Adaptation of the protocol of Lavefjord et al., 2025 for adolescents using Turrell & Bell, 2016.
| Triflex Process | ACT Process (Hexaflex) | Goal of the session | Treatment kernels |
|---|---|---|---|
| Openness | Acceptance | Discussing the “control agenda” and how trying to fight or suppress uncomfortable feelings often makes them worse. Introducing Willingness. | - Creative hopelessness until Willingness - / fixing things on the inside vs on the outside (M: Primitive’s mind) - Psychoeducation about Willingness - EE: Jumping Off a Chair - M: Struggle Switch - EE: Wrinkled Sock - HP: Audio-based skill training about willingness |
| Acceptance | Exploring willingness and introducing allowing. Practicing allowing in-session. | - What stuck from last session? - Review of HP - Psychoeducation about allowing - EE: Hedgie - Monsters on the bus - MD: Observe, Breathe, Expand - HP: Audio-based skill training with observe, breathe, expand | |
| Defusion | Learning to distance oneself from the literal meaning of thoughts in order to make conscious choices about behavior. | - What stuck from last session? - Review of HP - MD: Mindfulness of Bubbles combined with mindfulness of thoughts - M: Normalizing the mind’s job with “The bear and blueberry bush” - Ask about difficult thoughts (compare with categories of thoughts to defuse from) - EE: defusion techniques based on the category of thoughts (kidnap metaphor, “arm timeline”, “thank your mind”, …) - Introduce workability (what if you buy into this thought?) - Using defusion while exposure therapy in sensu - HP: Audio-based skill training with leaves on a stream | |
| Defusion | Understand how our mind is mostly unhelpful regarding events in the future or in the past. Understand “the story” that patients tell about themselves and defuse from it. | - What stuck from last session? - Review of HP - Psychoeducation about RFT: M: our problem-solving mind vs. our not-so-helpful mind - EE: Word link - EE: the Word Web - MD: mindful walking with “The Story” - HP: Coming up with metaphors by oneself about thoughts if one is defused from them | |
| Awareness | Present Moment | ||
| Present Moment | |||
| Self-as-Context | Help patients connect to their sense of their self as an observer, develop a sense of awareness in any given moment, understand how from this stance we can be more flexible about our behavior. | - What stuck from last session? - Review of HP - Psychoeducation about SaC - Case-presentation to reflect upon: Mia as stuck in a particular social role that hinders her from doing what is important - EE: Stickies - MD: Not good enough - HP: Audio-based M “the self as a checkers board” | |
| Self-as-Context | Help patients find a compassionate voice within themselves that can regard them with understanding, kindness, and compassion. Help the patients find this voice in daily business. | - What stuck from last session? - Review of HP - M: Two friends! - Ask the patient if they ever regarded themselves with kindness, understanding, or compassion - EE: Compassionate hand! - HP: Audio-based Tonglen MD | |
| Engagement | Values | ||
| Values | |||
| Committed Action | |||
| Committed Action |
EE = Experiential Exercise; M = Metaphor; MD = Meditation; HP = Home Practice; ! = Russ, 2009 (ACT made simple)