ACT Roadmap for super-feelers........................................................................................................................................

2
Weekly practice worksheet: Values in Action.................................................................................................................... 3
Worksheet: What’s the Payoff of My Emotions Running My Life? ..................................................................................... 4
Handout: the basics of emotion regulation....................................................................................................................... 5
Handout: emotion thesaurus ........................................................................................................................................... 6
Handout: Thoughts about Emotion .................................................................................................................................. 7
Noticing and Naming worksheet ...................................................................................................................................... 8
Worksheet: Inventory of quick-responses ........................................................................................................................ 9
Worksheet: Noticing gut Reactions and True awareness ................................................................................................. 10
Worksheet: mapping emotional chains .......................................................................................................................... 11
Weekly practice Sheet: mapping an unwanted emotion ................................................................................................. 12
Handout: Thoughts about Anger .................................................................................................................................... 13
Handout: inner voice ..................................................................................................................................................... 14
Worksheet: looking at the workability of the inner voice ................................................................................................ 15
Worksheet: Inventory and workability of your interpersonal rules .................................................................................. 16
Weekly practice sheet: inventory of fighting strategies against my personal stories ........................................................ 17
Handout: human figure .................................................................................................................................................. 18
Worksheet: affect – biased attention ............................................................................................................................. 19
Worksheet: Values based problem solving ..................................................................................................................... 20
Worksheet: checking the workability of attachment-driven behaviors........................................................................................22
Worksheet: Feedback sheet for the interviewer............................................................................................................................23
Handout: Thoughts about conflict ..................................................................................................................................................24
Worksheet: noticing the workability of thoughts about conflict ..................................................................................................25
Handout: go-to fight tactics.............................................................................................................................................................26
Worksheet: What’s the workability of your go-to fight tactics? ...................................................................................................27
Worksheet: Giving feedback............................................................................................................................................................28
Worksheet: Making requests ..........................................................................................................................................................29
Handout: steps for practicing empathic behaviors and making requests ......................................................................... 30
Handout: steps for giving and receiving feedback .........................................................................................................................31
Handout: thoughts about awareness .............................................................................................................................................32
Outcome measures for emotion regulation ...................................................................................................................................33
Process-based measures for Emotion Regulation and ACT: ..........................................................................................................33
iACT: Daily Log for Super-Feelers: thought awareness skills .................................................................................................34
iACT: Daily Log for Super-Feelers: body awareness skills ......................................................................................................35
iACT: Daily Log for Super-Feelers: interpersonal awareness skills ........................................................................................35
iACT: Daily Log for Super-Feelers: radical awareness skills ...................................................................................................37

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
ACT Roadmap for super-feelers
Choosing: what’s the values-based behavior I choose?

Choosing: what are the inner skills and outer skills I can use?

Checking what are my values-based options? What’s their workability? Write down an option
and place an “x” on the line of workability whether that option is close or far away to your values
Option 1: (write down here)

______________________________________________________________________
Closer Values Far away
Option 2:

______________________________________________________________________
Closer Values Far away
Option 3:
______________________________________________________________________
Closer Values Far away

Checking: what is my emotional machinery saying? Notice and name emotions, memories,
images, thoughts,____________________________________________________________________________
sensations and urges that are showing up.
Closer Values Far away

What’s the stuff I don’t have

control of?
Checking what truly matters to me in this situation?

What’s the situation? (be as specific as possible)

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Weekly practice worksheet: Values in Action

Values in Action Worksheet

Personal Value: _________________________________________________________________________________________

Is my value a personal value or am I trying to change a person or a person’s behavior?

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

After checking my value, what is the specific action I choose to take? (when, where, for how long)

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

When taking that specific action, my emotion machinery may come with uncomfortable feelings such as: (Name the distressful

feelings): ______________________________________________________________________________________________

How willing am I to have that feeling? (mark the number from 0 = lowest to 10 = highest)

0 1 2 3 4 5 6 7 8 9 10

What are the sensation(s) that I may struggle with when taking my values-based action?

______________________________________________________________________________________________________

What are the thought(s) that may show up when taking my values-based action?

______________________________________________________________________________________________________

What was the outcome after taking a values-based action?

