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White Bear Supression Inventory (WBSI)

Please indicate the degree to which you agree with each of the following items using the scale below. Simply circle your
response to each item.

1 2 3 4 5
strongly disagree somewhat neither agree agree strongly
disagree nor disagree somewhat agree

1. There are things I prefer not to think about. 1 2 3 4 5


2. Sometimes I wonder why I have the thoughts I do. 1 2 3 4 5
3. I have thoughts that I cannot stop. 1 2 3 4 5
4. There are images that come to mind that I cannot 1 2 3 4 5
erase.
5. My thoughts frequently return to one idea. 1 2 3 4 5
6. I wish I could stop thinking of certain things. 1 2 3 4 5
7. Sometimes my mind races so fast I wish I could stop 1 2 3 4 5
it.
8. I always try to put problems out of mind. 1 2 3 4 5
9. There are thoughts that keep jumping into my head. 1 2 3 4 5
10. Sometimes I stay busy just to keep thoughts from 1 2 3 4 5
intruding on my mind.
11. There are things that I try not to think about. 1 2 3 4 5
12. Sometimes I really wish I could stop thinking. 1 2 3 4 5
13. I often do things to distract myself from my 1 2 3 4 5
thoughts.
14. I often have thoughts that I try to avoid. 1 2 3 4 5
15. There are many thoughts that I have that I don’t 1 2 3 4 5
tell anyone.

Copyright (1994) by Blackwell Publishing Company. Reprinted with permission of the publisher.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance and Action Questionnaire (AAQ 19)

Below you will find a list of statements. Please rate how true each statement is for you by circling a number next to it. Use the
scale below to make your choice.
1 2 3 4 5 6 7
never very seldom true seldom sometimes frequently almost always always
true true true true true true

1. I am able to take action on a problem even if I am 1 2 3 4 5 6 7


uncertain what is the right thing to do.
2. When I feel depressed or anxious, I am unable to 1 2 3 4 5 6 7
take care of my responsibilities.
3. I try to suppress thoughts and feelings that I don’t 1 2 3 4 5 6 7
like by just not thinking about them.
4. It’s okay to feel depressed or anxious. 1 2 3 4 5 6 7
5. I rarely worry about getting my anxieties, worries, 1 2 3 4 5 6 7
and feelings under control.
6. In order for me to do something important, I have to 1 2 3 4 5 6 7
have all my doubts worked out.
7. I’m not afraid of my feelings. 1 2 3 4 5 6 7
8. I try hard to avoid feeling depressed or anxious. 1 2 3 4 5 6 7
9. Anxiety is bad. 1 2 3 4 5 6 7
10. Despite doubts, I feel as though I can set a course 1 2 3 4 5 6 7
in my life and then stick to it.
11. If I could magically remove all the painful experi- 1 2 3 4 5 6 7
ences I’ve had in my life, I would do so.
12. I am in control of my life. 1 2 3 4 5 6 7
13. If I get bored with a task, I can still complete it. 1 2 3 4 5 6 7
14. Worries can get in the way of my success. 1 2 3 4 5 6 7
15. I should act according to my feelings at the time. 1 2 3 4 5 6 7
16. If I promised to do something, I’ll do it, even if I 1 2 3 4 5 6 7
later don’t feel like it.
17. I often catch myself daydreaming about things I’ve 1 2 3 4 5 6 7
done and what I would do differently next time.
18. When I evaluate something negatively, I usually 1 2 3 4 5 6 7
recognize that this is just a reaction, not an objec-
tive fact.
19. When I compare myself to other people, it seems 1 2 3 4 5 6 7
that most of them are handling their lives better
than I do.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Mindfulness Attention Awareness Scale (MAAS)

Please indicate the degree to which you agree with each of the following items using the scale below. Simply circle your
response to each item.

1 2 3 4 5 6
almost very somewhat somewhat very almost
always frequently frequently infrequently infrequently never

