ACT Therapy Worksheets PDF: Values, Defusion and Matrix

Most ACT therapy worksheets you find online are links to someone else's handouts, a wall of thumbnails, or a PDF with no notes for the therapist. This page gives you five complete worksheets we wrote ourselves: a values worksheet across ten life areas, a cognitive defusion worksheet for sticky thoughts, a willingness log for acceptance, a committed action plan, and a matrix-style sheet for sorting a week into moves toward and away. Print this page or save it as a PDF, and fill in the first sheet with your client in session.

Around the worksheets is the part for you: the six core processes of acceptance and commitment therapy (ACT) in plain words, how the ACT Matrix works, how to use the sheets in session, what the evidence does and doesn't show, adaptations for teens, chronic pain and telehealth, and how to write ACT work into a progress note.

About these worksheets. ACT was developed by Steven Hayes, Kirk Strosahl and Kelly Wilson, and the ACT Matrix by Kevin Polk and colleagues. Their books, and the handouts other ACT authors publish, are copyrighted, and we don't reproduce them. The explanations, wording and layout on this page are our own, kept short so a client can fill in a sheet in a few minutes.

Every client in this article is invented. Any resemblance to a real person is a coincidence.

How to print this page or save it as a PDF

On a computer: press Ctrl+P (Windows) or Cmd+P (Mac).
On a phone: open your browser's share menu and choose Print.
To keep a PDF: in the print window, choose "Save as PDF" as the printer. You can then send the file to a client or keep it with your other handouts.
To print only the worksheets: in the print preview, find the pages from "Worksheet 1" to "End of the worksheets", and enter just those pages as the page range.
To print one worksheet: look for its title in the preview (for example, "Worksheet 2: Stepping back from a sticky thought") and print just those pages.
If the cookie notice is still open, choose an option first, so it doesn't print across the bottom of every page.

What ACT is, and who developed it

Acceptance and commitment therapy is a behavioral therapy developed by Steven C. Hayes, Kirk D. Strosahl and Kelly G. Wilson. Their book Acceptance and Commitment Therapy (Guilford, 1999) set out the model, and the second edition, The Process and Practice of Mindful Change (Guilford), first published in 2011, made psychological flexibility its organizing idea.

The Association for Contextual Behavioral Science (ACBS), the international professional and research community for ACT, defines psychological flexibility as "the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends" (ACBS, The six core processes of ACT).

The starting idea is simple to say and hard to live. Pain is part of a human life: loss, fear, illness, memories, self-doubt. Much of the suffering that brings people to therapy comes from the struggle to get rid of those experiences: avoiding places, numbing out, arguing with thoughts, waiting to feel ready. That struggle often works for a moment and narrows a life over months. ACT doesn't try to win the argument with a painful thought or feeling. It helps the client hold those experiences more lightly and put their energy into what matters to them. ACBS puts it this way: trying to change difficult thoughts and feelings "in a subtractive or eliminative way as a means of coping can be counter productive" (ACBS, About ACT).

ACT grew alongside Relational Frame Theory, a basic research program on human language and cognition (Hayes et al., 2006). Two practical points follow from how ACBS describes it:

ACT is not a fixed protocol.ACBS describes it as "not a specific set of techniques or a specific protocol." You choose exercises to fit the processes your client is stuck in, which is why worksheets are tools here, not a course to work through in order.
There is no ACT certification.ACBS states plainly: "There is no ACT certification process." It points clinicians to training from peer-reviewed ACT trainers, consultation groups and books instead (ACBS, ACT certification). Your licensing board's rules on practicing within your competence still apply.

The six core processes of ACT

ACT describes psychological flexibility through six processes, often drawn as a hexagon called the hexaflex. Each one has an opposite, a way of being stuck. ACBS lists the stuck side as "emotional inflexibility, cognitive inflexibility, attentional inflexibility, failures in perspective taking, lack of chosen values, and an inability to broaden and build habits of values-based action." Hayes and colleagues have also described the aim as a more "open, aware, and active" approach to living (Hayes et al., 2011), and ACT trainers often pair the processes that way: open (acceptance and defusion), aware (present moment and self-as-context) and active (values and committed action).

1. Acceptance (willingness)

Acceptance means making room for unwanted thoughts, feelings, body sensations, memories and urges, without trying to change how often they come or how strong they are, when the struggle costs more than the feeling. It is not resignation, approval, or putting up with harm. ACBS is clear that acceptance is "not an end in itself": it matters because it frees the client to act on their values.