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Values Meter: place a mark where it corresponds:

Far Away Closer

0 1 2 3 4 5 6 7 8 9 10

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: What’s the Payoff of My Emotions Running My Life?
As you continue to learn about your emotion machinery, choose 3 situations you went through the last 6 months when you felt an emotion very intensely and
took action based on it. Next, answer the questions below for each one of them.

Situation: describe it as specific as Emotion Behavior: Short-Term Payoff Long-Term Payoff

possible What did you what did you do or say? What were the short-term What were the long-term
feel? consequences consequences for you?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: the basics of emotion regulation

Use this handout to take notes of some of the key points for each one of these teaching points discussed in this session.

Teaching point: What are emotions?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Teaching point: What is emotion regulation?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

_________________________________________________________________________________________________

Teaching point: When does emotion regulation become a problem?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Teaching point: What are the types of emotion regulation?

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: emotion thesaurus

Successful Sad Joyful

Bitter Critical Discerning
Peaceful Powerful Quiet
Trapped Angry Scared
Light Hearted Playful Worthless
Curious Secure Overwhelmed
Calm Despairing Loved
Proud Appreciated Devastated
Numb Worthwhile Cold
Insignificant Betrayed Humiliated
Thankful Paralyzed Vulnerable
Inadequate Valued Helpless
Bored Tired Creative
Disconnected Empty Alive
Open Protected Safe
Imaginative Hostile Bewildered
Thoughtful Responsive Irritated
Daring Quiet Resentful
Confused Hopeless Energetic
Depressed Cheerful Furious
Stimulating Hopeful Warm
Relaxed hurt Respected
Shocked Understood Frustrated
Confident Nurturing Ashamed
Abandoned Sensuous Creative
Disgusted Optimistic Accepted

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: Thoughts about Emotion
This handout reviews the most common thoughts about emotions; feel free to write down any comment
or observations about each one of them.

Thoughts about emotions comments

Thought: Emotions come out of the blue.

Thought: I feel therefore I am.

Thought: Uncontrollable feelings last forever.

Thought: There are good emotions and there are bad

emotions

Thought: Painful emotions are bad.

Thought: The behaviors of others are responsible for

my feelings.

Thought: Expressing my intense feelings is always

healthy.

Thought: Painful emotions point toward what I need

to do.

Thought: All uncomfortable emotions are bad.

Thought: I should be able to control my emotions.

Thought: I feel it; therefore, I act.

Thought:
___________________________________________

Thought:
___________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Noticing and Naming worksheet
Throughout your day, notice what you are feeling and practice the skill of noticing that emotional experience and naming it.

What’s the situation? What did you notice? (bodily sensations, Can you name the emotion?
emotions, thoughts, urges)

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Inventory of quick-responses
Looking at different times in your life jot down the different quick responses you have been using to manage crushing emotions and next, write down the
short-term and long-term outcomes of them in your life. You can even go back to the times when you were a teenager and so on.

Age Range Quick responses Pay-Off (short term) Pay-Off (long term

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Noticing gut Reactions and True awareness
This is a moment to reflect about the times in which you experience gut reactions and true awareness; see if you can go back on time about 1 or 2 situations
for each one of them and do your best to check for yourself how you experience each one of them. On the chart on the top describe a particular situation in
which you had a gut reaction, hunch, gut feeling, a vibe, next write down what you did, and what was the pay off in both, long term and short-term

Situation What was your gut- Behavior Pay-Offs (short and long-term) Was this behavior a move
reaction? What did your towards or away from your
What was happening? feel or notice in your body? What did you do? values?

Situation What was the true Behavior Pay-Offs Was this behavior a move
What was happening? awareness reaction you (short and long-term) towards or away from your
What did you do?
had? values?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: mapping emotional chains
Based on what you learned today about emotional chains in which there is a string of emotions – behaviors – emotions – behaviors and so on, think about
three different situations in which you went and experienced an emotional chain. Remember, this is not about perfectly completing the worksheet but
doing your best to notice the emotion machinery in action when it gets turned on!

Emotion Behavior Emotion Behavior Emotion Behavior

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Weekly practice Sheet: mapping an unwanted emotion
Given that the world of emotions is a large one and today’s session only covered the most common ones, do your best to identify situations that started
different emotions than the ones that were covered in today’s session (e.g. disgust, hate, embarrassment, to name a few) and jot down the components of
that emotional experience.