1. I could be experiencing some emotion and not be 1 2 3 4 5 6


conscious of it until some time later.
2. I break or spill things because of carelessness, not 1 2 3 4 5 6
paying attention, or thinking of something else.
3. I find it difficult to stay focused on what’s happening 1 2 3 4 5 6
in the present.
4. I tend to walk quickly to get where I’m going with- 1 2 3 4 5 6
out paying attention to what I experience along the
way.
5. I tend not to notice feelings of physical tension or 1 2 3 4 5 6
discomfort until they really grab my attention.
6. I forget a person’s name almost as soon as I’ve been 1 2 3 4 5 6
told it for the first time.
7. It seems I am “running on automatic” without much 1 2 3 4 5 6
awareness of what I’m doing.
8. I rush through activities without being really atten- 1 2 3 4 5 6
tive to them.
9. I get so focused on the goal I want to achieve that I 1 2 3 4 5 6
lose touch with what I am doing right now to get
there.
10. I do jobs or tasks automatically, without being 1 2 3 4 5 6
aware of what I’m doing.
11. I find myself listening to someone with one ear, 1 2 3 4 5 6
doing something else at the same time.
12. I drive places on “automatic pilot” and then won- 1 2 3 4 5 6
der why I went there.
13. I find myself preoccupied with the future or the 1 2 3 4 5 6
past.
14. I find myself doing things without paying attention. 1 2 3 4 5 6
15. I snack without being aware that I’m eating. 1 2 3 4 5 6

Copyright (2003) by the American Psychological Association. Reprinted with permission of the publisher.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Emotional Avoidance Detour Illustration -- Ch 4

“Emotional avoidance detour” was illustrated and conceptualized by Joseph Ciarrochi and David Mercer, University of Wollongong, NSW, Australia.
Reprinted with permission of the authors.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Daily ACT Ratings Form -- Ch 7

DAILY ACT RATINGS


Life Enhancement Exercise Record Form

At the end of each day, please make a rating for each of the following four questions using the scale below. Ratings for each
question can range from 0 (not at all) to 10 (extreme amount):

0 1 2 3 4 5 6 7 8 9 10
None / Not at all Extreme amount

Suffering: How upset and distressed over anxiety were you today overall?

Struggle: How much effort did you put into making anxiety-related feelings or thoughts go away today (for example, by sup-
pressing them; distracting yourself; reassuring yourself or seeking reassurance from someone else)?

Workability: If life in general were like today, to what degree would today be part of a vital, workable way of living for you?

Valued Action: How much have you engaged in behaviors (actions) today that accord with your values and life goals?

Day Suffering Struggle Workability Valued Action


0–10 0–10 0–10 0–10
Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Centering Exercise Instructions -- Ch 7

This little exercise will help clients focus on where they are right now and why they are here. This exercise should take about five
minutes to complete. Just like with any other exercise or activity, before you start, ask clients whether they are willing to do it.
We suggest that therapists read the instructions to clients in a slow and soft fashion.

1. Go ahead and get in a comfortable position in your chair. Sit upright with your feet flat on the floor, your arms
and legs uncrossed, and your hands resting in your lap. Allow your eyes to close gently [pause 10 seconds].
Take a couple of gentle breaths: in … and out—in … and out. Notice the sound and feel of your own breath
as you breathe in [pause] and out [pause 10 seconds].

2. Now turn your attention to being inside this room. Notice any sounds that may occur inside the room [pause]
and outside [pause 10 seconds]. Notice how you are sitting in your chair [pause 10 seconds]. Focus on the
place where your body touches the chair. What are the sensations there? How does it feel to sit where you sit?
[pause 10 seconds] Next, notice the places where your body touches itself [pause 10 seconds]. Notice the spot
where your hands touch your legs. How do your feet feel in the position that they are in? [pause 10 seconds]
What sensations can you notice in the rest of your body? If you feel any sensations in your body, just notice
them and acknowledge their presence [pause 10 seconds]. Also notice how they may, by themselves, change
or shift from moment to moment. Do not try to change them [pause 10 seconds].

3. Now let yourself be in this room. See if you can feel the investment of you and I in this room—what we are
here for [pause 10 seconds]. If you are thinking this sounds weird, just notice that and come back to the sense
of integrity in this room. Be aware of the value that you and I are serving by being here [pause 10 seconds]. See
if you can allow yourself to be present with what you are afraid of. Notice any doubts, reservations, fears, and
worries [pause 10 seconds]. See if you can just notice them, acknowledge their presence, and make some
space for them [pause 10 seconds]. You don’t need to make them go away or work on them [pause 10 sec-
onds]. Now see if for just a moment you can be present with your values and commitments. Why are you here?
Where do you want to go? What do you want to do? [pause 10 seconds]

4. Then, when you are ready, let go of those thoughts and gradually widen your attention to take in the sounds
around you [pause 10 seconds] and slowly open your eyes with the intention to bring this awareness to the
present moment and the rest of the day.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Ratings of Distress and Disablement Form -- Ch 7

