Case Study 3: An acceptance commitment

and mindfulness based intervention for

a female hockey player experiencing post
injury performance anxiety
Jennifer Bennett & Pete Lindsay

Returning from injury in elite sport presents itself with numerous challenges. Although injury rehabilitation
has featured extensively in sport psychology literature, the application of case specific interventions remains
scarce. The current case study addresses the anxiety surrounding injury recovery, and presents a detailed
intervention program that was delivered to an elite female hockey player. This intervention demonstrates the
application acceptance commitment therapy (ACT; Hayes, Strosahl & Wilson, 1999), with mindfulness
and relaxation strategies to reduce imagined pain associated with an old injury, and manage anxiety
associated with return to play. Six key stages will be presented: background to case; formulation/assessment
multidisciplinary; client education; learning mindfulness and ACT in context; assessing readiness to
perform; intervention evaluation. The case concludes by summarising how ACT and mindfulness facilitated
recovery from injury and return to performance, providing tentative advice for practitioners wishing to adopt
an ACT based approach within the domain of pain management and injury recovery.
Keywords: Anxiety, mindfulness, injury, ACT, acceptance commitment.

Introduction and philosophical approach

M
Y PHILOSOPHICAL APPROACH
in this case study was supported by
Acceptance Commitment Therapy
(ACT; Hayes, Strosahl & Wilson, 1999), with
a specific focus on developing psycholog-
ical flexibility and mindful awareness. Over
the past decade several mindfulness and
acceptance-based models have been devel-
oped from the origins of clinical psychology
and the emotion sciences for the enhance-
ment of performance in competitive sport
(Gardner & Moore, 2012). The primary goal
of these models is to alter one’s relation-
ship with thoughts, feelings, emotions, and
physical sensations, rather than suppress, or
attempt to control them (Gardner & Moore,
2007). Specifically, the mindfulness and
acceptance-based approach supports that
optimal performance requires: 1) nonjudg-
mental present moment awareness and
acceptance of one’s internal state (whatever
that might be), 2) attentional focus on task
relevant stimuli, and 3) committed efforts
towards value-driven behaviour (Gardner &
Moore, 2012). This is aligned to my profes-
sional and personal values of supporting the
client to reach their potential by connecting
with their values, being present, and devel-
oping the skills to confidently overcome any
challenges or emotional difficulties.
ACT offers a relatively new form of mind-
fulness and acceptance-based therapy recom-
mended for psychological, behavioural, and/
performance difficulties. The ACT model is
consistent with the belief that thoughts are
transitory events within a continuous stream
of consciousness, and should therefore be
separated from the self. This belief assumes
that observing one’s experience with a sense
of detachment prevents thoughts, emotions,

36 Sport & Exercise Psychology Review, Vol. 12 No. 2

 Case Study 3: An acceptance commitment and mindfulness based intervention for a female hockey player

and physical sensations from fusing with
one’s self-identification (Fletcher, Schoen-
doerf & Hayes, 2010). Thus, the importance
of replacing experiential avoidance with
acceptance is a central component of the
ACT model (Hayes & Wilson, 1994). The
former can be defined as the attempt to
minimise, suppress, or replace distressing
thoughts, feelings, emotions and/or phys-
ical sensations, and has been linked to the
development of many psychopathologies
and emotional distress (Hayes & Wilson,
1994). In contrast, acceptance involves the
conscious decision to change one’s perspec-
tive, and allow current thoughts, feelings,
and sensations to be a part of one’s present
moment experience. More specifically, the
primary goal in ACT is to adopt a state of
psychological flexibility, or the acceptance
of emotional distress while simultaneously
engaging in value-driven behaviour (Hayes,
Strosahl & Wilson, 2011).
The practice of psychological flexibility
combines six processes, collectively forming
the ACT hexaflex (see Figure 1): 1) contact
with the present moment (mindfulness), 2)
acceptance of current experience, 3) diffu-
sion from thoughts, feelings, and emotions,
4) adoption of a contextual view of the self,
5) identification of personal values, and 6)
committed action towards values (Hayes et
al., 2011). Mindfulness has been defined as an
‘open-hearted, moment to moment nonjudg-
mental awareness’ (Kabat-Zinn, 2005, p.24).
Thus, with regards to the hexaflex, mind-
fulness (contact with the present moment)
refers to the ability to maintain awareness of
one’s current state, and to accept discomfort
without judgment (Cardacoitto et al., 2008).
As such, mindfulness encompasses both
attentional and acceptance-based compo-
nents (Bernier et al., 2009; Coffey et al.,
2010; Van Dam et al., 2011). The attentional
component involves the conscious choice
to observe one’s thoughts, emotions and
physical sensations in the present moment,
while simultaneously adopting an attitude
of openness, nonjudgmental awareness, and
receptivity (i.e., acceptance; Bishop et al.,
2004). The development of mindfulness also