When it's stuck:experiential avoidance. The client avoids situations, people and tasks, or uses alcohol, scrolling, sleep or reassurance to escape a feeling, and their life gets smaller.
In session:slow down when a feeling shows up, help the client find it in the body and describe it, and use a metaphor such as the tug-of-war with a monster: you can't win, but you can drop the rope.
Worksheet:Worksheet 3, the willingness log.

2. Cognitive defusion

Defusion means stepping back from thoughts so the client can see them as words and pictures their mind is producing, not as facts or orders. It changes how much grip a thought has, not what it says. ACBS describes the result as "usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency." This is the main difference from cognitive restructuring in CBT. A CBT thought record asks whether a thought is accurate. Defusion asks whether holding on to it helps the client live the way they want.

When it's stuck:fusion. The thought "I'll embarrass myself" is treated as a prediction that must be obeyed, so the client stays home.
In session:have the client add "I'm having the thought that..." in front of a thought, say it slowly or in a silly voice, repeat one word until it's only a sound, or watch thoughts float past on leaves on a stream.
Worksheet:Worksheet 2, stepping back from a sticky thought.

3. Contact with the present moment

This is flexible attention to what's happening now, inside and around the client, instead of being lost in worry about the future or going over the past. It's a skill of noticing, not of relaxing.

When it's stuck:rumination, worry and autopilot. The client misses what's in front of them, including the moments that would show them their life is working.
In session:short noticing exercises, pausing when the client drifts into a story to notice what is here right now, and grounding practices such as 5-4-3-2-1 grounding.
Worksheet:the two-minute "making room" practice on Worksheet 3, and the noticing questions on Worksheet 5.

4. Self-as-context (the noticing self)

Self-as-context is the sense of a "you" who notices thoughts, feelings and roles, and isn't the same as any of them. It helps clients who are fused with a story about who they are ("I'm broken," "I'm the strong one"). The chessboard metaphor from the original ACT book is the best known: thoughts and feelings are the pieces at war, and the client is the board that holds them all.

When it's stuck:attachment to a fixed self-story, so any experience that doesn't fit it feels like a threat.
In session:perspective-taking questions ("Who is noticing that thought?"), the chessboard, or the sky and the weather: storms pass through, and the sky is never harmed by them.
Worksheet:the noticing questions at the center of Worksheet 5.

5. Values

ACBS calls values "chosen qualities of purposive action that can never be obtained as an object but can be instantiated moment by moment." In plainer words, a value is how the client wants to act and what they want to stand for, in their relationships, work, health and community. A goal can be finished; a value is a direction. Values are chosen, not imposed: ACBS warns against choices based on avoidance, social compliance or fusion ("I should value X").

When it's stuck:no clear direction, or living by rules and other people's expectations.
In session:ask what the client would want their life to stand for, what they admire in others, or what their pain tells them they care about (we hurt where we care).
Worksheet:Worksheet 1, what matters to me.

6. Committed action

Committed action means taking steps guided by values, building them into bigger patterns, and coming back after getting off track. ACBS notes that here ACT "looks very much like traditional behavior therapy": goal setting, exposure, skills training and activity scheduling all fit. Our behavioral activation worksheets work well alongside this step.

When it's stuck:inaction, impulsive action, or pushing on with something that stopped working long ago.
In session:turn a value into one small, specific step, name what the client's mind will say about it, and plan what they'll do when it does.
Worksheet:Worksheet 4, the committed action plan.

The ACT Matrix: a simpler way to teach ACT

The ACT Matrix was developed by Kevin Polk and colleagues as a way to bring the six processes together in one simple picture. It was introduced in The ACT Matrix, edited by Polk and Benjamin Schoendorff (New Harbinger, 2014), and laid out session by session in The Essential Guide to the ACT Matrix by Polk, Schoendorff, Mark Webster and Fabian Olaz (New Harbinger, 2016). Its publisher describes the approach as one that treats behavior "as workable or unworkable, rather than good or bad."

To draw it, make a large plus sign on a sheet of paper:

The vertical line separates what you can notice with your five senses (above: what you do, what someone could see on a video) from what goes on inside (below: thoughts, feelings, memories, urges).
The horizontal line separates moving away (left) from moving toward (right).
The center is the client, noticing all of it.

