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ACT for Depression: Practice Worksheet

How ACT Helps with Depression
Depression often involves getting stuck in negative thinking patterns, withdrawing from activities that matter, and waiting to feel better before living. ACT offers a different approach: You can take meaningful action RIGHT NOW, even while experiencing depression. The goal isn't to eliminate depressive thoughts and feelings, but to develop psychological flexibility so you can live according to your values despite depression.
"You don't have to wait until you feel better to start living better."
— ACT Principle

Common Depressive Thoughts and Defusion Practice

Exercise 1: Defusing from Depressive Thoughts

Common depressive thoughts include:

What depressive thought shows up most often for you?

Now practice defusion. Rewrite the thought as: "I'm having the thought that..."

Example: Instead of "I'm worthless" → "I'm having the thought that I'm worthless"

Notice how this simple shift creates distance. The thought is still there, but you're observing it rather than being it.

What do you notice when you create this distance from the thought?

Acceptance of Depressive Feelings

Exercise 2: Making Room for Depression

Depression often comes with difficult feelings: sadness, emptiness, fatigue, hopelessness. Our natural instinct is to try to push these feelings away or wait for them to disappear before we do anything. ACT teaches acceptance—making room for these feelings while still taking action.

What depressive feelings are you experiencing right now?

What have you been doing to try to avoid or eliminate these feelings? (Examples: staying in bed, avoiding people, substance use, distraction)

Has struggling against these feelings made them go away, or has it kept you stuck?

💡 Acceptance Practice: Try saying to yourself: "I'm willing to make room for this sadness/emptiness/fatigue. I don't have to like it, but I can allow it to be here while I do what matters to me."

Values and Behavioral Activation

Exercise 3: Values-Based Action Despite Depression

Depression often pulls us away from what matters. We withdraw, isolate, and stop doing things we care about. ACT-based behavioral activation means reconnecting with values and taking action in that direction, even when you don't feel like it.

What values has depression interfered with? (Examples: being a caring friend, pursuing career goals, taking care of health, connecting with family)

Choose ONE value that matters to you. What's one small action you could take this week that aligns with this value, even if you're still feeling depressed?

Remember: You don't have to feel motivated or happy to take values-based action. You can feel depressed AND still do what matters. That's choosing values over comfort.

Weekly Values-Based Action Plan

Day Values-Based Action
(What I'll do despite depression)		 Did I Do It?
(Check when complete)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
💡 Start Small: If depression feels overwhelming, start with tiny actions. Even texting a friend, taking a 5-minute walk, or getting dressed counts as values-based action.

Self-Compassion Practice

Exercise 4: Self-Compassion for Depression

Depression often comes with harsh self-criticism. ACT includes self-compassion—treating yourself with the same kindness you'd offer a good friend.

What critical things does your mind say to you when you're depressed? (Examples: "You're lazy," "You should be better by now," "You're weak")

If a good friend was experiencing depression and having these same thoughts, what would you say to them?

Can you offer yourself that same compassion?

Self-Compassion Phrase to Practice:
"This is a moment of suffering. Depression is difficult. May I be kind to myself in this moment. May I give myself the compassion I need."

Present Moment Awareness

Exercise 5: Grounding in the Present

Depression often involves ruminating about the past ("I've failed," "I've wasted my life") or worrying about the future ("I'll never get better," "Nothing will change"). Present moment awareness brings you back to right now.

5-4-3-2-1 Grounding Exercise (do this when feeling overwhelmed by depression):

Practice this exercise now and notice what happens:

Reflection

What did you learn from completing this worksheet?

What's one ACT skill you'll practice this week?

What committed action will you take in service of your values, even if depression is still present?

"Between stimulus and response there is a space. In that space is our power to choose our response."
— Viktor Frankl
Remember: Depression tells you to wait until you feel better before living. ACT says you can live meaningfully RIGHT NOW, with depression along for the ride. You don't have to eliminate depression to have a life worth living.
© 2026 Syracuse Integrative Psychiatry | This worksheet is for educational purposes and is designed to supplement, not replace, professional mental health care. | If you're experiencing suicidal thoughts, call 988 (Suicide & Crisis Lifeline) immediately.