Figure 1: The ACT Hexaflex
Figure 1. The ACT Hexaflex.
Sport & Exercise Psychology Review, Vol. 12 No. 2 37

Jennifer Bennett & Pete Lindsay
supports the second process of the hexaflex,
acceptance of current state: observing one’s
current experience without reaction. Again,
similarly to mindfulness, diffusion from
thoughts, feelings, and/or emotions involves
observation and awareness of thoughts, and
subsequent disengagement from them. This
part of the model is based on the notion
that language can create suffering (Eifert &
Forsyth, 2005). The use of metaphor in sport
has received strong support (Anderson et al.,
2007; Lindsay et al., 2010). In ACT, experi-
ential exercises and metaphor are used to
promote disengagement from thoughts as
they occur (Hayes et al., 2011). Metaphor
also assists with developing the sense of self-
as-context. For example, using the metaphor
of a chessboard, the client is taught to iden-
tify with the board as a representation of the
self, and the pieces as thoughts. In doing this,
the client is able to view thoughts, feelings,
and emotions as temporary and passing, in
the same way a chess player moves the pieces
while remaining separate from them (Eifert
& Forsyth, 2005). The final processes in ACT
involve the identification of personal values,
and actively increasing behaviour in align-
ment with those values.
Both ACT and mindfulness hold the
client as the expert. To this end the psychol-
ogist’s role is to question the client in such a
way that facilitates their discovery of personal
values, strengths, and resources, before
channeling these towards their current situa-
tion (Høigaard & Johansen, 2004). The ACT
model has allowed me to draw on a range
of methods including metaphor, mindful-
ness, and acceptance to facilitate anxiety
management. I believe these methods offer
me a consultancy approach congruent with
my personal beliefs about human emotion,
cognition, and behaviour. Specifically, that
emotion, cognition, and behaviour are
inseparable, and by influencing cognitive
1 The physiotherapist and athlete have agreed that the information discussed in this case study can be shared,
however pseudonyms have been assigned to maintain a level of anonymity (see, Gilbourne & Richardson,
2006).
38 Sport & Exercise Psychology Review, Vol. 12 No. 2
processes, behaviour change is inevitable.
This is primarily because ACT and mindful-
ness see problems as existing only within
the client’s self-constructed experiential
state and cognitive narrative (cf. Hayes et al.,
2003). This also supports my belief that the
use of language, and self-constructed narra-
tives, often prevent people from finding
relief of dysfunctional symptoms, and conse-
quently holds them in a self-perpetuating
cycle of anxiety driven avoidance behaviour.
I believe that people have the strengths and
cognitive resources to detach themselves
from this bind, and live in their desired
problem free world (cf. Lindsay et al., 2014).
Background to the current case
In my role with the GB U21 women’s hockey
team I am required to travel to various
training and competition camps. A couple
of days into a non-competitive training
camp, I was approached by the team physi-
otherapist X1 regarding one of the players
she had spent some time working with. X
explained to me how she had been providing
physiotherapy treatment for B for a back
injury she incurred at the beginning of the
previous season. X described the nature of
the problem to me, and that it had previ-
ously caused significant lower back pain for
B, preventing her from training and playing
competitively for the majority of last season.
X was confident however that B was now
over the injury, and that there was no phys-
ical problem remaining (this diagnosis was
supported by two MRI scans and a clinical
medical assessment). X was now supporting
B with additional warm-up stretches to
strengthen her lower back and offer a
means of injury prevention. Despite being
physically free of the injury, B continued
to complain about pain in her lower back,
identified being fearful of returning to
training, and frequently requested time off
