Acceptance and commitment therapy applied to early psychosis: Therapeutic foundations and a narrative systematic review

Table 5 Description of the acceptance and commitment therapy in “Daily Life” key components

Module	Description
Creative hopelessness	Help patients understand that their previous attempts to solve their problems are failing and that they should consider other alternatives. The module contains two different ACT metaphors and four ACT exercises on “creative hopelessness.” The proposed exercises help patients to become more aware of their avoidant coping strategies
Acceptance	Acceptance is presented as an alternative to control and avoidance. Patients are provided with two ACT metaphors and seven ACT exercises focused on the “acceptance” component. These exercises are designed to help them put the theory into practice and experience their feelings and emotions without trying to change them
Cognitive defusion	Cognitive defusion is a chance to distance oneself from one's thoughts. Patients are guided through exercises focusing on observing and distancing from their thoughts. This week's mobile module includes two metaphors about the “cognitive defusion” component and 7 exercises for practicing cognitive defusion. Once patients can detach from their thoughts, they can transfer these strategies to thoughts about the self and let go of their self-image, which is the topic of the next module
Self as context	Distancing from unpleasant beliefs (learned during the cognitive defusion module) is generalized to include beliefs about the self. Once we understand that we are not what we think or feel, we can understand ourselves as observers of pleasant or unpleasant experiences. The self is resistant to change; on the contrary, its content can change. The daily life module for this week focuses on the “self as context” component and includes two metaphors and four “self as context” exercises (instead of “self as content”)
Contact with the present moment	This component helps patients focus less on the past and future and more on the “here and now.” Patients have practiced these skills throughout the other modules. The practice continues during the daily life module the week after this session, where two “contact with the present moment” metaphors remind patients to be aware of the present moment, and the same four exercises they have practiced during the session so far guide them in this process
Values	This module is designed to help people live a life guided by values rather than unpleasant experiences. During this session, patients are invited to think about their personal values, which serve as a guide in life and a pilot for their behavior. This module includes two metaphors from the “values” component. During the three days following the session, patients are supplied with 4 exercises to explore further which values are important to them. Exploring values is necessary to connect with the goal of the next module
Committed action	“Putting theory into practice” is a session dedicated to building meaningful, realistic, specific goals according to the personal values identified in the “values” session. The “committed action” daily life module includes two new metaphors and four new exercises to help patients set and achieve their objectives step by step
Psychological flexibility	The central theme of the last session is to understand how to apply ACT skills “in a flexible manner” to concrete situations, depending on the challenges of the present moment. Patients were given a module summarizing all previous components during this last week. The module contains one metaphor and one exercise related to each component (acceptance, cognitive defusion, values, and committed action)

ACT: Acceptance and commitment therapy.