Table 1

Summary of ACT modules

Module 1: mindfulness and unhooking
  • Normalising difficult thoughts and feelings, given the context of MD, and associated struggles.

  • Discussion of consequences from trying to get rid of unwanted thoughts and feelings and opportunities for alternative responses.

  • Introducing other ways to interact with unwanted thoughts and feelings:

    1. Mindfulness or learning to be present in the moment and experience thoughts and feelings in a non-judgemental way.

    2. Unhooking from thoughts or learning ways to step-back from thoughts that often restrict actions or lead to avoidance.

  • Homework 1: daily diary of mindfulness practice.

  • Homework 2: identifying where one struggles and experimenting with other responses.

Module 2: follow your values
  • Identifying values and ways to pursue them with MD. Exploring the link between difficult thoughts and feelings and one’s goals and values.

  • Homework 1: continuation of daily mindfulness practice

  • Homework 2: setting goals in the context of values, experimenting with taking the ‘smallest possible step’ which is consistent with one’s values, noticing the thoughts and feelings that occur in the context of values activity.

Module 3: take an observer perspective
  • Experimenting with taking an observer perspective on one’s experiences.

  • Considering labels one attaches to oneself (especially given the context of MD). Noticing a choice over buying into labels and the impact of labels over one’s behaviour.

  • Introducing a more flexible approach to mindfulness

  • Homework 1: continuation of daily mindfulness practice with addition of flexible attention and noticing the observer self

  • Homework 2: continuation of valued activities

Module 4: recap, reflection and suggestions for staying committed
  • Review of homework tasks and skills learnt.

  • Self-identification of effective and ineffective behaviour patterns.

  • Goal planning and normalisation of set-backs with a compassionate approach to getting back on track.

  • ACT, Acceptance and Commitment Therapy; MD, muscle disease.