The four sections are usually filled in this order:

Bottom right: who and what matters to the client.
Bottom left: the thoughts, feelings, memories and urges that show up and get in the way.
Top left: what the client does to get away from or control that inner stuff (away moves).
Top right: what the client does, or could do, to move toward who and what matters (toward moves).

Then comes the question that does the work: when you do the things on the left, do they bring you closer, in the long run, to the people and things on the bottom right? The same action can sit on either side. Going to the gym can be a toward move (health, energy for the kids) or an away move (escaping a home that feels tense). That's why the matrix asks what an action is for, not what it looks like.

An invented example: Malik, 16, has social anxiety and sketched this with his therapist in their third session.

Who and what matters:his friends, playing bass, his younger sister.
What shows up inside:"They'll think I'm weird," a tight chest, the urge to leave, the memory of freezing during a class presentation.
Away moves:skipping band practice, staying in his room on his phone, saying he's sick on presentation days.
Toward moves:going to practice and staying 20 minutes, texting his friend back, helping his sister with homework.

Most of what's known about the matrix comes from trials of ACT itself. Published studies of matrix-based programs on their own are few and small, such as a single-case study of online matrix training with four mothers (Kurumiya et al., 2022). Treat it as a clear way to teach and organize ACT, not as a separately proven treatment. Worksheet 5 is our matrix-style sorting sheet.

A way to explain ACT to a client

Before the first worksheet, give the client a reason for doing things differently. A rationale you can read aloud and change to fit them:

Wording to copy11 lines

You've worked hard to get rid of these feelings, andsome of what you've tried has helped for a while.But the feelings keep coming back, and avoiding themhas taken things away from you that you care about.In this work, we won't try to win the fight with yourthoughts and feelings. We'll practice holding themmore lightly, so they have less say in what you do.And we'll get clear on what matters to you, and takesmall steps toward it, even when your mind objects.The worksheets are practice between sessions.Does that fit what's been happening for you?

Worksheet 1: What matters to me (ACT values worksheet)

Your values across life areas

Values are about how you want to act and what you want to stand for. They're not things you get, feelings you have, or rules other people set for you. A goal can be finished ("get a new job"). A value is a direction you keep moving in ("doing work that helps people"). Nobody can tell you what your values should be.

For each life area that fits your life, write a few words about the kind of person you want to be there. Then rate it. Skip any area that doesn't fit your life right now.

How to rate

Importance:0 (doesn't matter to me right now) to 10 (matters a great deal).
Living it:0 (not at all this past week) to 10 (fully, this past week).

Partner or close relationship

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Family

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Parenting or caring for others

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Friends and social life

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Work or career

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Learning and growth

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Fun, play and rest

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Health and body

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Faith, spirit or meaning

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Community and the world around me

How I want to be here: ______________________
Importance ___ Living it ___
One small thing I could do this week: ______________________

Words that might help. Circle any that describe how you want to act, or add your own: accepting, adventurous, brave, calm, caring, connected, creative, curious, dependable, encouraging, fair, forgiving, generous, gentle, grateful, hardworking, honest, humble, independent, kind, loving, loyal, open, patient, persistent, playful, present, protective, respectful, responsible, self-caring, skillful, spiritual, supportive, trusting, warm.

Looking at your ratings

The two areas with the biggest gap between importance and living it: ______________________
What gets in the way in those areas (thoughts, feelings, situations): ______________________
Is this my own value, or a "should" from someone else? ______________________
One value I want to act on this week: ______________________

Worksheet 2: Stepping back from a sticky thought (cognitive defusion worksheet)

Your defusion practice

Your mind produces thoughts all day. Many are useful, some are harsh, and some keep you stuck. This sheet doesn't ask you to argue with a thought or make it go away. It helps you see a thought as words your mind is producing, so you can choose what to do whether or not the thought is there. Use it when one thought keeps hooking you.

The thought

The thought, in my mind's exact words: ______________________
When it usually shows up: ______________________
How believable it feels right now, 0 to 10: ______
How much it pushes me around, 0 to 10: ______
What I usually do when I'm hooked by it: ______________________
Does doing that move me toward what matters? Yes / No / Sometimes

Try one or two of these, for about 30 seconds each

Add a frame.Say or write: "I'm having the thought that..." and then the thought. Then try: "I notice I'm having the thought that..."
Name the story.If the thought belongs to a familiar story, give the story a title: "Here's the 'I always mess things up' story again."
Change the sound.Say the thought very slowly, sing it to a tune you know, or say it in a cartoon voice.
Repeat one word.Pick the strongest word in the thought and say it out loud, quickly, over and over for 30 seconds, until it's just a sound.
Thank your mind."Thanks, mind. I know you're trying to protect me."
Leaves on a stream.Picture a stream with leaves floating by. Put each thought on a leaf, whatever it says, and watch it drift past. If you get pulled in, notice that and come back to the stream.
Carry it with you.Write the thought on a card and put it in your pocket. You can take it with you and still do what you planned.