Situation Bodily sensation: Behaviors What was the pay-off What was the pay-off
(be as specific as possible) What did you feel? What did you do? (short-term) (long-term)

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: Thoughts about Anger

This handout reviews the most common thoughts about anger; feel free to take notes of examples or any
observations about how you relate to this thought.

Thoughts about anger comments

Thought: I only get mad because of what

others do, say, or what they don’t do too.

Thought: If I get angry, then others don’t

bother me

Thought: talking about what made me angry

is always helpful

Thought: anger is depression towards the self.

Thought:

Thought:

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: inner voice

Handout: inner voice

Below are the main concepts that we discussed in today’s session; use this handout to take notes of them for
the future.

The natural evolution of the inner voice as a “danger detector”

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

The natural protective function of the inner voice

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

The natural tendency of the inner voice to create all types of associations
__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

The natural ongoing activity of the inner voice:

__________________________________________________________________________________

__________________________________________________________________________________

_________________________________________________________________________________

the sweetness and the sourness of our inner voice

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: looking at the workability of the inner voice
When your emotion machinery gets turn on, your inner voice naturally gets turn on too, and as a special device pushes you to do something right away.
Check for yourself what happens if you do that. Choose a recent situation you went through, jot down the specifics of it and answer the questions in each
column.

Situation What did your What thought did What did you do? Did the behavior get you closer
What happened? emotion machinery your inner voice (private or public or far away from your values?
come up with? came up with? behavior?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Inventory and workability of your interpersonal rules
Have you learned specific “oughts, should or musts” thoughts about dealing with people when there is any possibility of getting hurt, and your emotion machinery
gets turned on and your inner voice quickly gets in motion organizing your behavior? Take a look at some of those interpersonal rules, check your go-to action, and
check their workability

What does your emotion machinery What are the What do you do? Do you get closer or far away from your values?
show up with? interpersonal rules your
inner voice comes up
with?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Weekly practice sheet: inventory of fighting strategies against my personal stories
As you move forward with learning ACT skills, take a moment to pause and check for yourself the different fight strategies you have use when dealing with
sticky stories about yourself and check the workability of them.

What’s the old story your inner What does your emotion What did you do? Catch What was the short- What was the long-term
voice holds against you? machinery come up with? your private and public term Payoff of holding Payoff of getting hooked on
behaviors onto that story? that story?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: human figure
After completing the body scan exercise, write down the sensations you noticed in your body and a word
describing it; you can use as a guidance some of the words next to the drawing of the human figure
below.

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: affect – biased attention
From time to time, when your emotion machinery gets turn on, naturally your inner voice is going to tell you all types of things about what’s
happening; it’s like “your feelings are dictating reality” but sometimes, the inner voice is far off from what’s really happening around you. If you
had moments like that, jotted down some of those situations, and check the outcome of getting hooked on your inner voice.

Past triggering situation What was your emotion Stepping back, what was really What was the outcome of listening
machinery coming up with so going on in that situation? to your emotion machinery so
What was the situation?
quickly that felt the absolute quickly?
truth??

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Values based problem solving

Not everything goes as we would like it to go, and more often than not, we have to face
problems of all types. Within ACT you’re asked to learn to solve a problem, not only as a
technique, but as another step towards your values. Choose a situation you’re struggling with,
and do your best to answer the questions below; it’s better if you choose a situation that you
may be ambivalent about or one in which you have high stakes.

Can you describe the situation as specific as possible?

_____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What’s the stuff do you have control of?

______________________________________________________________________________

______________________________________________________________________________

What’s the stuff you don’t have control of at all?

_____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

If you step back for a moment, what really matters to you in this situation? (watch out for any
“feeling hooks” when checking your values)

_____________________________________________________________________________

What is your emotion machinery coming up with about it? (feelings, sensations, urges,
memories, images, thoughts)
_____________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
What are the potential actions you could take and check for each one of them whether they take
you closer or far away from your personal values.

Potential actions Closer to values Far away from

(1-10) values (1-10)

Based on your responses to the above chart, what did you decide?

______________________________________________________________________________

______________________________________________________________________________

Let’s be real: whatever decision you choose, is not struggle free and your emotion machinery,
with a loud inner voice, and tons of body noise will be there. What emotions, thoughts,
sensations or urges do you need to make space for when choosing that behavior that takes you
closer to your values?

