Understanding the Stanza ACT program – XR Health Clinicians Page (en)

Stanza delivers Acceptance and Commitment Therapy (ACT), a form of Cognitive Behavioral Therapy (CBT). This article explains the core ACT skills your patients build in Stanza, along with the journals and awareness activities that support them. Use it to recognize where a patient may be struggling and how to support them between sessions.

For setup and day-to-day management, see Managing patients in Stanza.

The core ACT skills

Stanza introduces six ACT skills. For each, here's what it means, signs a patient may be struggling, and how you can help.

1.Acceptance

Letting experiences be as they are and approaching them with openness, as an alternative to avoidance — a foundation for doing what matters even when it's uncomfortable.

Signs of struggle: Avoiding activities they'd like to do but find uncomfortable; repeating the same ineffective strategies (for example, gardening all day and then crashing, rather than pacing).
How to support: Don't argue with their experience of pain — model acceptance. Explore what's outside their control, and focus on the choices they can make. Build plans that account for both difficulty and values.

2. Values

Freely chosen beliefs about what matters and who to be — directions to travel rather than goals to achieve, and a source of motivation.

Signs of struggle: Focusing on goals rather than life directions; holding "living pain-free" as a value (a goal, and usually unrealistic); difficulty naming any values.
How to support: Invite them to imagine what they'd want said about them at their 80th birthday. For a patient fixed on being pain-free, ask what they'd do without pain, and use the answer to surface values.

3. Defusion

Unhooking the mind from sticky thoughts and getting distance from unhelpful emotions and urges, so they can observe experiences rather than be dictated by them.

Signs of struggle: Repeating the same phrases; frequent "I can't" or "because I have fibro"; trying to control or argue with distressing thoughts.
How to support: Encourage them to simply notice thoughts. Suggest imagining thoughts as pop-up windows they can close. Reassure them they don't have to disprove a thought before letting it go.

4. Self-as-context

Awareness of the self as the container of experience — separate from the thoughts and feelings being observed — which allows responding rather than reacting.

Signs of struggle: Reacting quickly or negatively to discomfort like a pain flare; getting stuck as if there's no solution.
How to support: Encourage noticing thoughts. Invite the framing "I'm having the thought that…" (so "This pain is unbearable" becomes "I'm having the thought that this pain is unbearable"). Help them look at challenges rather than through them.

5. Mindfulness

Present-moment awareness — noticing sensations and habitual thoughts without judgment, practiced formally or informally.

Signs of struggle: Skipping mindfulness exercises; calling them silly; saying they "can't" be mindful; judging wandering thoughts as failure.
How to support: Remind them it's a skill that takes practice. Acknowledge it isn't for everyone, and ask if they're willing to try. Suggest informal practices like mindful eating or walking. Normalize wandering thoughts — what matters is noticing and returning.

6. Committed action

Taking action toward values, with willingness to meet obstacles and discomfort — doing what matters even when it's hard.

Signs of struggle: "I want to, but…"; giving up on the skills; returning to avoidance.
How to support: Reconnect current choices to their stated values, gently (patients may resist if pushed). Revisit things they accomplished before feeling stuck, and point out they managed them despite symptoms. This is an area where your professional support is especially valuable.

Journals in Stanza

Journals help patients apply the skills and track their progress. The main journals are:

Values Dartboard — identifies the patient's life values to guide decisions and motivation.
Values-Guided Action — turns values into personalized, trackable goals.
Disobeying unhelpful thoughts — identifies unhelpful thoughts and practices "disobeying" them.
Pacing — builds a personalized pacing plan to avoid overdoing it and crashing.
Exercise — personalizes an exercise plan to make movement feel more doable.
Mindfulness — helps the patient choose which mindfulness activities to practice.
Time well spent — connects daily activities to personal values and builds motivation.

Note: When a patient skips a journal, it's often where they're stuck. For example, a patient who avoids the Pacing journal may keep viewing activities as all-or-nothing.

Awareness activities in Stanza

Awareness activities give patients different ways to practice mindfulness, so they can find what works for them:

Diaphragmatic breathing — an accessible entry point that can calm heart rate and nervous-system activity.
Practicing awareness — staying with the present moment and watching thoughts come and go.
Foot grounding — body-awareness practice that strengthens the ability to shift focus.
Band of light — observing physical sensations, including pain, without judgment.
Leaves on a stream — letting thoughts pass rather than following them.
Walking with awareness — mindfulness through gentle movement, for patients who find sitting practice hard.
Creating space — combines body awareness with defusion by describing sensations in concrete, nonjudgmental terms.
Passive muscle relaxation — systematically relaxing muscle groups to notice and release tension.