Common issues facing adolescents and using ACT and DNA-V to support them

Adolescence is a time of significant growth, challenge, and opportunity with young people often facing difficulties related to identity, relationships, and emotional flexibility, alongside the pressures of modern life. Psychological flexibility models, such as acceptance and commitment therapy (ACT) and the DNA-V model (developed by Louise Hayes and Joseph Ciarrochi) offer nuanced, evidence-based frameworks to help adolescents navigate these challenges.

These approaches aim to enhance psychological flexibility, promote self-awareness, and support the development of essential life skills. In this blog, we present a fictional case study; “Emily”, to show how ACT and DNA-V can be applied effectively to specific adolescent issues. There are more examples like this shared in our resource hub for you to  download and use too.

Case study: Emily – Academic perfectionism and threat-driven overcontrol

Background and developmental context

Emily is a 16-year-old student in her GCSE year who has consistently been described by teachers as “bright,” “driven,” and “hard on herself.” From a young age, she learned that praise, attention, and a sense of safety came most reliably through achievement. When she did well academically, she felt valued and secure; when she made mistakes, she experienced intense shame and fear of letting others down.

Over time, school performance became the main way Emily organised her sense of self and coped with anxiety. As academic demands increased in adolescence, so did her efforts to control uncertainty and threat through excessive revision, perfectionistic standards, and constant self-monitoring. This has gradually crowded out rest, friendships, and enjoyable activities. She now reports chronic anxiety, poor sleep, headaches, and thoughts she is “never good enough,” despite consistently high grades.

Process formulation and conceptualisation (DNA-V terms in brackets)

Cognitions (Advisor):

Emily has commonly stated cognitions such as:

• “I can’t afford to relax.”
• “Other people manage more than me.”
• “One mistake will ruin everything.”

Emily is caught in a narrow pattern of psychological inflexibility organised around fear of failure and conditional self-worth.

Her internal world is dominated by threat-based thinking (“I must not mess this up,” “If I fail, I’ll disappoint everyone,” “I’m only worth something if I succeed”).

Emily’s “Advisor” is highly dominant and threat focused. It runs rigid rules about success, worth, and danger:

Sensory experiences (Noticer)

The core difficulty is that Emily’s nervous system and behavioural repertoire have become organised around threat, control, and performance as her primary way of coping.

Emily has learned to tune out bodily and emotional signals that would normally guide balance, such as fatigue, tension, hunger, or overwhelm. These cues are experienced as obstacles to performance rather than helpful information. As a result, she pushes through exhaustion and anxiety rather than responding with care or adjustment.

Actions and tracking (Discoverer)

Her actions include rigid overworking, hyper preparation, and constant self-criticism in an attempt to feel safe and in control.

In the short term her actions reduce anxiety and keeps performance high. In the long term it maintains chronic stress, exhaustion, and a life increasingly organised around avoiding failure rather than moving toward what matters.

Her “Discoverer” has become highly restricted. Most experimentation in Emily’s life happens only within the domain of academic success. Activities involving uncertainty, play, social connection, or learning through mistakes feel too risky. This has narrowed her identity to “the high achiever” and reduced opportunities for joy, growth, and resilience.

Values and motivation

Emily genuinely values learning, doing well, and having a good future. However, these values have become fused with fear, control, and self-worth. Other important values such as friendship, health, creativity, and enjoyment have been overshadowed by the single goal of not failing.

Self (self-view)

Emily is caught in her past learning and reinforcement for concepts. She has worked hard and achieved and has concepts that she is a good person when she succeeds, and has concepts, that if she fails, she will be unworthy.

Social (social view)

Emily has developed very rigid concepts of herself with others. She is not investing in friendships, and at the same time feels unsupported and unworthy.

Intervention approach (formulation led, not technique led)

The work would focus on helping Emily widen her life beyond threat driven performance, build flexibility with her internal experiences, and reconnect with values that support long term wellbeing.

1. Normalising and externalising the performance driven cognitions

Rather than challenging thoughts directly, Emily would be supported to understand how her mind and body learned to protect her through overworking and perfectionism.

Using DNA-V terms, Emily would be encouraged to practice being aware of when her “Advisor” is running the “stay safe through success” programme. She would be encouraged to try this out experientially in the session and later be supported to practice this at home.

The aim is compassion and awareness, not getting rid of thoughts. This helps Emily see that the pressure is understandable, but no longer helpful in running her life.

2. Strengthening “Noticer” skills around stress and limits

We would practice together helping Emily tune back into her body as a source of guidance rather than something to override.

A range of brief, practical noticing exercises linked directly to daily life, such as tracking signs of tension, fatigue, or overwhelm during revision, and experimenting with responding differently (short breaks, movement, slowing pace).

The goal is emotional flexibility and sensory integration, not formal mindfulness for its own sake.

3. Gently expanding the “Discoverer”

We would begin here by helping Emily to see her unworkable control agenda by using collaborative exercises.

Instead of “trying hobbies,” the Discoverer would be used to run small, meaningful experiments around balance, rest, and imperfection.

For example:

• Studying slightly less one evening and observing what actually happens
• Spending time with friends before finishing every task
• Attempting work without over checking

These experiments are framed as learning opportunities, helping Emily’s system discover that safety and success don’t require constant over control.

4. Reconnecting with values in a broader life context

Values work would explore what matters most to Emily and how she wants to be in the world, as a whole person, not just in achievement.

This might include themes such as being a supportive friend, looking after her health, enjoying learning rather than fearing mistakes, and having a balanced life.

Goals would then be shaped around living these values alongside academic effort, rather than replacing one with the other.

5. Releasing concepts of the self and social contexts

As Emily engaged in the noticing, advising and discovery tasks above, we would link these to a bigger sense of self, and also a flexible way of being with others. In other words, helping her see that she is more than her performance ability and that others will connect with her and be with her beyond these concepts of success.

 

For more examples like this one visit our resource hub:

To learn more about ACT for adolescents, join us this June for an intermediate training course. Led by internationally renowned clinical psychologist Dr Louise Hayes, this workshop focuses on advancing your skills using DNA-V, a developmental and neuroaffirming framework designed specifically for young people. Find out more on the ACT for adolescents workshop page.

 

 

 

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