RATINGS OF DISTRESS AND DISABLEMENT

0 1 2 3 4 5 6 7 8
Not at all Mildly Moderately Strongly Extremely

Domain Distress (0–8) Disablement (0–8)

Social Anxiety _______________________________ _______________________________

Post-traumatic stress disorder _______________________________ _______________________________

Panic disorder/agoraphobia _______________________________ _______________________________

Generalized anxiety disorder _______________________________ _______________________________

Obsessions and compulsions _______________________________ _______________________________

Specific phobias _______________________________ _______________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Living in Full Experience (LIFE) Form -- Ch 7

LIVING IN FULL EXPERIENCE—THE LIFE FORM


A Life Enhancement Exercise

Date: / / Time: A.M./P.M.

Check off any sensations you experienced just now:

Check what emotion best describes your experience of these sensations (pick one):

Now rate how strongly you felt this emotion/feeling (circle number):
0 1 2 3 4 5 6 7 8
Mild/Weak Moderate Extremely Intense

Now rate how willing you were to have these sensations/feelings without acting on them (e.g., to manage them, get rid of
them, suppress them, run from them):
0 1 2 3 4 5 6 7 8
Extremely Willing Moderate Completely Unwilling

Describe where you were when these sensations occurred: _________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Describe what you were doing when these sensations occurred: _____________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Describe what your mind was telling you about the sensations/feelings: _______________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Describe what you did (if anything) about the sensations/feelings: __________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

If you did anything about the sensations or feelings, did it get in the way of anything you really value or care about? If so,
describe what that was here: ________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Thoughts and Feelings Exercise Instructions -- Ch 8 1

1. First, I would like to ask your permission to do another experiential exercise. Are you willing to do that? [Get clients’
permission and then move on.]

2. Go ahead and get in a comfortable position in your chair. Sit upright with your feet flat on the floor, your arms
and legs uncrossed, and your hands resting in your lap (palms up or down, whichever is more comfortable).
Allow your eyes to close gently [pause 10 seconds].

3. Take a few moments to get in touch with the movement of your breath and the sensations in the body [pause
10 seconds]. Bring your awareness to the physical sensations in your body, especially to the sensations of
touch or pressure, where your body makes contact with the chair or floor [pause 10 seconds].

4. Now, slowly bring your attention to the gentle rising and falling of your breath in your chest and belly. Like
ocean waves coming in and out, your breath is always there. Notice its rhythm in your body [pause 10 sec-
onds]. Notice each breath. Focus on each inhale … and exhale [pause 10 seconds]. Notice the changing pat-
terns of sensations in your belly as you breathe in, and as you breathe out [pause 10 seconds]. Take a few
moments to feel the physical sensations as you breathe in and as you breathe out [pause 10 seconds].

5. There is no need to try to control your breathing in any way—simply let the breath breathe itself [pause 10
seconds]. As best you can, also bring this attitude of generous allowing and gentle acceptance to the rest of
your experience. There is nothing to be fixed, no particular state to be achieved. As best as you can, simply
allow your experience to be your experience, without needing it to be other than what it is [pause 15 seconds].

6. Sooner or later, your mind will wander away from the breath to other concerns, thoughts, worries, images,
bodily sensations, planning, or daydreams, or it may just drift along. This is what minds do much of the time.
When you notice that your mind has wandered, gently congratulate yourself—you have come back and are
once more aware of your experience! You may want to acknowledge briefly where your mind has been (Ah,
there’s thinking or there’s feeling). Then, gently escort your attention back to the sensation of the breath coming
in and going out [pause 10 seconds]. As best you can, bring a quality of kindness and compassion to your
awareness, perhaps seeing the repeated wanderings of your mind as opportunities to bring patience and gentle
curiosity to your experience [pause 15 seconds].

7. When you become aware of bodily sensations and feelings, tension, or other intense sensations in a particular
part of your body, just notice them, acknowledge their presence, and see if you can make space for them
[pause 10 seconds]. Do not try to hold on to them or make them go away [pause 10 seconds]. See if you can
open your heart and make some room for the discomfort, for the tension, for the anxiety, just allowing them
be there [pause 10 seconds]. Is there enough space in you to welcome in all of your experience? [pause 15
seconds]

8. Watch the sensations change from moment to moment. Sometimes they grow stronger [pause 10 seconds],
sometimes they stay the same [pause 10 seconds], and sometimes they grow weaker—it does not matter
[pause 10 seconds]. Breathe calmly in to and out from the sensations of discomfort, imagining the breath
moving in to and out from that region of the body [pause 10 seconds]. Remember, your intention is not to
make you feel better but to get better at feeling [pause 15 seconds].