 Case Study 3: An acceptance commitment and mindfulness based intervention for a female hockey player
the pitch. X was also concerned that B had
become dependent on her support, and
that B’s persistent request for this might
be misplaced anxiety, driven by an under-
lying fear of re-injury. X reported that she
had discussed with B exploring psychology
support, and that B was expecting to be
approached by me during the camp. In this
case study, I will outline the work I did with
B over a period of six months.
My applied consultancy is supported by
the English Institute of Sport (EIS). The EIS
team operate using a ‘buy-in’ confidentiality
policy. This policy specifies that informa-
tion discussed between an athlete and sport
psychologist can be shared with coaches and
support staff where appropriate. This allows a
practitioner to work effectively with coaches
and the wider support team, utilising the
unique strengths of a multidisciplinary team
(MDT) in supporting an athlete. Within
this policy, athletes are able to request that
information be kept confidential from their
coach, and the MDT at any time. When
an athlete enters the programme they are
required to sign a confidentiality form to
confirm they understand this policy. To
ensure a common policy is understood
and adhered to (Collins, Moore, Mitchell,
& Alpress, 1999), it is also communicated
to key stakeholders (e.g., Performance
Director, coaches, support staff). In keeping
with the British Psychological Society (BPS)
practice guidelines (BPS, 2009), this infor-
mation was reiterated to both B and X at
the start of our work together. Furthermore,
throughout all my work with B and X, I made
sure to prompt them if I believed that it
might be beneficial to involve other coaches
and/practitioners.
Summary of consultancy
I met with B almost immediately after seeing
X. Following an informal conversation to
get to know her, we discussed her current
situation. B was extremely open to talking
about her anxieties and discussed her symp-
toms in great detail. Specifically, B reported
disturbed sleep, persistent rumination about
Sport & Exercise Psychology Review, Vol. 12 No. 2 39
‘pain’ in her back, and active avoidance of
situations that might induce pain. Further-
more, she described holding a strong belief
that her injury would inevitably return and
worsen. As a result of these symptoms B
frequently withdrew from training, avoided
team-building sessions, and had become
noticeably more introverted in the training
environment.
During this first meeting with her I noted
her use of language, in particular her use of
negative descriptive words, significant self-
doubt, and frequent reference to past events.
Consistent with my consulting philosophy, I
asked B to talk about her state of comfort/
discomfort at the current time, identifying
thoughts, feelings, emotions, and physical
sensations. I also asked B to describe to
me what she meant by ‘pain’. The aim of
this was to increase B’s awareness of her
language attached to how she was feeling in
that present moment, rather than describing
her state filtered through assumption, and
previous experience. In line with mind-
fulness and ACT, individuals can become
fused to unhelpful thoughts, feelings, and
physical sensations, identifying with them as
their sense of self. According to ACT, prac-
ticing diffusion techniques would alleviate
this bind, I was therefore conscious to start
altering B’s perspective of language prior to
developing these skills.
Throughout this first stage I drew on
the ACT matrix to provide a framework for
shared conceptualisation of B’s current state
(see Figure 2). It is suggested that collabora-
tively evolving a case with the client facilitates
behaviour change and treatment effective-
ness (Polk & Schoendorff, 2014). Moreover,
it provides an effective tool for monitoring
treatment progress (e.g., symptom relief
and performance development according to
values).
Over a period of 6 months I met with
B formally for a further 12 sessions, each
of which lasted 60–90 minutes and were
conducted in various environments (e.g.,
training pitches, team hotels, physiothera-
pists treatment room etc.). The aim of
Jennifer Bennett & Pete Lindsay

