## Practical ACT Exercises for Trauma, Anxiety, or Depression See [[Acceptance and Commitment Therapy (ACT)|Acceptance and Commitment Therapy (ACT)]] ### 1. Cognitive Defusion Exercise: “Leaves on a Stream” Purpose: Help clients detach from intrusive or negative thoughts. **Instructions:** - Ask the client to close their eyes and visualize a stream. - Picture leaves floating on the water. - Each time a thought arises (positive, negative, or neutral), place it on a leaf and let it float by. - Remind the client that thoughts will come and go—they don’t need to hold onto them or push them away. **Trauma/Anxiety Context:** When distressing thoughts from past trauma or future worries arise, the client can visualize placing them on a leaf, reducing their emotional impact. ### 2. Acceptance Exercise: “Struggle Switch” Purpose: Reduce the fight against painful emotions. **Instructions:** - Describe the “struggle switch” as being ON when we resist emotions. - When it’s ON, pain increases (e.g., anxiety about feeling anxious). - Guide the client to notice the urge to resist, and practice allowing emotions to exist without trying to fix them. **Trauma Context:** Useful for clients avoiding memories or emotions. Helps create space for feelings without reactivating trauma. ### 3. Values Exploration: “80th Birthday Exercise” Purpose: Help clients reconnect with meaningful values. **Instructions:** - Ask the client to imagine their 80th birthday. People they love are giving speeches. - What would the client want them to say about their life? - What qualities (e.g., kindness, courage, authenticity) would they want remembered? - Reflect on how their current life aligns with these values. **Depression Context:** This helps clients shift from “getting rid of sadness” to “moving toward what matters,” fostering hope and purpose. ### 4. Committed Action: “Tiny Steps Toward Values” Purpose: Encourage value-based action, even in the presence of distress. **Instructions:** - Identify a small action aligned with their values (e.g., calling a friend, walking outside). - Emphasize: It doesn’t need to feel good—just needs to align with their chosen life direction. - Encourage consistency over intensity. **Depression/Anxiety Context:** Helps break avoidance cycles and build behavioral momentum. ## Sample ACT Session Plan (50-60 min) ### **Session Focus: Trauma + Anxiety** | **Time** | **Component** | **Purpose** | **Example Intervention** | | -------- | ----------------------- | ------------------------------------- | -------------------------------------------------------------------------------------------------------- | | 5 min | Check-In | Build rapport; assess distress level. | “How have things been since we last met?” | | 10 min | Present Moment Exercise | Grounding; introduce mindfulness. | “Let’s spend 2 minutes noticing our breath and sounds around us.” | | 10 min | Cognitive Defusion | Reduce power of intrusive thoughts. | “Let’s try ‘Leaves on a Stream’ together. What did you notice?” | | 10 min | Acceptance & Emotions | Normalize emotions; reduce avoidance. | Discuss the “Struggle Switch” concept. “What emotions do you feel you’re fighting?” | | 10 min | Values Exploration | Shift focus to meaningful living. | “Let’s talk about the kind of life you want to build. What matters most to you?” | | 10 min | Committed Action | Set small, value-driven goal. | “What’s one small action you can take this week that aligns with your values, even if anxiety shows up?” | #### Real-World Example: **Client:** A survivor of a car accident experiencing panic attacks and avoiding driving. **ACT Approach:** - **Defusion:** Externalize thoughts like “I’m not safe” into “I’m having the thought that I’m not safe.” - **Acceptance:** “Anxiety is here because you care about safety—it’s not the enemy.” - **Values:** Reconnect with independence and family connection. - **Action:** Practice driving short distances, accepting anxiety as part of the process. **Key Therapist Mindset in ACT:** - Be curious and non-judgmental. - Normalize discomfort—don’t promise symptom removal. - Model acceptance and willingness during the session. - Reinforce that progress is measured by value-based action, not feeling better.