Focused Acceptance and Commitment Therapy (FACT) for Stress, Anxiety, and Depression

The Distress Thermometer [DT] measures participants' perceived level of psychological distress on a scale from 0 (no distress) to 10 (extreme distress).

Patient Health Questionnaire-9 [PHQ-9] consists of nine items and is rated on a four-point Likert scale ranging from 0 (not at all) to 3 (nearly every day). Total scores range from 0 to 27, with higher scores indicating more severe depression

General Anxiety Disorder-7 [GAD-7] consists of 7 items scored from 0 (not at all) to 3 (nearly every day) with scores ranging from 0 to 21. Higher scores reflect more severe anxiety symptoms.

Perceived Stress Scale-10 [PSS-10]. The scale consists of ten items rated from 0 (never) to 4 (very often), producing a total score between 0 and 40. Higher scores reflect greater levels of perceived stress.

Valuing Questionnaire [VQ] consists of ten items rated on a seven-point Likert scale from 0 (not at all) to 6 (completely true). The measure yields two subscales: Progress and Obstruction.

• Progress (items, 3, 4, 5, 7,9. Range = 0 to 30) defined as enactment and perseverance in living consistently with one's values. Higher scores represent a closer alignment between one's internal values and one's actions.
• Obstruction (items 1, 2, 6, 8, 10. Range = 0 to 30) represents the extent to which various disruptions got in the way of valued living. Higher scores represent more interference with living consistently with one's values.

The Brief Experiential Avoidance Questionnaire [BEAQ] consists of 15 items rated on a six-point Likert scale from 1 (strongly agree) to 6 (strongly disagree), yielding total scores between 15 and 90. Higher scores reflect greater levels of experiential avoidance.

The Experience Questionnaire [EQ] includes 11 items on the decentering scale, each rated on a 5-point Likert scale from 1 (never) to 5 (all the time). Scores on the 11 items are summed to produce a total scale score, which can range from 11 to 55, with higher scores indicating greater levels of decentering.

The Sense of Agency Scale [SoA] consisting of 13 items with responses recorded on a scale from 1 (strongly disagree) to 7 (strongly agreee). It measures Sense of Positive Agency (SoPA) and Sense of Negative Agency (SoNA). SoPA refers to a person's experience of having control over their body, thoughts, and environment. SoNA, in contrast, describes the experience of feeling that these aspects are not under one's control.

The Self Compassion Scale - short revised [SCS - SF] is rated on a five-point Likert scale (1 = almost never, 5 = almost always), with higher total scores indicating higher self-compassion.

The Health Confidence Score [HCS] s rated on a four-point Likert scale. For analysis, response options are scored from 0 to 3, with 'strongly agree' = 3, 'agree' = 2, 'neutral' = 1, and 'disagree' = 0. Higher scores indicate greater health confidence.

Participants will be asked to report whether they receive any (additional) treatment related to the present-ing issue for which they initially sought help, and if so, the type and number of visits during the interim pe-riod. Reported treatments will be categorized into four types of health services: (1) Psychological services (e.g., sessions with a psychologist or psychotherapist); (2) Medical services (e.g., consultations with a psy-chiatrist, including pharmacological treatment); (3) Alternative treatments (e.g., reflexology, craniosacral therapy); and (4) Physical health services (e.g., physiotherapy or chiropractic care).

Number of minutes spent on physical activity involving strength training, ball games or activities that raise your heart rate in the past week.

At each FACT session, the duration of time spent in-session will be recorded.

Working Alliance Inventory - Short Revised [WAI-SR] consists of 12 items, each rated on a 5-point Likert scale from 1 (seldom) to 5 (always). Total scores range from 12 to 60, with higher scores indicating a stronger therapeutic alliance

The Negative Effects Questionnaire [NEQ] consists of 20 items and is a self-report measure comprising three parts. First, respondents indicate whether each negative effect occurred during treatment using a yes/no format (coded as 1/0). Second, they rate the severity of each endorsed negative effect on a 5-point Likert scale ranging from 0 ("Not at all") to 4 ("Extremely"), with higher scores reflecting greater severity. Third, respondents attribute each negative effect either to "the treatment I received" (coded as 1) or to "other circumstances" (coded as 0).

The following feasibility criteria will be evaluated: 1) within-group effect of Cohen's d >.5,

Fidelity of the interventions. Fidelity assessment of session recordings will include two components: 1) adherence to key FACT principles (i.e., whether the key therapeutic elements were delivered as intended) and 2) therapist competency, with both aspects rated on a 0-2 scale. Two independent raters will evaluate a random sample of 20% of cases in the FACT group, covering all sessions for each selected participant.

Minimal harm evaluated with NEQ

Prospective acceptability: Credibility/Expectancy Questionnaire for evaluating expected improvement of therapy [CEQ] will be measured post session one.

Retrospective acceptability: Client Satisfaction Questionnaire [CSQ-8], interest and usefulness of intervention [73].