Therapist

Acceptance and commitment therapy for the treatment of post-traumatic stress disorder

A number of people have had success in using Acceptance and Commitment Therapy (ACT) for posttraumatic stress disorder (PTSD). If you are struggling with symptoms of PTSD, ACT for PTSD may be helpful. Learn about why this therapy can help and the five goals of treatment.

The Rationale Behind Acceptance and Commitment Therapy for PTSD

From an early age, we learn to label some feelings as bad and others as good. For example, sadness and anxiety are viewed as bad or negative emotions and happiness and joy as good or positive ones.

It’s understandable, then, that we try to have a few painful feelings, and as many positive ones, as possible. In particular, when we feel emotional pain, we tend to try to get away from it, but this form of avoidance usually doesn’t work well in the long run.

Avoidance doesn’t work because emotional pain is a part of life. We can’t really avoid it. Everyone at some point or another has painful feelings such as sadness, anxiety, or anger. 

How we choose to respond to painful feelings can be the difference between getting through the pain or keeping it going and making it worse.

In fact, trying to avoid or escape painful thoughts and feelings may be what leads to suffering and psychological disorders. For example, a person who’s lived through a traumatic event may be constantly flooded by memories of the trauma as well as by anxiety and fear.

As a result, the person may try to get temporary relief through drugs or alcohol (self-medicating.) That may work in the short run, but in the long run, the alcohol or drugs will do nothing to relieve the pain. Instead, the pain is likely to get worse—and introduce a host of other problems.

What Can Be Done?

ACT is a behavioral treatment based on the idea that suffering comes not from feeling emotional pain but from our attempts to avoid that pain. ACT is used to treat PTSD and other mental health disorders.

The overall goal of ACT is to help people be both open and willing to experience their inner feelings while they focus attention, not on trying to escape or avoid pain (because this is impossible), but on living a meaningful life.

5 Goals of Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) for PTSD and other mental health disorders can be broken down into five goals. If you choose to have this therapy and pursue these goals, here’s what you can expect to learn and achieve:

Recognizing That Trying to Escape Emotional Pain Will Never Work

ACT therapists call this goal creative hopelessness. It’s met when you see that all the things you’ve been trying to do to avoid emotional pain do not work, and there will probably never be an effective way of completely removing emotional pain from your life.

Understanding That Control Is the Problem

A second goal of ACT is your understanding that your problems come not from the emotional pain itself but from your attempts to control or avoid it. In fact, from your ACT for PTSD, you may learn that trying to control emotional pain has the opposite effect: Besides potentially making the pain worse, you may spend so much time and energy trying to avoid it that you have none left for pursuing positive things in your life.

Viewing yourself as Separate From Your Thoughts

Our thoughts are very believable. A person who has experienced a traumatic event may have thoughts of being a bad person or “broken” or “damaged.” However, although these thoughts may feel true, they are only thoughts. They are not a reflection of what is really true.

A third goal in ACT for PTSD is for people to learn to “take a step back” from their thoughts and not buy into them as truth. A thought is just a thought. It is not a reflection of who the person really is.

Stopping the Struggle

During your ACT for PTSD, you’ll be encouraged to stop your tug-of-war with your thoughts and feelings. The goal is to let go of attempts to avoid or control your thoughts and feelings and, instead, to practice being both open and willing to experience thoughts and feelings for what they are and not what you think they are (for example, bad or dangerous).

Committing to Action

Avoiding emotional pain requires a huge amount of energy for people with PTSD. It can consume your life. As a result, you may not be placing much time or energy into living a meaningful and rewarding life. Therefore, the final goal of your ACT for PTSD is identifying areas of importance in your life (referred to as “values” in ACT) and increasing the time you spend doing things that are consistent with those values, no matter what emotions or thoughts may arise.

For example, a person who has experienced a sexual assault may fear or feel anxious about getting into relationships again, despite valuing closeness and intimacy.

In ACT, people are encouraged to engage in actions consistent with their values (for example, reconnecting with an old friend) while being open and willing to feel any anxiety that may arise as a result.

Not avoiding that anxiety keeps it from getting worse, and it will be less likely to get in the way of the person’s pursuit of a meaningful life.

Choosing ACT Therapy for Your PTSD

Many therapists now specialize in ACT therapy (see below) but there are other methods of pursuing this therapy as well. From primary care clinics to day-long group workshops, to smartphone applications and telehealth options, there are many ways in which people with PTSD can pursue acceptance and commitment therapy.

Where Can I Learn More About ACT?

ACT has been found to be helpful for a number of people suffering from psychiatric disorders and is gaining in popularity. You can learn more about ACT, as well as therapists who specialize in ACT in your area, at the Association for Contextual Behavioral Science’s website.

New Directions in the Treatment of PTSD

Acceptance and commitment therapy (ACT) offers a promising, empirically validated approach to the treatment of post-traumatic stress disorder (PTSD) and other trauma related problems. In this volume, you’ll find a complete theoretical and practical guide to making this revolutionary new model work in your practice.

After a quick overview of PTSD, the first part of Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems explains the problem of experiential avoidance as it relates to trauma and explores the verbal nature of post-traumatic stress. You’ll learn the importance of mindfulness and acceptance in the ACT model, find out how to structure sessions with your clients, and examine the problem of control. The section concludes by introducing you to the idea of creative hopelessness as the starting point for creating a new, workable life after trauma.

The book’s second section offers a practical, step-by-step clinical guide to the six core ACT components in chronological order:

•Creative hopelessness
•The problem of control
•Willingness and defusion
•Self-as-context
•Valued living
•Committed action

•Creative hopelessness•The problem of control•Willingness and defusion•Self-as-context•Valued living•Committed action

Each chapter explains how to introduce these topics to clients suffering from PTSD, illustrates each with case examples, and offers homework for your clients to use between sessions.