______________________________________________________________________________

______________________________________________________________________________

The next questions are answered after you took action about this problem,

What was the action you decided to take? ___________________________________________

______________________________________________________________________________

What were the pay-offs of this behavior in the short-term and long-term run?

______________________________________________________________________________

______________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: checking the workability of attachment-driven behaviors
After learning about the different attachment styles, anxious, disorganized, ambivalence and secure, take a peek at how they showed up in your
relationship, the most common things you do, and whether they are a move towards or away from your interpersonal values. To start choose a
relationship, identify your attachment style, and jot down your interpersonal value in that particular relationship. Next, do a mini-inventory of the
problematic situations in that relationship or times in which you got hurt, how it felt, what you ended up doing, and in the last column, check the
workability of that behavior.

Relationship with: __________________ Attachment Style___________________ Interpersonal Value: ______________

What was the problematic Situation in the What did your emotion What were the attachment-driven Did you get closer or far away
relationship? machinery come up with? behaviors? from the relationship I want to
have?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Feedback sheet for the interviewer

Observation sheet for the interviewer

Notice how the interviewee is participating in the role play, and jot down some observations
about each one of the following categories:

Presence: _________________________________________________________________

_________________________________________________________________

Posture: __________________________________________________________________

__________________________________________________________________

Body: ___________________________________________________________________

__________________________________________________________________

Face: ____________________________________________________________________

___________________________________________________________________

Observation sheet for the Interviewee

When participating in the role-play, check your inner experience and what showed up for you

Any type of past, future, reason-giving, labeling, stories, or ruling thoughts?

Any feelings? ______________________________________________________________

Any Sensations? __________________________________________________________

Any go-to actions: _______________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: Thoughts about conflict
Our inner voice naturally comes up with all types of thoughts about conflict. Below are some of the
popular ones; check the ones that apply to you, add other ones, and jot down the behaviors that come
along when getting fused with them.

Thoughts about conflict Most common behaviors when getting hooked on

those thoughts

You change first, then I’ll do it Refusing to adjust for others or the relationship.

Ignoring other’s requests or comments.

Sayings things like “I never had done anything like that”

or “why do I have to change.”

There are winners and losers in a fight Going into convincing mode so the other person agrees
with your point of view.

Proving at all costs the other person is wrong.

I don’t want to argue, I want to be liked! Doing things for others, making sure people have a good
time, not telling others what you’re really feeling

The person that started the conflict has to solve it. Refusing to learn the other person’s point of view.

Ignoring to see that the other person is struggling as

well.

Arguing weakens the relationship Ignoring conflict and quickly acting as if nothing had
happened.

Loosing sucks! Refusing to let go of the conflict and insisting on the

other person’s placating.

If I don’t say what’s going on right now, I won’t be Pinpoint the other person’s mistakes or making global
taken seriously. comments about the person’s character.

Don’t argue, wait for things to get better in their own. Ignoring feelings of being hurt, disappointed, etc.

Changing the topic of the conversation as quick as

possible.

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: noticing the workability of thoughts about conflict
Sometimes we get fused with all types of thoughts about conflict, get bossy around by them, and act too quick! Use this worksheet to check the “workability” of
those behaviors in your relationships and figure it out how do they really work in your life!

Triggering situation What did your emotion What thoughts about What did you do? Did you get closer or further away
What was the fight or conflict about? machinery come up with? conflict did you get fused from the relationships you want
with? to have?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: go-to fight tactics
How do you argue? Check the most common behavioral responses you depend on to manage
conflict; some of them may apply to you, others not.

Go-to fight tactic Behaviors associated

Forcing mode Going into forcing mode when arguing comes with making
threats, demands, and coercing the other person.

Blaming mode Blaming or externalizing go-to fight tactics make others

responsible for your distressful feelings or behaviors.

Reason-given mode Going into reason-given mode as go-to fight tactic is listing all
reasons, explanations, or justifications that your inner voice
comes up with as absolute truth without considering any
other options or alternatives.

Character attacks mode When feeling upset and going into character attacks mode is
like your inner voice goes into knife mode and will quickly
come up with tagging thoughts, labeling thoughts, and
criticisms about the other person.

Placating mode Placating, quickly agreeing, or dismissing your needs is

another go-to tactic to deal with conflict.