Five senses
experiencing
Q4 Q2

Disturbed sleep Increased physiotherapy support

Avoidance of training Attending camps and training
Not playing in competitive matches (even if I don’t play)
Avoiding social gatherings Healthy diet
Isolating myself Hockey related life-choices
Not talking to people Smiling
Avoiding group activities
Missing training

Away
→ Noticing → Toward

Anxiety Friendship, fun, enjoyment

Worry: e.g., ‘what if my back hurts’ Health and fitness
Fear of re-injury Teamplayer
Shortness of breath Hardwork
Panic Ambition
Obsession about lower back Courage
Upsetting: e.g., ‘I don’t want to feel this way’ Determination
Anger towards injury: e.g., ‘why me!’ Commitment to the team
Tough
Discipline

Q3 Mental Q1
experiencing

Figure 2: Completed matrix identifying B’s values,

toward and away behaviours, and current state

these sessions was to apply ACT to treat
B’s performance anxiety thereby reducing
symptoms and facilitating return to training
and competition. The intervention adopted
the standard ACT model (Hayes et al., 1999;
2011), with additional focus on mindfulness
practice both in session and as prescribed
homework (Thienot et al., 2014). This
model offered a different perspective on
B’s current state (e.g., anxiety, perceived
back pain, avoidance of training), what is
important to her (personal values), how she
currently avoids discomfort, and what she is
currently doing to move towards her values
(committed action).
The flexibility of the model allows the
practitioner and client to start in any of
the four quadrants, and to move between
them freely. Thus, having introduced B to
the model, we discussed an appropriate
starting point and agreed with identifying
and connecting with personal values. I then