By Sonja V. Batten, Ph.D.

This presentation is an excerpt from the online course “ACT for Trauma: PTSD and Beyond”.

Highlights

  • Several existing treatments for PTSD are effective but aren’t universally effective or accepted.
  • ACT addresses the limitations of these treatments.
  • ACT can be applied to the full range of emotional experience post trauma.
  • ACT addresses quality of life.
  • Studies show that ACT is effective for posttraumatic problems.

 

Transcript

In this next section, I’ll talk a little bit about what makes the acceptance and commitment therapy, or ACT, approach to trauma different.

So, first of all, as a reminder, some consistent findings from the PTSD literature. As we discussed, trauma exposure is extremely common, but PTSD is much less common. We know that many people recover naturally after a traumatic experience, but an important minority do go on to develop chronic and persistent symptoms. The good news: treatment works—especially if it’s provided early.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

And one of the interesting things is that most of the effective treatments for PTSD have an exposure component. And exposure is that part of therapy where the person is asked to go into and describe or reexperience the trauma event in a safe way, but to do so over and over in order to reduce some of the negative experiences that are associated with the memory.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

That exposure can be in vivo exposure, so in the real world. It can be imaginal, so in the person’s memory or imagination.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

And so current effective treatments for PTSD, as I mentioned, they almost all have some aspect of exposure and so that could be prolonged exposure therapy, cognitive processing therapy.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

Treatments like anxiety management training or stress inoculation training, combinations like exposure and anxiety management training, and even treatments like EMDR, which is probably like cognitive processing therapy, is a combination treatment that brings together several different components.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

So, if there are these existing treatments, why wouldn’t we just use existing treatments for PTSD? Well, first of all, even though they are quite effective, they’re not universally effective. Not everyone responds to those existing treatments. And as I mentioned, many of those treatments have an exposure component and not all clients are willing to do exposure. And in fact, not all therapists want to do exposure.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

In addition, exposure, at least originally, is built on a fear-based conceptualization of PTSD. So, the idea that if you go through and remember the details of a traumatic event over and over and over that the level of anxiety over time will habituate and reduce. So, it’s based on a fear- or anxiety-based conceptualization of PTSD. And what we know is that there is a broad range of emotional experiences that people have after a traumatic event. It’s not just fear and anxiety. And there’s also a little bit of data to show that clients whose primary emotional reaction is anger or guilt don’t benefit as much from existing treatments.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

So, what does ACT have to offer in the field of trauma?

First of all, it allows us to pay attention to that whole continuum of emotional experience: shame, guilt, fear, anxiety, anger, sadness, grief.

There’s also an added focus on quality of life, not just symptom reduction.

There’s also a little bit of evidence that doing ACT and working on values, especially, can improve response to exposure therapy.

References

Wharton, E., Edwards, K. S., Juhasz, K., & Walser, R. D. (2019). Acceptance-based interventions in the treatment of PTSD: Group and individual pilot data using acceptance and commitment therapy. Journal of Contextual Behavioral Science, 14, 55–64.

And it allows us to address additional clinical problems at the same time using a consistent theoretical framework. So, for example, if somebody has depression at the same time as PTSD or an alcohol use problem at the same time as PTSD, we don’t have to find a separate treatment to do for the depression or the substance use problem because, in fact, ACT has also been shown to be effective for those problems. So, we can use 1 model to address those problems at the same time.

References

Wharton, E., Edwards, K. S., Juhasz, K., & Walser, R. D. (2019). Acceptance-based interventions in the treatment of PTSD: Group and individual pilot data using acceptance and commitment therapy. Journal of Contextual Behavioral Science, 14, 55–64.

It’s important for treatment decisions to be made based on data. So, first of all, preliminary observational studies do suggest that ACT may be a promising intervention for the treatment of PTSD. For example, there are a handful of case studies examining ACT for the treatment of PTSD by itself or for PTSD and comorbid disorders that showed/demonstrated significant improvement in PTSD symptoms.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.
Thompson, B. L., Luoma, J. B., & LeJeune, J. T. (2013). Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 43(3), 133–140.
Twohig, M. P. (2009). Acceptance and commitment therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice, 16(3), 243–252.

There’s also a pilot study of ACT for co-occurring PTSD and alcohol use disorder and they found strong effect sizes for the reduction of PTSD scores and alcohol-related outcomes. There have also been 2 other open trials that found positive outcomes for reductions in PTSD symptoms, 1 with 30 female survivors of sexual assault and the other with 80 outpatient clients with a variety of traumatic experiences.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.
Thompson, B. L., Luoma, J. B., & LeJeune, J. T. (2013). Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 43(3), 133–140.
Twohig, M. P. (2009). Acceptance and commitment therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice, 16(3), 243–252.

And finally, correlational studies have found that measures of increased acceptance, psychological flexibility, and decreased thought suppression have been associated with improvement in PTSD symptoms as well as reduced anxiety and depression.

References

Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.
Thompson, B. L., Luoma, J. B., & LeJeune, J. T. (2013). Using acceptance and commitment therapy to guide exposure-based interventions for posttraumatic stress disorder. Journal of Contemporary Psychotherapy, 43(3), 133–140.
Twohig, M. P. (2009). Acceptance and commitment therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice, 16(3), 243–252.

So, to summarize some key points. There are several existing treatments for PTSD that are effective. However, they are not universally effective or accepted. And ACT addresses the limitations of some of these treatments while still incorporating effective components such as exposure. ACT can be applied to the full range of emotional experience post trauma.

And even better, it addresses quality of life above just symptom reduction. And preliminary studies show that ACT is effective for posttraumatic problems such as PTSD and substance use problems.

More ACT for Trauma: PTSD and Beyond

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