After you practice

What I tried: ______________________
How believable it feels now, 0 to 10: ______
How much it pushes me around now, 0 to 10: ______
What I noticed: ______________________
If this thought were just words, what would I do next that matters to me? ______________________

The goal isn't to make the thought disappear or to feel better right away. If the thought is still there but you can do what matters anyway, the practice is working.

This week's practice

Day ______ Thought ______________ What I tried ______________ Before ___ After ___
Day ______ Thought ______________ What I tried ______________ Before ___ After ___
Day ______ Thought ______________ What I tried ______________ Before ___ After ___

Worksheet 3: My willingness log (acceptance worksheet)

Making room for what shows up

Some feelings, memories, body sensations and urges can't be switched off, and fighting them can take up a lot of your life. Willingness means letting them be there, as they are, when that's what it takes to do something that matters to you. It doesn't mean liking them, wanting them, or putting up with being harmed. Fill in an entry when something difficult shows up this week.

Entry 1

Day and situation: ______________________
What showed up inside (thoughts, feelings, body sensations, urges, memories): ______________________
How strong it was, 0 to 10: ______
What I did with it (pushed it away, avoided, distracted myself, waited it out, let it be): ______________________
What that did for me right then: ______________________
What it cost me later, or kept me from: ______________________
How willing I was to have it, 0 to 10: ______
Something I did that mattered to me, with it there: ______________________

Entry 2

Day and situation: ______________________
What showed up inside: ______________________
How strong it was, 0 to 10: ______
What I did with it: ______________________
What that did for me right then: ______________________
What it cost me later, or kept me from: ______________________
How willing I was to have it, 0 to 10: ______
Something I did that mattered to me, with it there: ______________________

Entry 3

Day and situation: ______________________
What showed up inside: ______________________
How strong it was, 0 to 10: ______
What I did with it: ______________________
What that did for me right then: ______________________
What it cost me later, or kept me from: ______________________
How willing I was to have it, 0 to 10: ______
Something I did that mattered to me, with it there: ______________________

Making room: a two-minute practice

Notice where you feel it in your body.
Describe it as a curious scientist would: its size, shape, temperature, and whether it moves.
Breathe slowly, as if you were breathing in around it.
Let it be there. You don't have to like it or want it. Just stop pushing it away for a moment.
Widen your attention: the feeling, and also the room, the sounds, your feet on the floor.
Ask yourself: what matters to me right now, and what's one thing I can do?

At the end of the week

What happened when I struggled with a feeling: ______________________
What happened when I made room for it: ______________________

If things get worse

Making room for feelings never means staying in danger. If your feelings become too much to manage, or you have thoughts of hurting yourself, tell your therapist. If you might hurt yourself or someone else, or you're in danger, call or text 988 (the Suicide & Crisis Lifeline in the US) or call 911.

Worksheet 4: My committed action plan (committed action worksheet)

Taking steps toward what matters

Committed action means taking steps toward what matters, again and again, including after you slip. Start small, with a step you're almost sure you can do. Expect your mind to come up with reasons not to. That's what minds do, and you can take the step anyway.

My plan

The value this plan serves (from Worksheet 1): ______________________
My goal (something I could finish, with a date): ______________________
Why it matters to me: ______________________
Step 1 (what, when, where, how long): ______________________
Step 2: ______________________
Step 3: ______________________

What might get in the way

Thoughts and feelings that might show up: ______________________
Am I willing to have them and take the step anyway? Yes / Not yet
If not yet, a smaller first step: ______________________
Outside obstacles (time, money, transport, other people) and my plan for each: ______________________
Someone who could support me: ______________________
How sure I am that I'll do step 1, 0 to 10: ______ If it's low, make the step smaller.
If I get off track, I will: ______________________ (for example: notice it, be kind to myself, and take the next small step)

After step 1

What I did: ______________________
What showed up inside: ______________________
What I noticed about doing it: ______________________
My next step: ______________________

Worksheet 5: Sorting my week (ACT Matrix worksheet)

Toward moves and away moves

This sheet sorts what you do into moves toward what matters and moves away from difficult thoughts and feelings. Neither kind is good or bad. The question is what each one does for you over time. Fill in the sections in this order.