40 Sport & Exercise Psychology Review, Vol. 12 No. 2

 Case Study 3: An acceptance commitment and mindfulness based intervention for a female hockey player
questioned B to explore the left side of the
model, and based on our initial formulation
we identified symptoms of current suffering,
and experiential avoidant behaviours (e.g.,
avoidance of prolonged training, playing full
70 minute games, and team socials). The
completed model is presented in Figure 2.
Salmon, Hanneman and Harwood
(2010) investigated the relationship between
mindfulness, physical effort and pain percep-
tion, and recommended that mindfulness
might lead to a more objective perception
of physical sensation. Furthermore, they
suggested that acceptance of physical sensa-
tion (e.g., pain) also reduces maladaptive
emotional and/or cognitive responses.
Once we had completed all four quadrants,
we spent the next few sessions developing
acceptance of anxiety-related discomfort,
skills in mindfulness and cognitive diffu-
sion, and facilitating psychological flexibility
through experiencing anxiety whilst simul-
taneously committing to value driven behav-
iour. Frequent mindfulness practices were
conducted in sessions and as homework.
These practices focused on guided mind-
fulness connected to B’s warm up stretch
routine (i.e., increasing present awareness
of feeling, physical sensation, and manage-
ment of physical discomfort with mindful
breathing, facilitating altered perception of
pain and pain management).
Additional sessions of mindfulness
addressed sleep hygiene with prescribed
meditations prior to sleep, and relaxation
strategies incorporating mindful breathing
exercises. As B’s confidence with mindfulness
practice increased, exposure-based exercises
were integrated into regular training sessions
in which the aim was to deliberately create the
same physiological, emotional, and cognitive
symptoms associated with her performance
anxiety so that she could practice accepting
them with mindfulness and diffusion tech-
niques. For example, B often complained
of shortness of breath, lower back pain, and
panic 30 minutes into training. Thus, in line
with B’s personal values, I encouraged B to
increase training time and the intensity of
Sport & Exercise Psychology Review, Vol. 12 No. 2 41
sessions, during which she regularly engaged
in mindful breathing, conscious focus on
physical sensations in the lower back, and
rehearsal of cognitive diffusion. As the inten-
sity and duration of sessions increased B
increased the frequency of these practices.
To more effectively monitor the evolu-
tion of treatment, we ascribed numerical
ratings to each of the four quadrants based
on agreed values (where a quadrant 1 or 3
score of 1=very few moves toward/away from
values; and 8–10=sufficient; equally, a quad-
rant 2 or 4 score of 1=low level suffering/
low connection to values; and 10=extreme
suffering/complete connection to values).
We returned to these scores during each of
our sessions.
The personal values and towards values
behaviours guided the remainder of our
sessions. More specifically, we spent time
developing a value-driven behaviour plan
that we used to track progress. For example,
B identified a strong value for developing
friendships and engaging in teamwork with
those people. She explained this was the
reason she first started playing hockey, and
that establishing friendships in the team
contributed to her motivation and enjoy-
ment. I was aware that B’s love for friendship
and the link between friendship and enjoy-
ment of training might help her to change
her current situation and perspective of
the training environment. Indeed, B recog-
nised that her current state prevented her
from engaging with the rest of the team and
building friendships, consequently moving
her away from her values. Thus, the ‘friend-
ship plan’ was developed for her to practice
during training camps. Specifically, B was
instructed to be amongst the other players
before and after training, and to attend social
opportunities during camps. Initially she was
only required to be present, this required her
to be more mindful of emotional, cognitive
and physical symptoms of anxiety, mindfully
observing them and practicing diffusion.
This technique helped B to engage in value
driven behaviour whilst accepting and expe-
riencing discomfort. Once her comfort of
Jennifer Bennett & Pete Lindsay
these situations increased, B was encouraged
to proactively seek opportunities to engage
with other players, start conversation, and
approach groups during meal times. Other
values driven behaviour plans included the
‘hard-work plan’, the ‘courage plan’, and
the ‘play plan.’ B also continued to complete
prescribed mindfulness sessions, and started
a reflective journal to monitor her aware-
ness of anxiety-related discomfort, use of
language and thought processes related to
anxiety/injury, acceptance of discomfort,
commitment to values driven behaviour, and
sleep patterns. This was guided by Figure 2.
Evaluation of work
My work with B was assessed in several ways.
First, numerical data was collected for each
session, tracking B’s increase in values driven