9. If you ever notice that you are unable to focus on your breathing because of intense physical sensations of
discomfort in your body, let go of your focus on the breath and shift your focus to the place of discomfort.
Gently direct your attention on and into the discomfort and stay with it, no matter how bad it seems [pause 10

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Thoughts and Feelings Exercise Instructions -- Ch 8 2

seconds]. Take a look at it. What does it really feel like? [pause 10 seconds] Again, see if you can make room
for the discomfort and allow it to be there [pause 10 seconds]. Are you willing to be with whatever you have?
[pause 15 seconds]

10. Along with physical sensations in your body, you may also notice thoughts about the sensations and
thoughts about the thoughts [pause 10 seconds]. You may notice your mind coming up with evaluative
labels such as “dangerous” or “getting worse.” If that happens, you can thank your mind for the label [pause]
and return to the present experience as it is, not as your mind says it is, noticing thoughts as thoughts, physi-
cal sensations as physical sensations, feelings as feelings—nothing more, nothing less [pause 15 seconds].

11. To help you experience the difference between yourself and your thoughts and feelings, you can name
thoughts and feelings as you notice them. For instance, if you notice you are worrying, silently say to yourself,
“Worry … there is worry” just observing worry and not judging yourself for having these thoughts and feel-
ings [pause 10 seconds]. If you find yourself judging, just notice that and call it “Judging ... there is judging”
and observe that with a quality of kindness and compassion [pause 10 seconds]. You can do the same with
other thoughts and feelings and just name them as planning, reminiscing, longing, or whatever you experience.
Label the thought or emotion and move on [pause 10 seconds]. Thoughts and feelings come and go in your
mind and body. You are not what those thoughts and feelings say, no matter how persistent or intense they
may be [pause 15 seconds].

12. As this time for formal practice comes to an end, gradually widen your attention to take in the sounds
around you … notice your surroundings [pause] and slowly open your eyes with the intention to bring this
awareness to the present moment and into the upcoming moments of the day.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Thoughts and Feelings Practice Form -- Ch 8

ACCEPTANCE OF THOUGHTS AND FEELINGS

Life Enhancement Exercise Practice Form

In the first (left) column, record whether you make a commitment to practice the Acceptance of Thoughts and Feelings
exercise that day and include the date. In the second column, record whether you actually practiced, when you practiced,
and how long you practiced. In the third column, record whether you used a tape or not. In the fourth column, write down
anything that comes up during your practice and that you would like to talk about at our next meeting.

Commitment: yes/no Practiced: yes/no Tape/CD: Comments


Date: When practiced? yes / no
How long (min.)?

Saturday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Sunday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Monday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Tuesday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Wednesday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Thursday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Friday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Write Your Own Epitaph Worksheet -- Ch 8

WRITE YOUR OWN EPITAPH


“WHAT DO I WANT MY LIFE TO STAND FOR?”

An Experiential Life Enhancement Exercise

Here Lies
___________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


What Have I Given Up for Anxiety This Week? Worksheet -- Ch 8

WHAT HAVE I GIVEN UP FOR ANXIETY THIS WEEK?

Life Enhancement Exercise Record Form

The purpose of completing this exercise and record form is to let you examine on a daily basis how costly managing your anx-
iety is for you. What are you giving up in order to manage, reduce, and avoid anxiety? What opportunities to do things that
you like or that matter to you are you trading in to control and manage anxiety? What are you missing out on?
In the first (left) column, record the situation or event that triggered your anxiety, concerns, or worries. In the second
column, write down your anxiety, bodily sensations, thoughts, concerns, or worries. In the third column, record what you
actually ended up doing to manage your anxiety. In the fourth column, record what effect your efforts to control or reduce
your anxiety had on you. For instance, how did you feel afterward? In the fifth (right) column, write down the consequences
and costs associated with your efforts to manage your anxiety. What did you give up or miss out on?

