Table 1

Overview of the internet-delivered Acceptance and Commitment Therapy (ACT) intervention programme

WeekSessionSummary of content
1Session 1

  • Introduction to the ACT programme and programme overview

  • Review treatment history and evaluate it in terms of how it has worked relative to the participant's goals and expectations

  • Review interactions between thoughts, feelings and function, which often serve to make each other worse (eg, become a ‘vicious cycle’)

  • Introduce the idea that change is possible—not based on symptom reduction but on aiming to alter function

  • Introduction to mindfulness technique—which is followed by the mindfulness debrief regarding the participants’ experiences of mindfulness

2Session 2

  • Introduction to the concept of acceptance and how one's experience of pain may limit participation in valued activities

  • Values clarification exercises

  • Mindfulness and debrief

  • Homework assignment: mindfulness practice daily

3Session 3

  • Identification of values

  • Assessment and rating of values

  • Discrepancy between values and current function

  • Mindfulness of breath exercise

  • Mindfulness debrief

  • Homework assignment: mindfulness practice daily

4Session 4

  • Barriers to pursuing values

  • Overcoming barriers

  • Swamp metaphor—exercise exploring the possibility for value-based action even with aversive experiences. Discussion on the concept of willingness and unwillingness to have discomfort

  • Body scan mindfulness exercise

5Session 5

  • Goal setting exercise in line with three chosen values

  • Discussion on fluctuating levels of high and low functioning and benefits of activity pacing in order to achieve a more consistent level of activity from day to day.

  • Homework assignment: record performance over the next week regarding carrying out specific actions and pacing of activities

6Session 6

  • ‘Tricks of the mind’ exercises to raise awareness of language-based influences on function

  • Cognitive defusion exercises—‘catch’ your thoughts and label them

  • Homework assignment: practice mindfulness and cognitive defusion techniques daily

7Session 7

  • Planning and action

  • ‘Act On’=Taking the ‘I’ out of action

  • Homework assignment: commit yourself to action

8Session 8

  • End of programme

  • Emphasis on commitment to actions and values even when barriers exist and future planning—this is a ‘lifelong assignment’

  • Preparation for relapses and setbacks