Control, Influence, Accept: PDF Worksheet, Tools and Exercises

When a patient floods with anxiety ahead of a performance, a medical result, or a relational confrontation, telling them to "focus on what they can control" rarely lands. The phrase is too abstract, and without a scaffold, patients either over-claim control (fuelling hypervigilance and compulsive preparation) or surrender everything to helplessness. This fiche PDF gives that scaffold a concrete, visual form that you can work through together in session.

Why "What You Can Control" Is So Hard to Explain Verbally

The core clinical problem is categorisation under emotional load. Patients with generalised anxiety, a marked intolerance of uncertainty, or chronic need to control everything do not misunderstand the concept intellectually; they misapply it in the moment. Three sorting errors come up repeatedly in clinical work.

First, what others think lands in the Control column. The patient rehearses, over-explains, and reads every social signal as correctable feedback. Second, their own preparation slips into Accept ("I'll never be ready anyway"), leaving them paralysed rather than acting where action is genuinely available. Third, the Influence column disappears entirely. Without it, thinking collapses into the all-or-nothing binary that all-or-nothing cognitive distortions produce: either I control this outcome, or I'm helpless.

Saying "you can't control that" in session triggers either resignation or argument. A visual layout of three named, bounded columns makes the sorting concrete enough to debate productively.

What the Fiche Contains: A Three-Column Visual Map

The support visuel at the centre of this fiche is a three-columns map built around a single worked example: preparing a public talk on Thursday. Each column carries a label (Control / Influence / Accept), a one-line definition, a list of items from the example, and a concrete Actions block.

Control is defined as "depends only on me" and covers content, rehearsal, and slide design. Influence is framed as "I nudge, not decide" and covers audience attention and interaction level. Accept covers "others' reactions, opinions, uncertainty", with reframes such as "not everyone is receptive" and "let the thought pass."

A second panel, Common Sorting Mistakes, names the three misclassifications described above explicitly, which is clinically useful: you can show a patient the fiche and ask "which of these three mistakes is happening for you right now?" rather than spending session time eliciting the pattern from scratch.

A third panel, What Accepting Really Means, addresses the refusal that most patients express the first time you raise acceptance: "Accepting is not approving, not giving up, not pretending it doesn't matter." Having that spelled out visually saves you from a lengthy detour and keeps the focus on the functional shift. The framing is consistent with ACT psychological flexibility and with the ACT Hexaflex work patients may already be doing alongside this tool.

> Key point: This fiche is a psychoeducation visual support designed for use in session, not an autonomous questionnaire. You hold it, you walk through the columns together, and the patient leaves with a printed copy as a concrete reference between appointments.

When and How to Introduce the Fiche

The fiche fits naturally at the psychoeducation phase of a CBT or ACT formulation, once you have a shared understanding of the patient's core maintaining processes. It is particularly indicated for:

• GAD profiles where worry captures attention across multiple domains simultaneously
• Patients with adaptive versus maladaptive coping patterns skewed toward over-control or avoidance
• Uncertainty intolerance programs where you need a quick sorting exercise before moving to exposure work
• Clinical moments where the patient is stuck in rumination and needs a concrete action question to interrupt the loop

A low-threshold introduction: "Before we decide what to do about this, let's spend five minutes sorting it into three piles. I'll show you a map." Avoid framing it as a homework sheet. Present the example column first, let the patient build their own version verbally in session, then hand them the printed fiche.

To debrief, ask which column felt hardest to fill, and what happened in their body when they placed an item in Accept. That somatic response is the clinical material. Pair the fiche with ACT cognitive defusion techniques when the Accept column generates strong distress, or with the Choice Point framework when the patient needs to translate the Control and Influence columns into a committed action.

The fiche does not replace the formulation; it makes one key part of it visible enough to act on.

Sources

• Epictetus. Enchiridion (Dover Thrift Editions, trans. George Long). Dover Publications.
• Niebuhr, R. (1932). Serenity Prayer.
• Hayes, S. C., Strosahl, K. D., Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.
• Hayes, S. C., Strosahl, K. D. (2004). A Practical Guide to Acceptance and Commitment Therapy. Springer.
• Irvine, W. B. (2009). A Guide to the Good Life: The Ancient Art of Stoic Joy. Oxford University Press.