1. Who and what matters to me

______________________
______________________
______________________

2. What shows up inside me and gets in the way (thoughts, feelings, memories, urges)

______________________
______________________
______________________

3. What I do to get away from or control that inner stuff (away moves, things someone could see me do)

______________________
______________________
______________________

4. What I do, or could do, to move toward who and what matters (toward moves)

______________________
______________________
______________________

5. Noticing

A moment this week when I noticed I was about to make an away move: ______________________
What I noticed in my body or mind just before: ______________________
What I chose to do: ______________________

Sorting yesterday

Write five things you did yesterday. Mark each one toward or away, and whether it helped you in the long run.

______________________ Toward / Away. In the long run it: helped / cost me
______________________ Toward / Away. In the long run it: helped / cost me
______________________ Toward / Away. In the long run it: helped / cost me
______________________ Toward / Away. In the long run it: helped / cost me
______________________ Toward / Away. In the long run it: helped / cost me

Looking at the whole sheet

When I do my away moves, do they bring me closer to who and what matters over time? ______________________
One toward move I'll make this week, even if the inner stuff shows up: ______________________

If you have thoughts of hurting yourself, or you're in danger, call or text 988 (the Suicide & Crisis Lifeline in the US) or call 911, and tell your therapist.

End of the worksheets. The rest of this page is for therapists.

How therapists use these ACT worksheets

ACT has no required order, so let the client's formulation choose the sheet. A sequence that fits much outpatient work:

Map the stuck points. In the first sessions, sketch the matrix together or note which of the six processes are stuck. A client who avoids everything needs a reason to be willing before acceptance work makes sense, so values often come early.
Look at what hasn't worked. Ask what the client has tried to control the feeling, how well it worked in the short run and the long run, and what it cost. ACT calls this creative hopelessness. The aim is openness to something new, not despair, so go gently and validate how hard they've tried.
Do the exercise before you hand out the sheet. In a meta-analysis of 66 laboratory component studies, conditions that used experiential methods such as metaphors and exercises had larger effects than those that gave a rationale alone (Levin et al., 2012). Practice defusion or making room in the session, then send the worksheet home as practice.
Connect the sheets. Worksheet 1 finds the value, Worksheet 4 turns it into a step, Worksheet 3 handles the feelings that show up on the way, and Worksheet 2 handles the thought that tries to stop it. Worksheet 5 shows the whole pattern.
Talk about workability. Ask "How does that work for you in the long run?" rather than "Is that thought true?" or "Is that bad?" It keeps the conversation away from judging the client.
Review every sheet at the start of the next session. A half-finished sheet still shows something. If homework is never reviewed, clients soon stop doing it.
Repeat and widen. Use the same sheet across new situations, then move to larger steps as willingness grows.

How long it takes varies. APA Division 12 describes ACT for chronic pain as about 8 sessions (Society of Clinical Psychology), and many clients use the work for longer in combination with other treatment.

Common mistakes with ACT worksheets

Acceptance used as a new way to get rid of feelings."I accepted the anxiety, so why is it still here?" means the client is using acceptance to control. Go back to values: willingness is for doing what matters, not for making feelings leave.
Defusion that feels mocking.A silly voice can feel dismissive with grief, trauma memories or self-harm thoughts. Ask permission, explain the purpose, and choose a gentler technique such as "I'm having the thought that..."
Values that are really "shoulds".If a value comes from guilt or someone else's expectations, it won't carry the client through hard moments. Ask: "If nobody would ever know, would you still choose this?"
Values confused with goals or feelings."Being happy" and "being loved" are not values the client can act on. "Being loving" is.
Accepting what should change.ACT acceptance is about inner experiences, not about tolerating abuse, an unsafe home, discrimination or a medical problem that needs treatment. Changing the situation may be the committed action.
Skipping risk assessment.Willingness to have painful thoughts is never a reason to skip it. If suicidal thoughts come up, assess risk that day and use a safety plan when one is needed.
Ignoring culture and context.For many clients, values center on family, faith or community rather than personal growth. Work with the client's own values, in their own words.
Too many worksheets, too little experience.One sheet practiced well is worth more than five filled in at the last minute.