Figure 3: Tracking values for matrix quadrants with each session
42 Sport & Exercise Psychology Review, Vol. 12 No. 2
behaviour, and decrease in suffering and
avoidance (see Figure 3.). These scores
clearly highlight B’s progress throughout the
intervention, gradually reducing subjective
suffering (e.g., anxiety, pain, disturbed sleep
etc.,), and increasing behaviours toward
her values. Recording these scores in each
session provided B with an effective means
of watching her progress and directing the
extent to which we increased and/changed
practices.
Throughout the course of the current
intervention B kept a reflective diary, moni-
toring her progress. After our last session
together, I met with B to evaluate our work
together. B believed that the use of mindful-
ness practices towards her stretch routine,
in training, and also prior to sleep had had
the biggest impact. She felt her sense of
 Case Study 3: An acceptance commitment and mindfulness based intervention for a female hockey player
awareness and detachment from unhelpful
thoughts, feelings, and emotions had signifi-
cantly benefitted her general wellbeing and
allowed her to ‘slow down and just be here
and now.’ B also reported that doing these
practices had made her realise that often she
had been talking about pain, and assuming
its presence, without it being there, and
that she felt this might have been a habit
she developed over time. This is in line
with Hayes et al.’s (2010) suggestion that
emotional, behavioural and physical discom-
fort is often caused by a language-mediated
context as opposed to current reality. Thus,
practicing mindfulness had allowed B to
connect with her current state as opposed to
a language-mediated unreality. B reported
that using the matrix was the first time she
had ever identified her personal values, and
that she had never discussed, or reflected
at this level before. As such, she discussed
having more appreciation and motivation
to play as she re-connected with what was
important.
On completion of the current interven-
tion B reported she was no longer feeling
anxious about training, and that her persis-
tent worrisome thoughts were no longer
impacting on her life. Consequently, B
reported improved sleep, and that she was
enjoying training and playing again. This
was evident in observations of B’s increased
interactions with the rest of the team,
towards which she was considerably more
outgoing and involved. B continued with the
prescribed homework of mindful practice,
as she felt this had been a positive addition
to her routine and something she benefitted
from in more areas than that for which it was
initially introduced (e.g., anxiety-manage-
ment and sleep hygiene).
In addition to quantitative data and B’s
personal reflections, the intervention was
evaluated by X’s observations and feed-
back. Reflecting on her treatment with B,
X reported that B was no longer seeking
her support for additional treatment, and
that she no longer complained of pain in
her lower back. Furthermore, B was no
Sport & Exercise Psychology Review, Vol. 12 No. 2 43
longer requesting to be taken off the pitch
in training/competition. Reflecting on B’s
adherence to the additional stretches in
her warm-up, and use of mindful breathing
during this practice, X observed that B had
actually increased the amount of time she
was spending preparing herself for phys-
ical effort, unprompted by X, however she
felt that this was a positive and sign of her
increased awareness and ownership of her
performance, and reduced dependence on
X’s support. A second form of assessment
was the increased amount of time B was able
to train for. Specifically, B had increased
her training load from 30 minute sessions
to completing two 2 hour sessions per day.
B’s coach reported that ‘her efforts in these
sessions was equivalent to all the other
players’, and that he had seen ‘considerable
improvement in her focus, intensity, and
confidence on and off the pitch.’
Personal reflections
The following section is a brief reflection of
the work I did with B, and is guided by Gibbs’
(1988) reflective model. This particular case
study highlighted to me the impact that prac-
ticing according to my personal and profes-
sional values can have. As B demonstrated,
identifying and committing to values driven
behaviour is empowering, and supportive
of general wellbeing as well as the perfor-
mance problem for which this technique
was initially adopted to address. Working
with B also reinforced to me how important
it is to be experienced and practiced in the
methods prescribed for athletes. As a result
of my personal practice of mindfulness, and
use of the ACT matrix, I feel I was able to
provide a more open, and authentic support
for B, through which we were able to discuss
challenges, discomfort with acceptance of
anxiety-associated symptoms, and experi-
ences where B struggled to connect with
her current physical state. Furthermore, my
understanding and experience with these
methods allowed me to be more creative
with the techniques (e.g., development
of the friendship plan, and integration of
Jennifer Bennett & Pete Lindsay
