1. Counselling Applications of
The Mindfulness & Acceptance Workbook for Anxiety
Forsyth. J. P., & Eifert, G. H. (2007).
Robyn Polsfut & Molly Hayes

2. What we want you to know by the time we’re done
Counselling-specific applications of the techniques outlined in the workbook
Additional ACT theory, research, & application resources
The theoretical perspective of ACT
Hot topics in the field
The feel of each chapter
ACT & anxiety

3. 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, acceptance, or cognitive defusion, rather than changing events directly
Psychological inflexibility results from dominance of past & feared future/weak self-knowledge, lack of clarity of values, inaction/impulsivity/avoidance, attachment to conceptualized self, experiential avoidance, and cognitive fusion and aims to improve psychological flexibility through the following 6 functions:
Acceptance: active awareness and embracing of psychological experiences
Cognitive defusion: change the way one interacts with or relates to thoughts by creating contexts that downplay the power of negative thoughts
Being present: non-judgmental contact with psychological and physical environments to promote flexible behaviour and direct connections with the world
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)
Values: chosen qualities of purposeful action
Committed action: short, medium, and long term change goals
Click here for a brief overview
(Blonnar, 2010)
(Rhinewine, 2013)
(Hayes, Luoma, Bond, Masuda, & Lillis, 2006)

4. Choose a New Approach to Get a Different Outcome
ACT as “accept, choose, take action” 1
“Acceptance will help you make anxiety just a part of your larger life” (p. 13)
Don’t change your thoughts, watch them with non-judgment
Accept
Choose a direction for your life
Live to be well, rather than living to feel & think well
Choose
Realize your “valued life goals” (p. 14)
Do something about it
Take Action
Hot topic, check at the end for more information & watch for more hot t
Why choose ACT over other CBT practices? “Because research shows that anxiety 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)

5. 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” (p.32) 2
Anxiety tends to be:
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 Attack
Social anxiety
PTSD
GAD
Phobias
OCD
(Forsyth & Eirfert, 2007)

6. 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. 3
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)

7. Myths About Anxiety & Its Disorders4
Anxiety Myths
ACT Truths
Anxiety problems are biological and hereditary
Genes make you more vulnerable to anxiety problems but 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 vital life
“Anxiety management and avoidance leave you feeling safe and less anxious in the short term and greatly limit what you can do. This inaction is the problem” (p.63).
(Forsyth & Eirfert, 2007)

8. 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 5
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”
(URL is in notes section)
Click here to view a cognitive defusion technique called “mind watching” or “leaves on a stream”
(Artofmindfulliving, 2012)
(Forsyth & Eirfert, 2007)

9. Facing the Costs to Take Charge of Your Life6
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)
Take stock of your coping strategies (what are the short and long term costs and benefits of my anxiety management?) (p.91)
Situation/Event
Anxiety/Concern
Anxiety Coping Behaviour
Effects on You
Costs
WAF coping strategy
Costs
Benefits
Short-Term
Long-Term
(Forsyth & Eirfert, 2007)

10. What Matters More to You: Managing Your Anxiety or Living a Good Life?7
Helping you to connect with what you want from this life through a few activities:
Anxiety Management Epitaph (what would your gravestone say about your anxiety management?) & My Valued Life Epitaph (what would your gravestone say if you were free from WAFs?)
Click here for
Living in Full Experience – The Life Form: A Life Enhancement Exercise
(URL is in notes section)
Funeral Meditation
(imagine attending your own funeral. What did people say about you? What did you want to hear them say?)
(Forsyth & Eirfert, 2007)

11. Ending Your Struggle With Anxiety is the Solution8
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
(Forsyth & Eirfert, 2007)

12. You Control Your Choices, Actions, & Destiny9
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)

13. Getting Into Your Life With Mindful Acceptance10
Four qualities of mindful acceptance:
Paying attention
On purpose
In the present moment
Nonjudgmentally
Click below to view a video that explains mindfulness in ACT
(Rhinewine, 2013)
(Forsyth & Eirfert, 2007)

14. Learning Mindful Acceptance11
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)

15. Taking Control of Your Life12
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)

16. Finding Your Values 13
Completing the Valued Directions Worksheet will help you:
Focus on life domains that you find important
Discover your intentions
Highlight if your actions reflect what matters to you
Uncover possible roadblocks to living your values
Click the lotus to see the Valued Directions Worksheet
(URL is in note section)
(Forsyth & Eirfert, 2007)

17. Getting Ready to Face Anxiety With Mindful Acceptance14
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)

18. Bringing Compassion to Your Anxiety15
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
Awareness: wake up the hurt and pain without judgment or denial
Separation: Use your Wise (observing) Mind and invite healing change
Compassionate Witness: Extend compassion to your experience and others
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)

19. Developing Comfort in Your Own Skin16
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:
Identify a valued domain
Practice an exercise from the form
Apply your mindful and acceptance skills
Chart your progress
Reflect on your practice
Repeat exercises
Review your rating on your Bodily Discomfort Form
(p. 219)
(Forsyth & Eirfert, 2007)

20. Developing Comfort With Your Judgmental Mind17
The key to unhinging your mind from traps, suffering, and self-judgment is to engage your wise mind
Wise Mind
The wise mind is able to separate painful thoughts, feelings, and actions
The wise mind is able to extend compassion and forgiveness (steps on slide 18) to these thoughts, feelings, and actions
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, accept them, and let them go
Thoughts
Action
Feelings
(p. 155)
(Forsyth & Eirfert, 2007)

21. Moving Toward A Valued Life18
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)
(p. 253)
My Value:
Goal I want to achieve:
Steps to goal
Barriers
Strategies
Date(s) achieved
(Forsyth & Eirfert, 2007)

22. Staying the Course Tips to Keep On Moving (p. 256-261)19
Tips to Keep On Moving (p )
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)

23. Tools & Counselling Applications
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

24. 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.

25. 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), 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), doi: /j.brat
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: / a
Artofmindfulliving (2012, March 26). Handling stressful thoughts. ACT leaves on a stream exercise [Video file]. Retrieved from
Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), doi: /clipsy/bpg015
Blonnar (2010, March 10). Conquering your stress podcast #8: introduction to acceptance & commitment therapy (ACT) [Video file]. Retrieved from
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, doi: /S
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), doi: /
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: /a
Oliver, J. (2011, January 31). The unwelcomed party guest – an acceptance and commitment therapy (ACT) metaphor [Video file]. Retrieved from
Rhinewine, J. (2013, January 25). Mindfulness in acceptance and commitment therapy (ACT), part 1: contact with the present moment [Video file]. Retrieved from
Rhinewine, J. (2013, February 8). The self-as-context: mindfulness in acceptance and commitment therapy, part 4 [Video file]. Retrieved from
Shapiro, S. L. (2009). The integration of mindfulness and psychology. Journal of Clinical Psychology, 65(6), doi: /jclp.20602
Twohig, M. P. (2012). Acceptance and Commitment Therapy. Cognitive and Behavioral Practice, 19(4), doi: /j.cbpra