Table 1.

Overview of the BrainACT intervention.

Session number	Content	Experiential exercises and metaphors	Homework exercises
1	Value exploration and defining core values	–Bus of life metaphor –Values sorting exercise –Describing your gravestone or 80th birthday exercise –Writing down core values	–Reading or listening to the summary of this session –Explore which values deserve more or less attention –Making pictures of valuable moments
2	Committed action on the long and short term in relation to values. Education about mindfulness and practising contact with the present moment	–What's the next stop of your bus of life? (defining short-term goals) –Keep driving (defining long-term goals) –Introduction mindfulness: raisin exercise	–Reading or listening to the summary of this session –Perform a daily activity with full attention –Valuable activity of the week: performing one concrete action that fits within one of the patient's values –Defining obstacles while making these homework exercises
3	Creative hopelessness; the undeniability of human suffering and the consequences on the long term of trying to control it. Identifying strategies used to cope with negative thoughts and emotions	–Mindfulness exercise: mindful breathing –Identifying how the patient copes with unpleasant experiences –Tug-of war with a monster or bouncing ball metaphor –Mindfulness exercise: body scan	–Reading or listening to the summary of this session –Keeping track of unpleasant thoughts or feelings and how the patient coped with them –Reread the metaphor of the monster or bouncing ball –Valuable activity of the week
4	Introducing acceptance as an alternative to control	–Tug-of war with a monster, unwanted guest in your bus of life, or the finger trap metaphor –Explanation of the difference between pain and suffering with the glass of water exercise –Mindfulness exercise: making space, and allowing what is there	–Reading or listening to the summary of this session –Willingness exercise –Valuable activity of the week
5	Changing the relationship with thoughts, naming the mind	–Mindfulness exercise: attention for thoughts –The passengers in your bus of life (in combination with post-its) –Defusion exercise: naming the mind –Defusion exercise: singing difficult thoughts –Mindfulness exercise: floating leaves on a river	–Reading or listening to the summary of this session –Watch the YouTube video of the bus of life –Practice defusion exercises –Valuable activity of the week –Observing the mind during valuable activity
6	Changing the relationship with thoughts about oneself and introducing the constant self	–Metaphor: the sky and the weather –Exercise: lifeline –Metaphor: Suits (thoughts about oneself) that don’t fit –Exercise: backpack	–Reading or listening to the summary of this session –Take off a suit that doesn’t fit (anymore) –Practice a mindfulness exercise -Valuable activity of the week
7	Repetition on defusion and mindfulness	–Mindfulness exercise: the body scan –Defusion exercises: physicalizing the thought –Mindfulness exercise: mindful breathing	–Reading or listening to the summary of this session –Practice a mindfulness exercise daily –Valuable activity of the week
8	Review of the different core components, explanation on how these skills together lead to psychological flexibility, and preparation on relapse and setbacks	–Mindfulness exercise: attention for noise –Car metaphor –Bus of life metaphor and exercise –Strategies on how to keep using acquired ACT skills in daily life	–Reading or listening to the summary of this session –Try to keep practising with the different ACT skills –Start integrating ACT into your daily life –Live your life as is valuable to you! Stop fighting, start living!