Regulate to Choose: A Breath-Based, ACT and Schema-Informed Therapist Guide for Behavioural Addictions

What it helps with

• Formulating a behavioural-addiction episode as a five-stage cycle with a distinct physiological-arousal stage, rather than treating an urge as a single, undifferentiated event.
• Sequencing eight sessions of technique across four modalities — breathwork, ACT, CFT, Schema Therapy — without the components competing with each other for session time.
• Deciding when to intervene: at the physiological-spike and cognition stages, where regulation and defusion are most achievable, rather than at the moment of highest arousal.
• Identifying the early maladaptive schema most associated with a client's cycle, and why that piece tends to reduce how often and how intensely the cycle recurs.
• Screening a client into or out of this indicated intervention, and recognising when gambling-harm, eating-disorder, or substance-use pathways should take priority.

How clinicians use it

• Read the guide in full before introducing any worksheet, and use it as the session-by-session spine for an 8-session block plus two optional booster sessions at 4 and 12 weeks.
• Treat Sessions 3 (Regulate) and 4 (Defuse) as the mechanistic core — do not compress them; extend the protocol rather than shortening either session.
• Screen every client against the contraindications before starting: active suicidal ideation, an active eating disorder, a current substance use disorder, or moderate-to-severe gambling disorder with debt or safeguarding risk all need referral or adaptation first.
• For a client with a trauma history involving dissociation or panic disorder, screen before teaching the breath skill in Worksheet 2 — titrate pace, keep eyes open, and have a grounding alternative ready.
• Name the evidence honestly to clients: no study reviewed tested this exact four-part combination, and the breathwork component is an extrapolation from general stress and neuromodulation evidence, not a directly evidenced craving-management technique.

Clinical Implementation Guide

1. Formulate before assigning anything: build the five-stage Craving Reset Cycle with the client in Session 1, using their own recent example.
2. Keep Sessions 3 and 4 unhurried and in order — the breath skill needs dedicated in-session practice before it is usable under real trigger conditions.
3. Screen contraindications before starting, and schedule the two optional booster sessions at 4 and 12 weeks at the point of finishing the core protocol.

What the worksheet looks like

Clinical cautions

This is an indicated intervention for adults and older adolescents (16+) already showing a subclinical-to-moderate behavioural addiction or compulsive pattern, not a universal psychoeducation programme. Refer on or adapt before proceeding for moderate-to-severe gambling disorder with debt, legal or safeguarding risk; an active eating disorder rather than compulsive overeating; a current substance use disorder; active suicidal ideation with intent or plan; and trauma history with dissociation or panic disorder, where slow-paced breathing can occasionally increase distress. Confirm with the client's GP before breathwork practice where a cardiorespiratory condition is present. This tool does not diagnose any condition and is not a substitute for individual face-to-face therapy or for emergency crisis support. Anyone in immediate distress should contact their local emergency service or crisis line.

References

1. Lindenberg, K., Kewitz, S., Neumann, I., et al. (2026). Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder: A Randomized Clinical Trial. JAMA Network Open, 9(9), e2631942. https://doi.org/10.1001/jamanetworkopen.2026.31942
2. Li, X., Gao, Y., Xia, L., et al. (2026). The effectiveness of an online acceptance and commitment therapy self-help course in reducing excessive gaming behavior through inhibitory control: A pilot randomized controlled trial. Journal of Behavioral Addictions, 15(1), 342-356. https://doi.org/10.1556/2006.2025.00199
3. Martsyniak-Dorosh, O. (2026). Effectiveness of the Combination of Schema Therapy and ACT in the Treatment of Compulsive Overeating in Clinical Practice. International Journal of Psychiatry in Medicine. Advance online publication. https://doi.org/10.1177/00912174261474935
4. Sumińska, S., Rynkiewicz, A., & Szulczewski, M. (2026). Resonance frequency versus fixed 0.1 Hz breathing in HRV biofeedback: a four-week randomized comparison. Scientific Reports, 16, 53333. https://doi.org/10.1038/s41598-026-53333-6
5. Li, C., Wang, X., Zhu, F., et al. (2026). Efficacy of a high-frequency repetitive transcranial magnetic stimulation for craving reduction in adolescents with gaming disorder: a 4-week randomized control trial with 24-week follow-up. European Archives of Psychiatry and Clinical Neuroscience, 276(7), 3791-3801. https://doi.org/10.1007/s00406-026-02343-6

Part of

Regulate to Choose

Related worksheets

• Mapping My Craving Reset Cycle
• The Regulate Skill: Breath-Based Urge De-escalation
• My Values-Based Engagement & Relapse-Prevention Plan

Next steps

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