Situation/Event Anxiety/Concern Anxiety Control Effect on You Costs


Example: was invited Example: was afraid of Behavior Example: felt lonely, Example: lost out on a
to go out with some having a panic attack Example: stayed at sad, and angry with good time with my
friends home and watched myself for being so friends; missed an
TV weak opportunity to deepen
friendships

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Valued Directions Worksheet -- Ch 9 1

VALUED DIRECTIONS

Below are areas of life that some people value. We are concerned with your quality of life in each of these areas. One aspect of
quality of life involves the importance you put on different areas of living. First rate the importance of each area by circling a
number on a scale of 0, 1, or 2. Not everyone will value all of these areas, or value all areas the same. Rate each area according
to your own personal sense of importance. If you rated an area as unimportant (0), move right on to rate the importance of the
next area. If you rated an area moderately or very important (1 or 2), make a rating of how satisfied you are with the quality
and depth of your experience in this area of life. Then rate how often you have done something to move you forward in this
area during the last week. After completing your ratings, write down your intention of how you would like to live your life in
that area (e.g., what is most important to you in that area?) Always leave the second line (barriers) blank. We will discuss
them and complete those lines in the next session.

Family (other than marriage or parenting): How do you want to interact with your family members? What type of sister or
brother do you want to be? What type of son or daughter do you want to be?

How important is this area to you?


0 = not at all 1 = moderately 2 = very important

Overall, how satisfied are you with the quality and depth of your experience in this area of life?
0 = not at all 1 = moderately 2 = very important

How often have you done something to move you forward in this area during the last week?
0 = no action 1 = once or twice
2 = three or four times 3 = more than four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Intimate Relationships (e.g., marriage, couples): What is your ideal relationship like? What type of relationship would you like
to have? What kind of partner do you want to be in an intimate relationship? How would you treat your partner?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Valued Directions Worksheet -- Ch 9 2

Parenting: What type of parent do you want to be? How do you want to interact with your children?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Friends / Social Life: What type of friend do you want to be? What does it mean to be a good friend? How would you behave toward
your best friend? Why is friendship important to you?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Work / Career: What do you value about your work? Financial security? Intellectual challenge? Independence? Prestige? Getting to
interact with other people? Helping people? What type of work would you like to do?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Valued Directions Worksheet -- Ch 9 3

Education / Training: Why is learning important to you? Are there any skills you’d like to learn?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Recreation/Fun: What type of activities do you enjoy? What type of activities would you really like to engage in? Why do you enjoy
them?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Spirituality: This domain is about faith and spirituality rather than organized religion. Why is faith important to you? If this is impor-
tant in your life, what is it that makes this so important?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Valued Directions Worksheet -- Ch 9 4

Citizenship/Community Life: What can you do to make the world a brighter place? Are community activities (e.g., volunteering,
voting, recycling) important to you? Why?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

Health/Physical Self-Care: What issues related to health and physical well-being do you care about (e.g., sleep, diet, exercise)?
Why and how do you take care of yourself?
Importance: 0 = not at all 1 = moderately 2 = very important
important important
Satisfaction: 0 = not at all 1 = moderately 2 = very satisfied
satisfied satisfied
Actions (last week): 0 = no action 1 = once or twice 2 = three or 3 = more than
four times four times

Intention: _______________________________________________________________________________________

Barriers: ________________________________________________________________________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Anxiety Exercise Instructions -- Ch 9 1

1. In our previous exercises, we have used the breath as the focus of attention. When the mind wandered off and
started focusing on thoughts, worries, images, or feelings, you were asked to notice these thoughts and feel-
ings and then gently redirect attention back to your breath. In this exercise, we actively and openly invite into
our awareness bodily sensations and unwanted thoughts, worries, and images so that you may learn to
approach them in an accepting and compassionate way. Just like in the finger trap and tug-of-war exercises,
this exercise encourages you to lean into anxiety rather than fight it. Leaning into anxiety means creating a
space for you to feel your emotions and think your thoughts, experiencing them as they are, rather than what
your mind tells you they are. It also provides you with space to do things with your life that you may have put
on hold for a long time. Are you willing to do an exercise to help you do that? [Wait for client’s permission and
then move on.]

2. Go ahead and get in a comfortable position in your chair. Sit upright with your feet flat on the floor, your arms
and legs uncrossed, and your hands resting in your lap (palms up or down, whichever is more comfortable).
Allow your eyes to close gently [pause 10 seconds].

3. Take a few moments to get in touch with the physical sensations in your body, especially the sensations of
touch or pressure where your body makes contact with the chair or floor. Notice the gentle rising and falling
of your breath in your chest and belly. There is no need to control your breathing in any way—simply let the
breath breathe itself [pause 10 seconds]. As best you can, also bring this attitude of allowing and gentle accep-
tance to the rest of your experience. There is nothing to be fixed. Simply allow your experience to be your
experience, without needing it to be other than what it is [pause 10 seconds].