mindful breathing to B’s stretch routine).
As a result, B reflected developing skills and
habits she was enthusiastic about continuing
(e.g., mindfulness). Finally, I feel that the
ACT model provided a necessary structure
for each session in and around training.
Sharing the current state conceptualisation
in this way not only supported B’s adherence,
References
Anderson, N.D., Lau, M.A., Segal, Z.V. & Bishop, S.
R. (2007). Mindfulness-based stress reduction
and attentional control. Clinical Psychology &
Psychotherapy, 14, 449–463.
Bernier, M., Thienot, E., Cordon, R. & Fournier, J.F.
(2009). Mindfulness and acceptance approaches
in sport performance. Journal of Clinical Sport
Psychology, 25, 320.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,
Anderson, N.D., Carmody, J. & Devins, G.
(2004). Mindfulness: A proposed operational
definition. Clinical psychology: Science and practice,
11, 230–241.
British Psychological Society (2009). Code of ethics
and conduct: Guidance published by the ethics
committee of the British psychological society.
http://www.bps.org.uk/sites/default/files/
documents/code_of_ethics_and_conduct.pdf
Cardaciotto, L., Herbert, J.D., Forman, E.M., Moitra,
E. & Farrow, V. (2008). The assessment of
present moment awareness and acceptance: The
Philadelphia Mindfulness Scale. Assessment, 15,
204-223. doi: 10.1177/1073191107311467.
Coffey, K.A., Hartman, M. & Fredrickson, B.L. (2010).
Deconstructing mindfulness and constructing
mental health: Understanding mindfulness and
its mechanisms of action. Mindfulness, 1, 235–253.
Collins, D., Moore, P., Mitchell, D. & Alpress, F.
(1999). Role conflict and confidentiality in multi-
disciplinary athlete support programmes. British
Journal of Sports Medicine. 33, 208-211.
Eifert, G.H. & Forsyth, J.P. (2005). Acceptance and
commitment therapy for anxiety disorders: A practition-
er’s treatment guide to using mindfulness, acceptance,
and values-based behavior change. New Harbinger
Publications.
Fletcher, L.B., Schoendorff, B. & Hayes, S.C. (2010).
Searching for mindfulness in the brain: A
process-oriented approach to examining the
neural correlates of mindfulness. Mindfulness, 1,
41–63.
44 Sport & Exercise Psychology Review, Vol. 12 No. 2
and a means of monitoring her progress, it
has also provided her with a model she now
uses regularly when faced with challenge. As
a result of my work with B my confidence in
applying ACT and mindfulness for anxiety-
associated problems has increased substan-
tially, and I will certainly look to integrate
these methods in my practice in the future.
Gardner, F.L. & Moore, Z.E. (2007).  The psychology
of enhancing human performance: The Mindfulness-
Acceptance-Commitment (MAC) approach. Springer
Publishing Co.
Gardner, F.L. & Moore, Z.E. (2012). Mindfulness
and acceptance models in sport psychology: A
decade of basic and applied scientific advance-
ments. Canadian Psychology/Psychologie Cana-
dienne, 53, 309.
Gibbs, G. (1988). Learning by doing: A guide to teaching
and learning methods. Oxford, UK: Oxford
Brookes University.
Hayes, S.C., Masuda, A. & De Mey, H. (2003). Accept-
ance and commitment therapy: Een derde-gener-
atie gedragstherapie. Gedragstherapie.
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. & Wilson, K.G. (2011).
Acceptance and commitment therapy: The process and
practice of mindful change. Guilford Press.
Hayes, S.C. & Wilson, K.G. (1994). Acceptance
and commitment therapy: Altering the verbal
support for experiential avoidance. The Behavior
Analyst, 17(2), 289.
Hoigaard, R. & Johansen, B.T. (2004). The solution-
focused approach in sport psychology. The Sport
Psychologist, 18, 218–228.
Kabat-Zinn, J. (2005). Coming to our senses: Healing
ourselves and the world through mindfulness.
Hachette UK.
Lindsay, P., Pitt, T. & Thomas, O. (2014). Bewitched
by our words: Wittgenstein, language-games, and
the pictures that hold sport psychology captive.
Sport & Exercise Psychology Review, 10, 41–54.
Lindsay, P., Thomas, O. & Douglas, G. (2010).
Exploring and transforming client generated
metaphors in applied sport psychology. The Sport
Psychologist, 24, 97–112.
 Case Study 3: An acceptance commitment and mindfulness based intervention for a female hockey player

Polk, K.L. & Schoendorff, B. (2014). The ACT matrix:
A new approach to building psychological flexibility
across settings and populations. Content Press:
Oakland, CA.
Salmon, P., Hanneman, S. & Harwood, B. (2010).
Associative/dissociative cognitive strategies in
sustained physical activity: Literature review and
proposal for a mindfulness-based conceptual
model. The Sport Psychologist,24, 127–156.
Thienot, E., Jackson, B., Dimmock, J., Grove, J.R.,
Bernier, M. & Fournier, J. F. (2014). Develop-
ment and preliminary validation of the mindful-
ness inventory for sport. Psychology of Sport and
Exercise, 15, 72-80.
Van Dam, N.T., Sheppard, S.C., Forsyth, J.P. & Earley-
wine, M. (2011). Self-compassion is a better
predictor than mindfulness of symptom severity
and quality of life in mixed anxiety and depres-
sion. Journal of Anxiety Disorders, 25, 123–130.

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