)
• Techniques for letting go of the anxiety
struggle (slide 17)
• TLC strategies (slide 18)
• Bodily Discomfort Form (slide 19)
• Wise Mind chart (slide 20)
• Values and Goals Worksheet (slide 21)
Hot Topics
• ACT focuses on accepting anxiety,
rather than attempting to manage it;
this concept contradicts traditional CBT
perspective that believes developing
tools for anxiety (like changing
cognitions) will manage the symptoms
• The myths about anxiety outlined in
the workbook have been disputed by
medical-model of mental illness
(American Psychiatric Association,
2013)
• ACT approaches stressful events by
looking inwards with self-compassion
as opposed to attempting to
externalizing solutions
• Wise mind is a internal source of self-
efficacy and self-compassion that ACT
helps individuals develop
 Additional Resources
To you provide you with additional resources pertaining to ACT, a brief synopsis of the following articles
can be found below. Full references are on the following slide.
Arch & Craske (2008): While there are marked differences between the techniques used in ACT and CBT there are similar mechanisms at play
in their empirically validated outcomes. ACT and CBT work to develop an objective stance to thoughts, feelings, and behaviours while
providing responsive techniques to aversive stimuli that produces long-term success at symptom reduction
 
Arch, Eifert, Davies, Vilardaga, Rose, & Craske (2012): This study tested the hypothesis that ACT would yield better client improvement in
mixed-anxiety symptoms than CBT. Although the study only found partial results, ACT approach lead to higher psychological flexibility than
CBT.

Baer (2003): Findings from this meta-analysis demonstrate that mindfulness-based interventions are helpful in treatment across anxiety and
depressive disorders, in in- and outpatient populations, and improves psychological functioning. An ACT mindfulness technique: separating
the person from their thoughts, feelings, and behaviours for example rather than saying, “I’m a bad person,” try, “I am having a thought that
I’m a bad person.”
 
Fledderus, Bohlmeijer, Pieterse, & Schreuers (2012): Significant reductions in depression, anxiety, fatigue, avoidance, and improvement of
mental health were found in the experimental group. Follow-up at the 3-month mark showed that these effects remained.
This research validates the use of books such as the one this one by Forsyth and Eifert (2007).
 
Karlin, Walser, Yesavage, Zhang, Trockel, & Taylor (2013): This study found that ACT to be an effective therapeutic intervention for depression
with older war veterans.

Luoma, Kohlenberg, Hayes, & Fletcher (2012): This study used a mindfulness and acceptance approach to shame-based substance abuse and
found that ACT techniques resulted in better program attendance and reduced substance use compared to usual treatment approaches.

Shapiro (2009): This review of the literature names many benefits of mindfulness interventions on clients including increased levels of self-
regulation, values clarification, and cognitive and behavioural flexibility.

Twohig (2012): An introduction to ACT and a clinical model for psychological flexibility and provides a thorough overview of empirical support
for ACT, specifically with the treatment of anxiety disorders.
 References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Arch, J. J., & Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar
mechanisms? Clinical Psychology: Science and Practice, 15(4), 263-279. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and
commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25. doi: 10.1016/j.brat.2005.06.006
Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus
acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of consulting and clinical psychology, 80(5), 750. doi: 10.1037/a0028310
Artofmindfulliving (2012, March 26). Handling stressful thoughts. ACT leaves on a stream exercise [Video file]. Retrieved from
http://www.youtube.com/watch?v=FLlVV3dKl9w
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143. doi:
10.1093/clipsy/bpg015
Blonnar (2010, March 10). Conquering your stress podcast #8: introduction to acceptance & commitment therapy (ACT) [Video file]. Retrieved from
http://www.youtube.com/watch?v=8GZcTBVbwz4
Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreuers, K. M. G. (2012). Acceptance and commitment therapy as guided self-help for psychological distress and
positive mental health: A randomized controlled trial. Clinical Medicine, 42, 485-495. doi: 10.1017/S0033291711001206
Forsyth. J. P., & Eifert, G. H. (2007). The mindfulness and acceptance workbook for anxiety. A guide to breaking free from anxiety, phobias, and worry using acceptance
and commitment therapy. Oakland, CA: New Harbinger Publications Inc.
Karlin, B. E., Walser, R. D., Yesavage, J., Zhang, A., Trockel, M., & Taylor, C. B. (2013). Effectiveness of acceptance and commitment therapy for depression: Comparison
among older and younger veterans. Aging & mental health, 17(5), 555-563. doi: 10.1080/13607863.2013.789002
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy
targeting shame in substance use disorders. Journal of consulting and clinical psychology, 80(1), 43. doi: 10.1037/a0026070
Oliver, J. (2011, January 31). The unwelcomed party guest – an acceptance and commitment therapy (ACT) metaphor [Video file]. Retrieved from
http://www.youtube.com/watch?v=VYht-guymF4
Rhinewine, J. (2013, January 25). Mindfulness in acceptance and commitment therapy (ACT), part 1: contact with the present moment [Video file]. Retrieved from
http://www.youtube.com/watch?v=TYPcPh4H3bE
Rhinewine, J. (2013, February 8). The self-as-context: mindfulness in acceptance and commitment therapy, part 4 [Video file]. Retrieved from
http://www.youtube.com/watch?v=sVD_WD_9Avs
Shapiro, S. L. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology, 65(6), 555-600. doi: 10.1002/jclp.20602
Twohig, M. P. (2012). Acceptance and Commitment Therapy. Cognitive and Behavioral Practice, 19(4), 499-507. doi: 10.1016/j.cbpra.2012.04.003