4. It is natural for your mind to wander away to thoughts, worries, images, bodily sensations, or feelings. Notice
these thoughts and feelings, acknowledge their presence, and stay with them [pause 10 seconds]. There is no
need to think of something else, make them go away, or resolve anything. As best you can, allow them to be
… giving yourself space to have whatever you have … bringing a quality of kindness and compassion to your
experience [pause 10 seconds].

5. Allow yourself to be present to what you are afraid of. Notice any doubts, reservations, fears, and worries. Just
notice them and acknowledge their presence, and do not work on them [pause 10 seconds]. Now see if for just
a moment you can be present with your values and commitments. Ask yourself, Why am I here? Where do I
want to go? What do you want to do? [pause 15 seconds]

6. Now focus on a thought or situation that has been difficult for you. It could be a particular troubling thought,
worry, image, or intense bodily sensations [pause 10 seconds]. Gently, directly, and firmly shift your attention
on and into the discomfort, no matter how bad it seems [pause 10 seconds]. Notice any strong feelings that
may arise in your body, allowing them to be as they are rather than what you think they are, simply holding
them in awareness [pause 10 seconds]. Stay with your discomfort and breathe with it [pause 10 seconds]. See
if you can gently open up to it and make space for it, accepting and allowing it to be [pause], while bringing
compassionate and focused attention to the sensations of discomfort [pause 15 seconds].

7. If you notice yourself tensing up and resisting what you have, pushing away from the experience, acknowl-
edge that and see if you can make some space for whatever you’re experiencing [pause 10 seconds]. Must this
feeling or thought be your enemy? [pause 10 seconds] Or can you have it, notice it, own it, and let it be?
[pause 10 seconds] Can you make room for the discomfort, for the tension, for the anxiety? [pause 10 sec-
onds] What does it really feel like—moment to moment—to have them? [pause 10 seconds] Is this

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Anxiety Exercise Instructions -- Ch 9 2

something you must struggle with or can you invite the discomfort in, saying to yourself with willingness, “Let
me have it; let me feel what there is to be felt because it is my experience right now”? [pause 15 seconds]

8. If the sensations or discomfort grow stronger, acknowledge their presence, stay with them [pause 10 sec-
onds], breathing with them, accepting them [pause 10 seconds]. Is this discomfort something you must not
have, you cannot have? [pause 10 seconds] Even if your mind tells you that you cannot, can you open up a
space for it in your heart? [pause 10 seconds] Is there room inside you to feel that with compassion and kind-
ness twoard yourself and your experience? [pause 15 seconds]

9. Apart from physical sensations in the body, you may also notice thoughts coming along with the sensations,
and thoughts about the thoughts. When you notice any such thoughts, also invite them in . . . softening and
opening to them as you become aware of them [pause 10 seconds]. You may also notice your mind coming up
with evaluative labels such as “dangerous” or “getting worse.” If that happens, you can simply thank your
mind for the label [pause 10 seconds] and return to the present experience as it is, not as your mind says it is,
noticing thoughts as thoughts, physical sensations as physical sensations, feelings as feelings—nothing more,
nothing less [pause 15 seconds].

10. Stay with your discomfort for as long as it pulls on your attention [pause 10 seconds]. If and when you sense
that the anxiety and other discomfort are no longer pulling for your attention, let them go [pause 15
seconds].

11. Then, when you are ready, gradually widen your attention to take in the sounds around you in this room
[pause 10 seconds]. Take a moment to make the intention to bring this sense of gentle allowing and
self-acceptance into the present moment [pause 5 seconds], and when you are ready, slowly open your eyes.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Acceptance of Anxiety Record Form -- Ch 9

ACCEPTANCE OF ANXIETY

Life Enhancement Exercise Record Form

In the first (left) column, record whether you made a commitment to practice the Acceptance of Anxiety exercise that day
and include the date. In the second column, record whether you actually practiced, when you practiced, and how long you
practiced. In the third column, record whether you used a tape or not. In the fourth column, write down anything that comes
up during your practice and that you would like to talk about at our next meeting.

Commitment: yes/no Practiced: yes/no Tape/CD: Comments


Date: When practiced? yes / no
How long (min.)?

