Free Committed Action Plan Worksheet: Values-Based Goals Across Life Domains
ACT · ACT · Research-supported
An expanded committed-action worksheet that helps clients set one specific, values-aligned SMART goal per life domain — relationships, work, health, personal growth — anticipate the internal barriers likely to arise for each, and track willingness-based action daily over a two-week period.
Underlying mechanism: Committed action across multiple life domains within the ACT model
What it helps with
- Spreading behaviour change across several life domains rather than one, so progress doesn't depend entirely on a single goal succeeding.
- Keeping each individual goal genuinely small and specific, which the daily tracking format makes easier to check.
- Surfacing, before the fact, which domains carry the lowest willingness — a useful signal for where acceptance work is still needed.
- Building a two-week track record the client and clinician can review together rather than relying on end-of-week recall.
How clinicians use it
- Introduced from session 4 onward in an ACT protocol, after values clarification and initial acceptance/defusion skills are established.
- Used to set no more than one goal per domain at a time, resisting the pull to over-commit across all domains at once.
- Reviewed daily-tracker entries the following session, using low-willingness days as a specific, dated example to explore rather than a general theme.
Clinical Implementation Guide
- Limit the plan to one goal per domain at a time — a four-domain plan with two goals each is eight commitments, which usually collapses within days.
- Use the daily willingness column even on days with no scheduled action, since dips often show up before a missed goal does.
- Treat a domain with consistently low willingness as a cue to pause that domain and return to values or acceptance work before setting a new goal there.
What the worksheet looks like
| Life Domain | Value | SMART Goal (This Week) | Daily Willingness (Mon-Sun) |
|---|---|---|---|
| Relationships | Connection | Call one friend I haven't spoken to in a month, by Friday. | 6, 7, -, 8, -, 9, - |
| Work | Competence | Ask my manager one clarifying question in Wednesday's meeting. | -, -, 5, -, -, -, - |
| Health | Vitality | Ten-minute walk after lunch, four days this week. | 7, 6, -, 8, 7, -, - |
Clinical cautions
Ensure goals are genuinely small and achievable. Overly ambitious goals set clients up for failure and reinforce the narrative of inadequacy. If willingness is below 5, revisit acceptance work before proceeding.
References
- Harris, R. (2019). ACT made simple (2nd ed.). New Harbinger.
- Luoma, J. B., Hayes, S. C., & Walser, R. D. (2017). Learning ACT (2nd ed.). New Harbinger.
Part of
ACT (Acceptance & Commitment) Matrix Toolkit