Present moment focus
- Employing flexible and focused attention to ongoing events.
o Alternative: detached focus on conceptualized past, present, or
future
- Present moment work
o Clinical example: Jim begins to describe a distressing experience
that occurred last weekend. He reports that he arrived at a
reception for his brother and began to experience increasing
anxiety mostly around the number of people present and the
possibility of inadequate security. He reports that he eventually
left the reception. Jim’s speech becomes rapid and his intonation
stereotyped as he begins to describe this experience. His posture
tightens and his eye contact becomes variable. He begins to repeat
himslef, seemingly ruminating over the same ideas of how he
“should” have handled this. Jim includes some descriptions of his
current experiences, and sometimes appears connected with what
he is describing.
 “Slowing Down” (Advanced work) – Clinician has Julie tell
the story, but with prompts to speak more slowly, describe
more individual details across sensory, emotional and
cognitive domains, and to not offer explanations, just to
notice them as thoughts.
 If Julie had fewer skills in repertoire, clinician might limit to
experiences in present, or just to one or two sensory
domains.
Cognitive Defusion
- Experiencing an event fully for its complexity, without certain emotions
or cognitions about the event dominating the experience.
o Alternative: fusion
- Defusion work
o Clinical example: Susan is describing struggling to collaborate with
doctors to create a satisfactory plan for her diet. It becomes
evident as she speaks that she is responding primarily to her
classification of foods into “safe” and “dangerous.”
 “The Buffet” (Early work) – Clinician has Susan imagine
foods coming toward her on a conveyer belt. She names the
food, and the clinician describes the food, directing Susan’s
attention to different aspects of the experience. Depending
on Susan’s response, clinician may prompt Susan to try
with increasingly “dangerous” foods.
 If Susan had more skills, clinician might provide less
guidance, having Susan describe different aspects of the
experience. She might also emphasize “dangerous” foods.
Experiential Acceptance
-
Involves openly embracing one’s experiences, good and bad, without
attempting to change them.
o Alternative: avoidance
Acceptance work
o Clinical example: Marsha is describing how self-injury makes her
“head shut up,” so she can relax. She describes experiencing it like
she is drowning and this is the only thing that “stops the water
from rising.”
 “Floating” (Advanced work) – Clinician extends the
metaphor. She directs Marsha to call to mind the
experience of feeling waves coming toward her, the water
rising around her, and to attend to different aspects of the
experience. Clinician then describes two postures, one
rigid and one flexible. The rigid posture may be partially
effective, but eventually, a big wave comes and the person
is knocked down. The flexible posture is sort of
uncomfortable because the person is easily lifted and
carried by the water this way and that, but even the biggest
wave can’t put them on their ass with water over their head
because you learn when you’re flexible that you float. The
clinician walks slowly through this metaphor, allowing
Marsha to supply descriptions or conclusions along the way
and wrapping her additions into the metaphor.
 If Susan had fewer skills, the clinician might not introduce
the concept of acceptance, even metaphorically. She might
simply have Marsha imagine conditions under which she
can accept certain experiences.
Transcendent Self-Awareness
- Involves contacting different ways of experiencing one’s self flexibly, such
that a sense of self that separate from any particular experience emerges.
o Alternative: fusion with conceptualized self
- Self work
o Clinical example: Tonya is describing how “sick” and “screwed up”
she is, in contrast to her “perfect” childhood. She attributes her
repeated relationship problems to a trauma experienced as a
teenager, and attributes that trauma to her “carelessness.” Tonya
describes trying to appear perfect, which alienates her from her
peers, and completely withdrawing from all activities at the first
sign of imperfection.
 “I-Contact” (Advanced work) – Clinician leads eyes-closed
exercise in which Tonya notices specific details of her
appearance, ending with her eyes. Then, while Tonya
continues to imagine looking into her own eyes, the
clinician guides her attention to different experiences she’s
had of herself, others, and the world

If Tonya had fewer skills, the clinician might have her use
an actual mirror instead of imagining. She might also have
Tonya do a similar exercise, but with “a person who has
struggled like you do”
Valued Living
- Living in such as way so as to facilitate contact with the way an individual
chooses to work and live
o Alternative: fused valuing,
- Values work
o Clinical example: Mark describes a “values conflict” between his
painting and being a father.
 “You Get to Pick” (Advanced) – The clinician asks Mark to
describe a specific instance during which the “values
conflict” was salient. Clinician directs his attention toward
different details of that instance, including the thoughts he
had around there being a conflict in values. When Mark
proposes abandoning of one or the other, clinician guides
Mark’s attention to a moment in which contacts value of
painting and value with being a father. Finally clinician
guides Marks attention to the idea that painting might
serve being a father, and vice versa.
 If Mark had fewer skills, the clinician might provide more
guidance by doing eyes closed exercise.
Committed Action
- Involves noticing when actions are not consistent with values, and gently
turning back to valued living
o Alternative: inaction, persistent avoidance
- Commitment Work
o Clinical example: Beth describes questioning her commitment to
her marriage since her husband admitted that he had an affair the
last time she was in inpatient treatment for eating problems. She
expresses guilt for considering leaving her marriage, saying “a
good wife wouldn’t even consider leaving.”
 “It’s Not in the Cards” (Intermediate) – Clinician asks Beth
to write on index cards: 1) three facts or feelings that feel
like reasons to hold onto the marriage, 2) three facts or
feelings that feel like reasons to leave the marriage, 3) three
worries that feel like reasons to leave the marriage, 4) three
hopes that feel like reasons to hold onto the marriage, 5)
what “saving the marriage” would involve, 6) what “letting
go” of the marriage might involve, 7) six possible outcomes
for how things turned out 3 to 6 years from now, 8) “and
that’s okay” and “and that’s not okay.” Clinician has Beth
tell a story using the cards to predict how this should go.

Clinician suggests that her choice can be independent of
any of the details on the cards.
If Beth had more skills, the clinician might end with Beth
making a commitment to some small action that is
independent of everything that seems to push her in one
direction or the other.