Saturday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Sunday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Monday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Tuesday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Wednesday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Thursday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

Friday: Practiced: yes / no


Date: Time: A.M./P.M.
Minutes:

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Anxiety News Radio Metaphor -- Ch 9

ANXIETY NEWS RADIO (WANR): “This is Anxiety News Radio, WANR, broadcasting inside your head
twenty-four hours a day, seven days a week. Wherever you are, the signal will reach you. When you wake in the
early hours, we’ll be there to make you aware of all the unhappy aspects of your life, even before you get out of bed.
Let us take over and control your life. Anxiety News Radio is compelling listening, and guess why! It’s the news
station you’ve grown up with, and now it comes to you automatically, 24/7. Pay attention! Anxiety News Radio
knows what’s best for you and we want you to buy our products. We advertise only what is most disturbing and dis-
tressing to you personally. So don’t forget that, and remember, if you should forget us and ACT without seeking
permission, then we’ll broadcast all the louder. Remember, what you think and feel inside your skin can be really
awful, so you should stay tuned to this station to know what to think and how to control it.”

JUST SO RADIO (WJSR): “Wake up! Anxiety News Radio is just a station—you can tune in, or you can tune
out! One thing is guaranteed though, whatever the time of day, you’ll hear the same old stuff on WANR. If that’s
been really helpful to you, then go ahead, tune in and stay tuned. That would make sense. If not, then tune in more
often to Just So Radio. We bring you the news of actual experience, in the moment—all live, all the time. Actuality
is our business! We give it to you straight—as it is, not as your mind says it is. In contact with the world outside and
inside the skin, you can experience what it is to be human, and it’s entirely free! We can guarantee that experienc-
ing what’s inside the skin—exactly as it is—will never damage you, but it just might bring you joy. Just So Radio
brings you information about how things are, not how you fear they might be. Just So Radio invites you to step for-
ward and touch the world, just as it is, and to touch your life, just as it is. We get louder the more you listen to us.
So, stay tuned. Give us a fair trial, and if not convinced by your own experience (please don’t take our word for it)
then WANR—Anxiety News Radio—is still there on the dial.”

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


LIFE COMPASS
Life Compass -- Ch 9

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Figure 3. The Life Compass—a behavioral compass of valued life domains, intentions in each area, and potential barriers to reaching those goals (adapted from Dahl et al., 2004;
Copyright 2004 by the Association for the Advancement of Behavior Therapy). Reprinted by permission of the publisher.
Bus Driver Diagram -- Ch 10

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


General Format and Procedure of FEEL Exercises -- Ch 10

General Format and Procedure of FEEL Exercises

1. Provide the rationale for the exercise and ask clients to apply a mindfulness posture during exercise.

2. Conduct FEEL exercises, continuing for 30 to 60 seconds beyond the point at which the sensations are first
noticed, and 5 minutes beyond the point at which the imagery is vivid.

3. Obtain FEEL Record ratings.

4. Ask clients to return to mindfulness practice for approximately 1 to 2 minutes, and provide occasional
prompts for clients to observe and make space for what they are experiencing.

5. Ask what clients did during the FEEL exercise and briefly discuss their experience; also provide feedback and,
if necessary, make suggestions for mindful acceptance.

6. If clients report or show high levels of unwillingness, struggle, or avoidance, therapists should conduct a more
closely guided FEEL exercise (see section below). Therapists can also use these exercises to defuse any
evaluative thoughts clients report (“This is not working,” “I can’t stand this anxiety anymore”). Ask clients to
approach the exercise from an observer perspective the next time (“I am having the thought that this is not
working,” “I am having the thought that I can’t stand this anxiety anymore”).

7. Repeat FEEL exercises in this session and, if necessary, in subsequent sessions until client willingness levels
are 7 or higher and struggle and avoidance levels are 3 or lower.

8. Include at least one full repetition of a particular FEEL exercise in subsequent sessions.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


FEEL Sensation Record -- Ch 10

FEEL SENSATION RECORD


(FEELING EXPERIENCES ENRICHES LIVING)

Date: Time: A.M./P.M.

0 1 2 3 4 5 6 7 8 9 10
Low Moderate Extreme

Sensations Willingness to Struggle with Avoidance of


Intensity Anxiety Level Experience Experience Experience
Exercise (0–10) (0–10) (0–10) (0–10) (0–10)

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


FEEL Imagery Record -- Ch 10

FEEL IMAGERY RECORD


(FEELING EXPERIENCES ENRICHES LIVING)

Date: Time: A.M./P.M.

