Table 1

Overview of the ‘ACTing Mind’ intervention and everyday journal instructions

Session 1 (week 1): acceptance and openness to pain
  • Chapter 1—Acceptance

  • Introducing participants to the video game and ACT in everyday journal.

  • A brief overview of the purpose of the programme and the content of each session.

  • Explaining basic ACT tenets through introduction text of journal.

  • Explaining the nature of painful thoughts and memories and getting caught up in the struggle explained through journal.

  • Basic story context about the character being depressed and why, at start of video game.

  • Explaining the objective of the video game, that is, to transcend form psychological inflexibility to psychological flexibility.

  • Exercise, within the game there are choice, either to suppress, and break thoughts, or to accept and be open to them.

  • Acceptance and openness are rewarded by psychological flexibility points on the ‘psychoflexameter’ and game progression, while suppression actions (breaking or suppressing painful memories) are punished with physical barriers, and sinking sand, which prevent the player from progressing in the game.

  • A monster pulls against the player to prevent progress, but if the player fights with the monster, they get even more stuck (analogous to the drop the rope and sinking sand metaphor). Again, acceptance is important and must be learnt here.

  • Reflecting in the journal about how this might be applied in life, and when this has occurred throughout the week daily.

Session 2 (week 1): being present (mindfulness)
  • Chapter 2—Being present (mindfulness)

  • Some instructions form the journal about being present and mindful is given, why it is useful and how to go about achieving with breathing exercises.

  • The character is approached by monsters in the game in the past and future making him worry excessively about imaginary dangers, and reminding him of painful events.

  • The game (in the form of the character’s wife’s ghost) instructs the player to be present, to focus on your breathing for 10 min.

  • As the participant learns and completes relevant psychological flexibility tasks psychological flexibility on the ‘psychoflexameter’ will increase, which rewards the player for being present.

  • Reflecting in the journal about how this might be applied in life, and when this has occurred throughout the week daily.

Session 3 (week 2): values identification and commitment
  • Chapter 3—Values identification and commitment

  • Instructions about what are values (a life compass) explained through the journal.

  • Acceptance and commitment to values orientation as opposed to avoidance behaviour is rewarded.

  • There are challenges to reach goals which are linked to the character’s values, such as scary weather and monsters.

  • Psychological flexibility on the ‘psychoflexameter’ and game progress, will increase with values consistent behaviour which rewards the player for committing to values.

  • Reflecting in the journal about how this might be applied in life, and when this has occurred throughout the week daily.

Session 4 (week 2): defusion
  • Chapter 4—Defusion

  • Instructions about what is cognitive fusion and defusion (holding self-stories lightly) explained through journal.

  • The character goes back into the ‘Mind Escape’ machine but this time there is a flowing river with leaves (analogous to leaves on a stream metaphor).

  • Some of the character’s painful memories will beg the player to help them, but if the player interacts, barriers and quicksand appear, punishing the player and preventing them from progressing in the game (analogous to the sinking sand metaphor).

  • The ghost of the character’s wife eventually instructs the player to put the memories and thoughts onto the leaves and watch them flow down the river, without interacting with them, and to simply observe.

  • Psychological flexibility on the ‘psychoflexameter’, will increase when all of the memories and thoughts as left to go down the stream, hence the player is rewarded for defusing.

  • Reflecting in the journal about how this might be applied in life, and when this has occurred throughout the week daily.

Session 5 (week 3): self as context
  • Chapter 5—Self as context

  • Instructions about what is self as context (being the observer of your thoughts and not your thought) are explained through journal.

  • The world starts to fall apart and becomes abstract, like a chess board.

  • The player realises that they are the white pieces on the chessboard (analogous to chess board metaphor).

  • The player is compelled by the game to beat the black pieces in the chess game.

  • But the more the players fights against the black pieces, the more they lose points on the ‘psychoflexameter’ and cannot progress in the game.

  • The player must let the battle play out, once they do, they become aware that they are the chess board (they become it) and realise they do not need to be part of the never-ending battle between the opposing forces.

  • Finally, a bus arrives, memories of the character’s wife beg the player to stay, and the monsters pull on player.

  • The player needs to get onto the bus with the monsters to move towards their values, a new beginning (analogues to bus metaphor).

  • Finally, the player has a choice, go back and change the events that led to your wife’s death, or stay on the bus with the monsters.

  • Trying to change events leads to a loss in points and prevents game progression.

  • Only staying on the bus, towards values, and accepting the monsters allows the player to complete the game successfully.

  • Reflecting in the journal about how this might be applied in life, and when this has occurred throughout the week daily.