What the evidence says about ACT

Better than no treatment or usual care.A meta-analysis of 39 randomized trials (1,821 patients) found ACT outperformed control conditions overall (Hedges' g = 0.57), including waitlist (0.82), psychological placebo (0.51) and treatment as usual (0.64). It found no significant difference between ACT and CBT (A-Tjak et al., 2015).
A critical review found smaller effects.Lars-Göran Öst's review of 60 trials (4,234 participants) found a small mean effect (0.42), no improvement in study quality since his earlier review, and a small, non-significant difference (0.16) against cognitive or behavioral treatments. He concluded ACT was not yet well established for any disorder, was probably efficacious for chronic pain and tinnitus, and possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse and work stress (Öst, 2014). ACT researchers disputed his methods in a published response, and he replied (Atkins et al., 2017; Öst, 2017).
A review of 20 meta-analyses.Written by ACT researchers, it covered 100 controlled effect sizes and 12,477 participants and found ACT efficacious for anxiety, depression, substance use, pain and mixed groups, generally better than inactive controls, usual care and most active treatments, with CBT the exception (Gloster et al., 2020).
Depression.Across 18 studies (1,088 participants), ACT reduced depressive symptoms against control groups (SMD 0.59), with most studies of moderate quality and wide variation between them (Bai et al., 2020).
Chronic pain: the strongest support, with real limits.In 11 trials, ACT beat controls with small to medium effects on functioning, anxiety and depression, but pain intensity and quality of life did not change significantly, and effects were smaller at follow-up (Hughes et al., 2017). APA Division 12 lists ACT for chronic pain as having strong research support. A Cochrane review, in contrast, rated the evidence from the ACT trials it analyzed as very low quality, leaving the authors very uncertain about its benefits (Williams et al., 2020).
How it works is supported, but not settled.Mediation studies are generally consistent with the psychological flexibility model, but limited in quality and focused on a few processes (Stockton et al., 2019).

In practice: ACT is a reasonable, evidence-based option for depression, anxiety, chronic pain and mixed presentations, about as effective as CBT rather than better than it. Study quality is the main weakness, so track your own client's outcomes rather than assume the average effect.

Adaptations: teens, chronic pain and telehealth

Teens

Expect a real but uncertain evidence base. A meta-analysis of 27 randomized trials (2,860 adolescents) found ACT better than inactive controls for anxiety and depression and better than other active controls for depression, but not better than CBT, and all included studies were at high risk of bias (López-Pinar et al., 2025). In youth aged 15 to 25, a meta-analysis of 65 studies found a moderate effect (g = 0.72), with very low quality of evidence (Keulen et al., 2025).
Make it concrete. The matrix works well on a whiteboard or a phone note, and teens often find "toward and away" easier than "values and avoidance".
Use values from their world: friends, sports, music, gaming with friends, being a good older sibling. Don't steer them to adult values like career.
Choose playful defusion carefully. Silly voices often land with teens, but not when the thought is about self-harm or a trauma.
Simplify ratings to 0 to 5 for younger clients, and let them fill in sheets on their phone.
Agree at the start what parents will see. Values and willingness logs can hold private material.
Screen for risk regularly. For conversation starters, see our therapy questions for teens.

Chronic pain

Set expectations early. ACT aims at living well with pain, not at removing it, and in trials pain intensity changed less than functioning did.
Use Worksheet 3 for pain itself: where it is, what the mind says about it, and what the client does to escape it.
Fit committed action to the body. Keep the value and change the form: watching a grandchild's game from a chair still serves "being there for my family."
Watch for pushing through. Willingness doesn't mean ignoring the body's limits. Plan steps the client can repeat on an average day, not just on a good one.
With consent and a signed release of information, coordinate with the client's physician or physical therapist.
Our DAP notes examples follow an invented client through two ACT sessions for low mood after a back injury, from a values worksheet to her first valued activity with pain present.

