Table 1 UP protocol adapted from Barlow et al. (2011) and ACT protocol taken from Hayes et al. educational therapy package (1999)

First

Increasing readiness and motivation to participate in treatment, motivational interviewing, and psychological training for patients' participation and engagement, strengthening self-efficacy, and belief in personal ability, presenting the logic of treatment and determining treatment goals, and providing workbooks, and worksheets for recording the assignments of the sessions

Establishing a therapeutic relationship, introducing the therapist, and explaining the logic of the treatment, providing explanations about the treatment and the effect of mental states on the individual, the family, and its relationship with the symptoms of the disease

Tasks of session: How did I feel knowing the different feelings and doing the assignment? What did I feel?

Second

Psychological training, search and monitoring of emotional experience, recognition of emotions and the concept of learned responses, training of three-component model of emotional experiences, AR model (history, responses, and results), and training of emotional awareness

Behavioral goals: the awareness of individual emotional response patterns and the factors that create and maintain them

Practicing the learned skills: monitoring and searching for multiple emotional experiences, determining maintaining factors, such as common triggers, environmental dependencies, and individual emotional response patterns in a sample of emotional experiences

Psychological training, creative frustration, the metaphor of falling into a well

Tasks of session: An introduction to creative helplessness, an introduction to the practice of experiencing and doing, to gain a better understanding of how the symptoms, thoughts, and feelings associated with IBS interact

Third

Learning to observe emotional experiences (emotions and reactions to emotions) using mindfulness techniques, such as non-judgmental and present-focused awareness of emotional experiences

Behavioral goals: acquiring the skills of objective observation of emotional experiences when they occur and at the moment of doing, identifying thoughts, physical feelings, and behaviors that contribute to discomfort, and understanding the concept of being mindful

Practicing learned skills: determining how to react, responding to emotions, and practicing non-judgmental, present-focused awareness in multiple emotional experiences

Identifying the client's values and their difference with their goals, clarifying the client's values and obstacles

Tasks of session: Experiencing and doing, what I have been avoiding? Zorg the alien-Exploring your values, Your 100th birthday

Fourth

re-evaluation and cognitive reappraisal, creating awareness of the effect and interrelationship between thoughts, and emotions, identifying self-inconsistent self-evaluations, cognitive reappraisal, and increasing flexibility in thinking

Behavioral goals: Identifying the role of maladaptive automatic evaluations in creating emotional experiences, identifying thinking patterns, learning ways to correct maladaptive thinking, and flexibility in emotional self-evaluations

Practicing learned skills: identifying how to react, responding to emotions, non-judgmental awareness, and focusing on the present in the emotional experiences

Examining the client's values and using metaphors related to them, making the right choices in life

Tasks of session: Identifying values, practice What have I avoided? Values-consistent goals

Fifth and sixth

Identifying emotion avoidance patterns and examining behaviors caused by emotion that cause recurrence of disease symptoms

Acquaintance and identification of emotion-induced behaviors, and understanding their impact on emotional experiences, identifying maladaptive emotion-demand behaviors (EDBs), and creating alternative action tendencies by confronting emotions

Behavioral goals: To understand how the emotional patterns of EDBs affect, and their role in the persistence of discomfort and to use them to change the current patterns of emotional responses

Practicing learned skills: identifying emotional patterns, EDBs, and how it affects the persistence of discomfort in individual emotional experiences

Fifth: Psychological training on the concept of defusion, checking the amount of defusion in references, doing exercises for defusion using related metaphors, and teaching to accept internal events

Tasks of session Fifth: Fusion diary notice and record the moments you engage in one or more forms of fusion, and what it leads to

Sixth: Psychological education of the concepts of role and context to patients, education of self-observation and self-awareness that does not change

Tasks of session Sixth: Labeling your experience

Seventh

Visceral confrontation and confrontation with situation-based emotions, becoming aware of the logic of emotional dreams, teaching how to prepare a hierarchy of fear and avoidance, designing frequent and effective emotional confrontation exercises visually and objectively, and preventing avoidance

Behavioral goals: planning the hierarchy of emotional avoidance, including a set of situations and encounters hierarchically, increasing tolerance to emotions and learning new contexts, and using them in new behavioral and emotional experiences

Practicing learned skills: Endogenous coping exercises aimed at evoking bodily sensations similar to discomfort; these exercises aim to identify the role of bodily sensations in thoughts, behaviors, and their interaction with bodily sensations

Communicating with the present and now, providing training on the effective use of present and now, and training to have a non-judgmental and anticipatory view

Tasks of session: Looking for the observing self, right here, right now

Eighth

Relapse prevention, overview of treatment concepts, and discussion of patient's recovery and treatment progress

Behavioral goals: using the techniques taught in the previous stages to improve progress to achieve short-term and long-term goals, identifying ways to sustain therapeutic results and possible future problems, practicing practical methods for daily use of therapeutic techniques to improve progress in achieving short-term and long-term goals

Developing effective and developed action patterns, choosing the most valuable behaviors, examining the life story, and summarizing the treatment

Tasks of session: Turning the acceptance switch on, making a commitment plan, are you living in the bullseye, Building a support team