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 were

done
Counsellingspecific
applications of
the techniques
outlined in the
workbook

ACT &
anxiety

The
theoretical
perspective
of ACT

Hot
topics
in the
field

Additional ACT
theory,
research, &
application
resources

The feel of
each
chapter

Acceptance & Commitment Therapy

Third-wave approach that seeks to change the function of

psychological events and individuals relationship to them
Click here
through strategies such as mindfulness, acceptance, or cognitive for a brief
defusion, rather than changing events directly
overview
Psychological inflexibility results from dominance of past & feared
(Blonnar, 2010)
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:
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
(Rhinewine, 2013)
6. Committed action: short, medium, and long term change
goals
(Hayes, Luoma, Bond, Masuda, & Lillis, 2006)

Choose a New Approach to Get a Different

Outcome

ACT as accept, choose, take action

Choose
Acceptance will help
you make anxiety just
a part of your larger
life (p. 13)
Dont 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
practices?

Realize your
valued life
goals (p.
14)
Do
something
about it

Take Action

Why choose ACT over other CBT

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 isnt a failure, it is simply a fall
of the bike

Hot topic,
check at
the end for
more
information
& watch for
more hot t

(Forsyth & Eirfert,

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)
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 its 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

Phobias

Social
anxiety

OCD

PTSD

GAD

(Forsyth & Eirfert,

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 isnt 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,

Myths About Anxiety & Its Disorders

Anxiety Myths

ACT Truths

Anxiety problems are biological

and hereditary

Genes make you more vulnerable to anxiety

problems but dont give you anxiety problems.

Intense anxiety is abnormal

Intense anxiety is not the problem, its 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,

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 here to view a
cognitive defusion
technique called
mind watching or
leaves on a stream

Click below to learn how

to practice mindful
walking
(URL is in notes section)

(Artofmindfulliving, 2012)

(Forsyth & Eirfert,

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/Ev Anxiety/Con
Anxiety
Effects on
Costs
ent
cern
Coping
You
Behaviour

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

Costs
Short-Term

Long-Term

Benefits
Short-Term

Long-Term

(Forsyth & Eirfert,

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:

Funeral
Meditation
(imagine attending your
own funeral. What did
people say about you?
What did you want to hear
them say?)

Anxiety
Management
Epitaph (what
would your
gravestone say
about your anxiety

&
My Valued
Life Epitaph

management?)

(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)

(Forsyth & Eirfert,

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,

You Control Your Choices, Actions, & Destiny

Learning what the difference between what I can and

cannot control
You can control your actions but you cant control
your feelings, thoughts, or other peoples
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 cant?

(Forsyth & Eirfert,

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,

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,

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,

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,

14

Getting 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 youre 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.
Id like to go to the mall but Im 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,

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
(Forsyth & Eirfert,

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,

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
Wise
Mind

Though
ts

(p. 155)

Action

Feelings

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
(Forsyth & Eirfert,

Moving Toward A Valued Life

18

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:
Steps
to goal
(p. 253)

Barriers

Strategies

Date(s) achieved

(Forsyth & Eirfert,

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,

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 medicalmodel 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 selfcompassion 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, Im a bad person, try, I am having a thought that Im 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 shamebased 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.

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