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Table 3 Session-by-session overview of the Acceptance and Commitment Therapy programs, Cool Mind and Mindchill

From: Acceptance and Commitment Therapy for anxious children and adolescents: study protocol for a randomized controlled trial

Session Mindchill program (adolescents) Cool Mind for Kids program (children)
1 Introductions, group expectations and an emphasis on the importance of practice tasks; psychoeducation on anxiety, values and feelings; introduction to acceptance and mindfulness as alternatives to ‘getting rid’ of unpleasant thoughts and feelings. Practice tasks: Mindful smiling Introductions, group rules, psychoeducation on anxiety, learning about feelings, Feeling/worry scale, pink elephant and Chinese finger trap exercises to introduce the futility of control and acceptance as an alternative; introduction to mindfulness. Practice tasks: What I think and feel, mindful smiling/breathing whilst waking up
2 Barriers to mindfulness practice, mindfulness of the breath, mindful eating, choosing to live a valued life regardless of fear, mindful movement, rewards, Practice tasks: Additional mindfulness practice Mindfulness of the breath, mindful eating, thoughts/feelings and control; anxiety and my body, psychoeducation on acceptance; mindful movement. Practice tasks: Mindfulness of the breath, mindfulness while lying down, mindfulness in everyday activities, ‘Me and My Body’ physiological aspects of anxiety
3 Mindful breathing; ‘milk, milk, milk’ exercise as introduction to defusion; mindful thinking; acceptance versus tolerance of anxiety. Practice tasks: Defusion and mindfulness exercises Mindful breathing; ‘milk, milk, milk’ exercise as an introduction to defusion; introduction to and practice of defusion strategies; mindful thinking; introduction to rewards. Practice tasks: Defusion exercise, mindfulness of the breath, mindfulness in everyday activities
4 Body scanning; creating a fears and worries list; mindful thinking practice; introduction to stepladders (exposure) and first attempt to create own exposure hierarchy. Practice tasks: Body scanning, mindful thinking and working on personal stepladder Body scanning; mindful thinking practice; creating a fears and worries list; introduction to stepladders (exposure) and first attempt to create own exposure hierarchy. Practice tasks: Daily body scanning, mindful thinking worksheets, create first stepladder
5 Imaginal exposure using stepladders; experiential avoidance and taking our worries with us through life; mindful thinking additional practice; revising stepladders. Practice tasks: Mindfulness practice and stepladders Imaginal exposure using stepladders; experiential avoidance and taking our worries with us through life; mindful thinking for big worries; stepladders for big worries. Practice tasks: Body scanning, mindful thinking and exposure
6 Mindfulness practice, leaves on a stream exercise; judging versus describing, ‘unhooking’ from thoughts; letting go of negative self-judgements, acceptance. Practice tasks: Stepladders Mindfulness practice, leaves on a stream exercise; judging versus describing, acceptance; working on stepladders for big worries. Practice tasks: Mindfulness meditation, imaginal exposure practice about the worst that can happen if he or she confronts the difficult situation and work on stepladders
7 Body scanning additional practice; dealing with set-backs or getting stuck; coping strategies; problem-solving skills building. Practice tasks: Body scanning and imaginal exposure on stepladders Body scanning additional practice; mindful touch; problem-solving skills building; mindful thinking. Practice tasks: Mindfulness body scanning, exposure (both imaginary and real life)
8 Mindfulness practice; assertive communication; in-session exposure related to stepladders or fears and worries list; problem-solving any set-backs. Practice tasks: Mindful thinking worksheets with stepladders, seeking feedback for areas of self-doubt Mindfulness practice; assertive communication; in-session exposure related to stepladders or fears and worries list; problem-solving any set-backs. Practice tasks: Mindfulness thinking, exposure in real life, practicing problem-solving
9 Mindful breathing additional practice; coping with teasing and bullying; external strategies to manage worries; review of progress towards goals; additional in-session exposure. Practice tasks: Act on one goal not yet achieved, family discussion of managing anxiety and stress in everyday life Mindful breathing additional practice; outsmarting bullies; review of progress towards goals; additional in-session exposure. Practice tasks: Practicing describing thoughts rather than judging, practicing assertiveness, mindfulness activities, 10 minutes/day
10 Loving kindness meditation; reviewing goals; planning for the future; dealing with set-backs and celebrating success Friendly wishes meditation; reviewing goals; focus on values guiding action; planning for the future; dealing with set-backs and celebrating success