0 1 2 3 4 5 6 7 8 9 10
Low Moderate Extreme

Sensations Willingness to Struggle with Avoidance of


Intensity Anxiety Level Experience Experience Experience
Exercise (0–10) (0–10) (0–10) (0–10) (0–10)

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

_______________ _______________ _______________ _______________ _______________ _______________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Weekly Valued Life Goal Activities Form -- Ch 10

WEEKLY VALUED LIFE GOAL ACTIVITIES

Life Enhancement Exercise Record Form

Record your FEEL exercises and other goal-related activities for each day of the week, based on your commitments made in
session. Record whether you engaged in the activity and how much time you spent on each activity. Then rate how much
anxiety you experienced, how willing you were to have what you experienced, and how much you struggled with your experi-
ence at the beginning and at the end of each activity using the same 0 (low) to 10 (high) scale as on the FEEL forms.

Day Activity Yes/No Duration Anxiety Willingness Struggle


Commitment (minutes) Beg/End Beg/End Beg/End
Mon _____________________________ Y/N ________ / / /
_____________________________
_____________________________

Tues _____________________________ Y/N ________ / / /


_____________________________
_____________________________

Wed _____________________________ Y/N ________ / / /


_____________________________
_____________________________

Thurs _____________________________ Y/N ________ / / /


_____________________________
_____________________________

Fri _____________________________ Y/N ________ / / /

_____________________________
_____________________________

Sat _____________________________ Y/N ________ / / /


_____________________________
_____________________________

Sun _____________________________ Y/N ________ / / /


_____________________________
_____________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Watching Thoughts Drift By Instructions -- Ch 11

1. First, I would like to ask your permission to do another mindfulness exercise. Are you willing to go ahead with
that? [Get clients’ permission and then move on.]

2. Just get in a comfortable position in your chair. Sit upright with your feet flat on the floor, your arms and legs
uncrossed, and your hands resting in your lap, palms up or down, whichever is more comfortable. Allow your
eyes to close gently [pause 10 seconds].

3. Take a few moments to get in touch with the physical sensations in your body, especially the sensations of
touch or pressure where your body makes contact with the chair or floor [pause 10 seconds].

4. It is okay for your mind to wander away to thoughts, worries, images, bodily sensations, or feelings. Notice
these thoughts and feelings and acknowledge their presence. Just observe passively the flow of your thoughts,
one after another, without trying to figure out their meaning or their relationship to one another. As best you
can, bring an attitude of allowing and gentle acceptance to your experience. There is nothing to be fixed. Sim-
ply allow your experience to be your experience, without needing it to be other than what it is [pause 15
seconds].

5. Now, please imagine sitting next to a stream [pause 10 seconds]. As you gaze at the stream, you notice a num-
ber of leaves on the surface of the water. Keep looking at the leaves and watch them slowly drift downstream
from left to right [pause 15 seconds].

6. Now, when thoughts come along into your mind, put each one on a leaf, and observe as each leaf comes closer
to you. Then watch it slowly moving away from you, eventually drifting out of sight. Return to gazing at the
stream, waiting for the next leaf to float by with a new thought [pause 10 seconds]. If one comes along, again,
watch it come closer to you and then let it drift out of sight. Think whatever thoughts you think and allow
them to flow freely on each leaf, one by one. Imagine your thoughts floating by like leaves down a stream
[pause 15 seconds].

7. You can also allow yourself to take the perspective of the stream, just like in the chessboard exercise. Being
the stream, you hold each of the leaves and notice the thought that each leaf carries as it sails by. You need
not interfere with them—just let them flow and do what they do [pause 15 seconds].

8. Then, when you are ready, let go of those thoughts and gradually widen your attention to take in the sounds
around you in this room [pause 10 seconds]. Take a moment to make the intention to bring this sense of gen-
tle allowing and self-acceptance into the present moment … and when you are ready, slowly open your eyes.

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005


Goal Achievement Record -- Ch 11

GOAL ACHIEVEMENT RECORD

Life Enhancement Exercise Record Form

First state the name of the goal (use a separate record form for each major goal). On the next line, record the date on which
you have set your goal and committed to it. Use the following lines in the left column to record the activities (mini-goals)
necessary to achieve the larger goal. In the middle column, always record the date you made a commitment to doing an
activity. In the right column, always record the date you completed the activity. Once you have reached the larger goal
stated at the top, you can also record the date you achieved it.

Name of Goal: ___________________________________________________________________


Date Committed to Goal: _______________ Date Goal Achieved: _____________________________________
Activities Date Committed Date Completed

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

______________________________________ ___________________________ ___________________________

© Georg H. Eifert and John P. Forsyth/New Harbinger Publications 2005

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