Disconnecting mode Going into disconnecting mode is like going into ice-cube
mode; it refers to moments in which you disconnect
emotionally and even physically from the person you’re
arguing with.

Measuring mode Measuring mode is evaluating another’s behavior in regard

to the relationship: do they always drive to see you or do you
also drive to them? Are they spending as much money as
you’re spending in the relationship or it’s just them?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: What’s the workability of your go-to fight tactics?
It’s natural to argue, fight, or dispute, that’s just part of any relationship. And it’s natural to have classic go-to fight tactics to manage those arguments. Take a peek
at yours, based on the handout you received in group, and check the workability of them in your relationships.

What was the argument about What did your emotion machinery show up with? What was the go-to fight tactic you Did you get closer or far
and with whom? (feelings, sensations, urges, memories, etc.) used in that argument? away from your
interpersonal values?

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Giving feedback

What’s the situation? ____________________________________________________________________

_________________________________________________________________________________________

What’s my value? _______________________________________________________________________

Notice and name your emotion machinery in action (feelings, thoughts, bodily sensations, urges)
__________________________________________________________________________________

________________________________________________________________________________________

Jot down the specific feedback / request

Make sure to include an appreciation, the reasons for giving feedback, your feelings about it and the specific
request
________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Worksheet: Making requests
All relationships are going to require you to make a petition or request at some point. Do your best to use this
worksheet to prepare for any scenario in which you need to make a request.

What’s the situation? (be as specific as possible)

_____________________________________________________________________________________

_____________________________________________________________________________________

What do you really have control of?

_____________________________________________________________________________________

_____________________________________________________________________________________

Are you getting hooked on any change agenda?

_____________________________________________________________________________________

_____________________________________________________________________________________

Notice your emotion machinery in action (feelings, thoughts, bodily sensations, urges)

_____________________________________________________________________________________

_____________________________________________________________________________________

Request: (a) state clearly what the situation is, your (b) thoughts about it, (c) emotions when looking at it, and
(d) your specific request.

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: steps for practicing empathic behaviors and making requests

Steps for practicing empathic behaviors so all Steps for making requests
participants

1. Notice and name your emotional Step 1: To be clear about what the request is:
machinery in action (feelings,
sensations, images, memories, past, (a) Check your personal value about the
future, ruling, labeling thoughts). situation

2. Notice any go-to actions that are (b) Notice what you have control of and what
showing up in the moment. you don’t have control of.

3. Ground yourself with your breathing: (c) Check what you need more or less, to start
drop your anchor! or to stop in the relationship

4. Focus your attention on the other (d) Notice and name what your emotion
person by asking three questions machinery comes up with when thinking about
about their hurt: what they think making this request.
about it, how they feel about it, and if
there is anything you can do about it. Step 2: Make the request

(a) state clearly what the situation is, your (b)

thoughts about it, (b) feelings you have about
it, and (c) your specific request.

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: steps for giving and receiving feedback
Steps for giving feedback Steps for receiving feedback

(1) Notice and name what your emotion machinery comes up with Stage 1: Preparation steps to give feedback
(feelings, bodily sensations)
(1) Be clear about the upsetting situation for you (be as specific as
(2) Notice and name what your inner voice comes up with about the possible).
person giving you feedback or the situation (any stories, ruling,
past, memories, images, future or labeling thoughts) (2) Check what really matters to you in regard to this relationship
(personal value, relationship values)
(3) Notice your go-to actions: check those go-to fight tactics.
(Forcing, blaming, reason-given, character attacks, placating, (3) Notice and name what your emotion machinery comes up with
disconnecting modes) when thinking about this situation.

(4) Ground yourself over and over to stay in the moment: drop your Stage 2: Delivering feedback
anchor!
(4) Appreciate what needs to be appreciated in the other person’s
(5) Check your values: what’s really important to me on this behavior or person
interaction? (and remember, there is always something to appreciate).

(6) Choose your values-based behavior: what do I need to do to stay (5) Be specific about the feedback you want to give the other person
close to my values in this situation? (describe the behavior, not a label about the person).

(6) Be specific about your feelings and thoughts when giving

feedback to the other person.

(7) State the reasons why it’s important to you to give this feedback.

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Handout: thoughts about awareness
This handout reviews the most common thoughts about awareness; feel free to write down any comment
or observations about each one of them.

