Table 1

Overview of contents and techniques of all sessions

ModuleKey module contentsFocused ACT techniques
0Introduction to the structure and basic ideas of the ACT training, explanation of the SMS coach, presentation of accompanying case vignettes of the training; sources and evidencePsychoeducation*
1Fostering of treatment expectations and motivation, psychoeducation on diabetes and its complications, diabetes distress and associations between diabetes and mental health; development of the individual diabetes history and coping mechanisms; introduction to the ideas of ACT; elaboration of a good reason for processing through ACTonDiabetes; clarification of individual objectives for the training; introduction to mindfulness and conscious breathing; elaboration of the individuals′ previous handling of diabetes distress, previous strategies with short-term and long-term success; presentation of possible different approaches alongside ACTPsychoeducation* Acceptance
Generation of creative hopelessness
2Introduction to the concepts of control and acceptance, development of the idea of mindfulness: the body; introduction of the diabetes diary within which the focus is on components of the SORC-model95 (Behavioral analysis model, acronym: Situation, Organism, Reaction, Contingency/ Consequence); diabetes distress and (un-)influenceable variables in life; primary and secondary suffering; introduction to behavioural experiments, self-observation tasks, homework, ACT metaphors and mindfulness exercises. Further optional diaries are offered to support self-observational processes/tracking behaviour (eg, acceptance diary, mindfulness diary)Experiential acceptance*
Recognising malfunctions of control strategies; acceptance as alternative concept
3Elaboration of and differentiation between thoughts and feelings; development of the idea of mindfulness regarding thoughts; dealing with negative thoughts and feelings; language processes and vocabulary tips to support defusion processesDefusion,* recognising the meaning of language; creating distance from own thoughts
4Self-conceptualisations; three senses of self; being the observing self; development of the idea of mindfulness regarding all sensesSelf as context*
Defusing from implicit evaluations; getting to know the observing self
5Introduction to values; values as chosen life directions; choosing values; goal-setting strategies, mindfulness regarding feelingsValues;* developing value awareness
6Commitment and its influence on a value-driven life, mindfulness in the everyday life, ACT formula; begin to take actionCommitted action, ACT formula;* learning ways to act in accordance to values
7Development of the way forward; commitment; conclusion and future perspective, skills overview and maintenanceCommitted action, mindfulness;* sustainable anchoring of the learning content in everyday life
  • Every module starts with a review of key elements from the last session and ends with a summary and outlook.

  • *Inclusion of metaphors (eg, man in the fountain; playing tug of war with unchangeable aspects in life), tasks and exercises to make contents experienceable.

  • ACT, Acceptance and Commitment Therapy; SMS, short message service.