Telehealth

ACT works by video. In a trial of 128 veterans with chronic pain, 8 weeks of ACT by video was not worse than in person for pain interference, though more people dropped out of the video group (Herbert et al., 2017). Internet-based ACT programs show small effects across 25 trials, with larger effects on depression when a therapist guides them (Thompson et al., 2021).
Share the worksheet on screen, or send the link to this page before the session. The client keeps their copy and reads out their ratings.
Draw the matrix live on a shared whiteboard, or have the client draw it on paper and hold it up to the camera.
Use the home setting: plan a toward move the client can start as soon as the call ends.
If a client wants to send you a photo of a sheet, agree on how first. Our article on whether Gmail is HIPAA compliant covers what HHS allows when you email clients.
Confirm where the client is at the start of every session. HHS guidance says professionals must "be licensed or legally permitted to practice in the state where the patient is located," and that "All providers should establish and maintain an emergency plan" (HHS, Licensure for behavioral health). Our telehealth consent form covers both.

Tracking progress in ACT

Symptoms.Give the PHQ-9 or GAD-7 at intake and every two weeks or so. Our PHQ-9 calculator and GAD-7 calculator add up the total and show the severity band in your browser, without saving anything.
Psychological flexibility.The Acceptance and Action Questionnaire-II (AAQ-II) is a widely used measure of psychological inflexibility and experiential avoidance (Bond et al., 2011). One study found its items relate more closely to distress than to acceptance (Wolgast, 2014), so read it next to a symptom measure rather than as a pure process score.
Fusion.The Cognitive Fusion Questionnaire was built to measure how caught up a person is in their thoughts (Gillanders et al., 2014).
Values.The Valued Living Questionnaire rates how important each life area is and how consistently the person has lived by it (Wilson et al., 2010), the same idea as Worksheet 1's two ratings. Get each measure from its published source.
The worksheets.Track believability ratings on Worksheet 2, willingness ratings on Worksheet 3, the importance and living-it gap on Worksheet 1, and committed actions done on Worksheet 4.

If several weeks of consistent practice haven't moved symptoms or daily functioning, review the formulation with the client, check for other diagnoses, medical problems or substance use, consider a different or added treatment, and bring the case to consultation. If the client is getting worse, act sooner.

How to note ACT work in a progress note

"Did ACT exercises" tells a reviewer almost nothing. A useful note shows which process you targeted, what you did, how the client responded and what comes next:

The process and the technique by name:for example, defusion with "I'm having the thought that...", a willingness exercise, values clarification, committed action planning.
Homework review:which worksheet, how much was done, and what it showed.
The client's ratings:believability before and after defusion, willingness, the values gap, steps taken.
Measures:the PHQ-9 or GAD-7 total next to the last one, and what you asked about risk.
The plan:the specific toward moves agreed, with days and times, linked to a treatment plan goal.

An example in BIRP format. Invented client: Dana, a 34-year-old accountant who has panic attacks and has stopped driving on highways, in her sixth video session of ACT.

Wording to copy23 lines

Behavior: Session 6 of ACT, by video. Client joinedfrom home in Colorado, alone, private room confirmed.Reported 2 panic attacks this week (4 last week).Completed 3 willingness log entries. Drove one highwayexit with her sister on Saturday, 1 of 2 planned steps;willingness 3/10 before, 6/10 during. Skipped the seconddrive: "I kept thinking I'll pass out and crash."GAD-7 today 11 (15 at intake). Denied thoughts ofsuicide or self-harm when asked directly.Intervention: Reviewed the willingness log and thecommitted action plan. Defusion with the thought "I'llpass out and crash" using "I'm having the thoughtthat..." and saying it slowly; believability 8/10before, 5/10 after. Two-minute making-room exercisewith chest tightness. Revised the plan, linked to hervalue of being there for her family.Response: Client said the thought "feels more like awarning than a fact now." Agreed to two drives thisweek, one of them alone. Rated confidence 7/10.Plan: Highway drive Tuesday with sister (two exits)and Saturday alone (one exit), with a willingness logentry after each. GAD-7 again in 2 weeks. Next sessionin 1 week by video. Treatment plan goal 2 continues.

In DAP, the log review, ratings and exercises go in Data and your reading of the avoidance pattern in Assessment. In SOAP, the GAD-7 and what you observed go in Objective. The progress notes cheat sheet lists ACT technique names (defusion, values clarification, committed action, willingness, present-moment exercise) next to words for client response, and our BIRP note examples show the format in full.

How this works in TranqBay

TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions and session notes in one place. Here is where ACT work fits.