Thoughts about awareness comments

Thought: we can only practice awareness when we are

in silence and it’s quiet.

Thought: awareness helps us to control your emotions

Thought: awareness works when we get to be relaxed

Thought: awareness applies only for positive feelings.

Thought: awareness is all we need to manage our

emotion machinery

Thought:
_________________________________________

Thought:
_________________________________________

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Outcome measures for emotion regulation

Difficulties in Emotion Regulation Scale (DERS)

Borderline Symptom Checklist 23 (BSL-23)

Depression, Anxiety, and Stress Scale (DASS)

Novaco Anger Inventory 25, short-version (NAI-25)

Eating Disorder Examination Questionnaire (EDE-Q 6.0)

Physical Appearance State and Trait Anxiety Inventory – State Version (PASTA-S) Interpersonal Inventory
of Interpersonal Problems (IIIP-48)

PCL - 5 (trauma)

Process-based measures for Emotion Regulation and ACT:

Five Facet Mindfulness Questionnaire (FFMQ)

Acceptance and Action Questionnaire (AAQ-II)

Valued Living Questionnaire (VLQ)

CFQ (Cognitive Fusion Questionnaire)

Self as Context Scale (SACS)

Difficulties in Emotion Regulation Scale (DERS) (*)

White Bear Suppression inventory (WBSI)

Mindfulness Attention Awareness Scale (MASS)

Body Image Acceptance and Action Questionnaire (BI-AAQ)

Acceptance and Action Questionnaire for Weight (AAQ-W)

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
iACT: Daily Log for Super-Feelers: thought awareness skills

Name: _______________________________________________________________________ Date: ___________________

Practice and practice makes a difference! At the end of your day, take a moment to reflect on your day, and make a checkmark if you practiced
any of the skills from the thought awareness module.

Thought Awareness Skills Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Noticing and Naming

• Past Thoughts

• Labeling Thoughts

• Future Thoughts

• Ruling Thoughts

• Interpersonal Ruling Thoughts

• Narrating Thoughts

Checking workability of thought-driven actions

Checking values

Choosing to defuse from unworkable thoughts

Observations:

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
iACT: Daily Log for Super-Feelers: body awareness skills
Name: ___________________________________________________________________Date: __________________

Practice and practice makes a difference! At the end of your day, take a moment to reflect on your day, and make a checkmark if you practiced
any of the skills from the body awareness module.

Body Awareness Skills Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Noticing and Naming

• Freezing State

• Fleeing State

• Fighting State

• Attentional Bias

• Multitasking Attention/scattered attention

Checking workability of body-based actions

Checking values

Choosing other behaviors:

• Values-based problem-solving skills

• Compassionate Touch

• Soothing Skills

• Grounding Skills

iACT: Daily Log for Super-Feelers: interpersonal awareness skills

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
Name: _______________________________________________________________________ Date: __________________
Practice and practice makes a difference! At the end of your day, take a moment to reflect on your day, and make a checkmark if you practiced any of the
skills from the interpersonal awareness module.

Interpersonal Awareness Skills Mon Tue Wed Thu Fri Sat Sun
Noticing and Naming

Attachment style/go -to behaviors

Body language (body, posture, facial expression)

Go-to urges to fight

Go-to conflict tactics (forcing, blaming, placating, reason-giving, disconnecting,

measuring, character attacks)
Noticing chronic debilitating emotions that come along with a story of who I’m

Noticing my change agenda

Checking workability of go-to conflict-tactics

Choosing other behaviors:

Interpersonal values-based behaviors

Being present with others (body language, facial expression)

Empathic behaviors

Making requests

Giving/receiving feedback

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications
iACT: Daily Log for Super-Feelers: radical awareness skills
Name: _______________________________________________________________________ Date: ___________________
Practice and practice makes a difference! At the end of your day, take a moment to reflect on your day, and make a checkmark if you practiced any of the
skills from the radical awareness module.

Radical Awareness Skills Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Noticing and Naming

Emotion machinery in full motion

Change agenda about what I’m feeling

Change agenda about what’s happening outside of me

Checking workability of go-to urges

Choosing other behaviors:

Awareness on the fly

Awareness on the quiet

Awareness when I’m hurting

Observations:

© Patricia E. Zurita Ona, Psy.D. - 2020 - www.thisisdoctorz.com - distributed with permission of N.H. Publications