How do you write a SOAP note for ACT?

Record the client’s report of difficult thoughts, avoidance and values in Subjective; the ACT process targeted, the exercise used, engagement and scores in Objective; change in psychological flexibility and symptoms in Assessment; and the committed action and practice in Plan.

What are the six core processes of ACT?

Acceptance, cognitive defusion, present-moment awareness, self-as-context, values and committed action. Together they aim to increase psychological flexibility: the ability to stay in contact with difficult thoughts and feelings while acting on what matters to you.

What measures can you use to track ACT progress?

A common process measure is the Acceptance and Action Questionnaire-II (AAQ-II), where lower scores mean more psychological flexibility. Pair it with a symptom measure that fits the diagnosis, such as the PHQ-9 for depression or GAD-7 for anxiety, and track valued activities completed.

What is a committed action in an ACT note?

A committed action is a specific behavior the client chooses to take in line with a value, even if difficult thoughts or feelings show up. Write it so you can check it next session, for example “attend Sunday dinner for the first course.”

Can ACT notes support insurance billing?

Yes, when they show medical necessity: a diagnosis, symptoms or functional problems the treatment targets, the specific interventions used, and measurable progress toward treatment-plan goals. Billing uses the usual psychotherapy codes; ACT is the approach, not a separate code.

SOAP Notes for ACT: Template + Examples (2026)

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Overview

This guide is part of our complete SOAP notes hub — format structure, a full clinical example, and all 72 diagnosis-specific templates.

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Short answer: a SOAP note for Acceptance and Commitment Therapy (ACT) records the session in four parts. Subjective: the client’s report of difficult thoughts and feelings, what they avoided or did, and the values they named. Objective: the ACT processes you worked on and the exercises you used (for example defusion or a values card sort), how the client engaged, symptom and process measure scores, and mental status. Assessment: your judgment about change in psychological flexibility and symptoms, and progress toward treatment-plan goals. Plan: the committed action the client chose, practice between sessions, and the next session’s focus.

ACT aims to increase psychological flexibility through six core processes: acceptance, cognitive defusion, present-moment awareness, self-as-context, values and committed action. A useful ACT note names which process you targeted, the exact exercise or metaphor, and a concrete, values-based behavior the client will try. Pair process measures such as the Acceptance and Action Questionnaire-II (AAQ-II) with a symptom measure such as the PHQ-9 or GAD-7, so the note shows both how the client relates to their symptoms and how severe the symptoms are.

What to document in an ACT SOAP note

What to document in each SOAP section for ACT, with fictional example wording
Section	What to document	Example wording
Subjective	Difficult thoughts and feelings, avoidance, values named, practice since last session	“Attended son’s football game despite ‘they’re better off without me there’ thoughts; skipped Sunday dinner. Practiced the defusion exercise on 3 days.”
Objective	ACT process targeted, exercise or metaphor used, engagement, measures, mental status	“Values card sort; client chose ‘being a present father.’ Defusion: ‘I’m having the thought that…’ practiced in session. AAQ-II 26 (was 31).”
Assessment	Change in psychological flexibility and symptoms, progress on goals, risk	“Early gains in willingness: attended one football game despite difficult thoughts, the first in two months; family-dinner avoidance persists. PHQ-9 down from 15 to 11.”
Plan	Committed action, practice, next process to target	“Committed action: attend son’s Saturday game and stay for the whole match. Next: self-as-context.”

Safety. ACT is often used for depression, anxiety and chronic pain, where suicide risk can rise. If a client reports suicidal thoughts, assess and record current thoughts, plan, intent, preparatory behavior, past attempts, access to means (including firearms and medications), protective factors, your risk formulation and the safety plan. The 988 Suicide & Crisis Lifeline takes calls and texts at 988; for imminent danger, call 911 or go to the nearest emergency department.

How to Document SOAP Notes for Acceptance and Commitment Therapy

Subjective

Record the client's reported symptoms, concerns, mood, and perspective in their own words

When documenting the Subjective section in ACT sessions, capture the client’s own report of their internal experiences, including thoughts, feelings, and behaviors that relate to their values and psychological flexibility.

Client’s description of distressing thoughts or emotions experienced since the last session
Identification of specific triggers or contexts that have impacted the client’s mood or behavior
Self-reported successes or difficulties in practicing mindfulness or acceptance strategies
Client’s expression of values or life domains currently most relevant or challenging
Reported changes in motivation or willingness to engage in valued actions

Objective

Document clinical observations, affect, behavior, appearance, and measurable data

In the Objective section for ACT, document observable clinical data such as the client’s engagement with therapeutic exercises, behavioral responses, and the specific ACT techniques or interventions applied during the session.

Therapist’s observation of client’s affect and body language during mindfulness exercises
Use of specific ACT interventions such as cognitive defusion or values clarification
Client’s participation in experiential exercises or metaphors introduced during the session
Noted changes in client’s verbalizations indicating shifts in perspective or awareness
Application of behavioral activation or committed action tasks as demonstrated in session

Assessment

Provide clinical interpretation, diagnostic impressions, and progress evaluation

The Assessment section should synthesize clinical impressions based on observed progress, client reactions, and the effectiveness of ACT interventions, highlighting diagnostic considerations and treatment responsiveness.

Evaluation of client’s psychological flexibility improvements or barriers encountered
Clinical impression of symptom severity in relation to ACT processes targeted
Assessment of client’s ability to engage with acceptance and mindfulness strategies
Review of client’s adherence and response to homework or between-session assignments
Consideration of any emerging diagnostic issues or comorbid conditions impacting treatment

Plan

Outline treatment strategy, interventions, homework, and follow-up schedule

The Plan section outlines the next steps in therapy, including tailored ACT strategies, homework assignments, any adjustments to the treatment approach, referrals, and scheduling details.

Assignment of specific mindfulness or acceptance exercises for practice before the next session
Plan to introduce new ACT components such as values-based goal setting or defusion techniques
Modification of therapeutic approach based on client’s progress and feedback
Referral to additional services if comorbidities or external factors require specialized care
Scheduling or confirming the date and focus of the next session