Measures before each session. TranqBay's form library has ready-made templates you can send a client for a session, including the PHQ-9 and GAD-7, plus intake and consent forms. The client fills them in online and the answers wait with the session. TranqBay doesn't score them; add up the total, or use the calculators linked above, and record it in your note.
Video sessions are end-to-end encrypted and HIPAA-ready. TranqBay provides a Business Associate Agreement that applies when you accept the Terms, with no separate document to sign.
Session notes come in BIRP, DAP, SOAP or GIRP format, or as a blank note in your own words. The structured formats are part of the advanced note templates, which some plans include.
The worksheets live on this page. Send your client the link, or print them.

If ACT is how you work, your practice website is where a future client first reads it. A plain line such as "We won't try to win a fight with your thoughts. We'll work on what matters to you, and on taking steps toward it" tells them what to expect better than a list of acronyms. Our therapist bio examples include one that mentions ACT in plain words. practice.tranqbay.health shows the website designs made for therapy practices, with a "My approach" section where a line like that would sit, and the booking page a client would use.

Frequently asked questions about ACT therapy worksheets

What are ACT therapy worksheets?

Short forms clients use between sessions to practice the skills of acceptance and commitment therapy: clarifying values, stepping back from thoughts, making room for feelings, planning valued action and noticing toward and away moves. They support in-session work; they don't replace it.

Is there an ACT worksheets PDF I can download?

This page works as one. Print it, or choose "Save as PDF" in your browser's print window. Set the page range to the worksheet pages if you only want the client handouts.

What are the six core processes of ACT?

Acceptance, cognitive defusion, contact with the present moment, self-as-context, values and committed action. Together they make up psychological flexibility, and each has a stuck opposite, such as avoidance for acceptance and fusion for defusion.

What is the difference between a value and a goal in ACT?

A goal can be finished, such as running a 5K. A value is a direction that is never finished, such as caring for your health. Values give goals their meaning, and the ACT values worksheet on this page turns one into the other.

What is an example of cognitive defusion?

Taking the thought "I'm a failure" and saying instead, "I'm having the thought that I'm a failure." The words are the same, but the client starts to see the thought as something their mind is doing, which often makes it less believable and less in charge.

How is defusion different from cognitive restructuring?

Cognitive restructuring in CBT tests whether a thought is accurate and looks for a more balanced one. Defusion leaves the content alone and changes the client's relationship to the thought, asking whether following it helps them live as they want.

What is the ACT Matrix and how do you fill it in?

A cross drawn on paper, developed by Kevin Polk and colleagues. The vertical line separates what can be seen from what goes on inside, and the horizontal line separates away moves from toward moves. Fill in who and what matters first, then the inner stuff that gets in the way, then away moves, then toward moves.

Is acceptance in ACT the same as radical acceptance in DBT?

They're related but not the same. Radical acceptance in DBT is about fully accepting reality as it is, often facts that can't be changed. Acceptance in ACT is mostly about making room for inner experiences so the client can act on their values. Our DBT worksheets place radical acceptance among DBT's reality acceptance skills.

Is ACT evidence-based?

Yes, with honest limits. Meta-analyses find ACT works better than waitlist and usual care and about as well as CBT for depression, anxiety and chronic pain. Study quality is often weak, and critics such as Öst have found smaller effects than ACT's supporters.

Do I need to be certified to use ACT?

There is no official ACT certification. ACBS recommends training from peer-reviewed ACT trainers, consultation and supervision. Your license, scope of practice and competence rules still apply.

Can I use these ACT worksheets with teenagers?

Yes, with adjustments: simpler words, ratings from 0 to 5, values from the teen's own world and care with playful defusion. Trials in adolescents are encouraging but mostly at high risk of bias, so track outcomes closely.

Before your next session

Print Worksheet 1 or sketch the matrix with your client, and fill in the first section together before they leave. Next week, start with what they wrote, and let it decide which sheet comes next.

If you want booking, video sessions and session notes in one place, see how TranqBay works for private practice: you can look at the practice website designs and the booking page your clients would use. If you're deciding whether to join, this page explains how joining TranqBay works.

Sources

30 sources

Books 1contextualscience.org 3Research 21newharbinger.com 2div12.org 1HHS 1988 Lifeline 1

Books and publishers1

1Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change, 2nd edition. Guilford Press (first published 2011; first edition 1999)guilford.comhttps://www.guilford.com/books/Acceptance-and-Commitment-Therapy/Hayes-Strosahl-Wilson/9781462528943

contextualscience.org3

Research21

newharbinger.com2

Updated October 25, 2026. Found it useful? Send it to a colleague.