ACT and Trauma Therapy

ACT and Trauma Therapy

Trauma therapy looks different depending on the therapist you work with, their therapeutic approach, and your goals for therapy. Let's talk about what trauma-informed therapy means in Acceptance and Commitment Therapy (ACT).

Trigger warning: this blog post discusses trauma.

What is 'trauma'?

A trauma is defined as a deeply distressing or disturbing experience. More specifically, trauma is what comes from exposure to a single incident or series of events that are disturbing or life-threatening in nature with lasting adverse impact.

3 Parts of a Trauma-Related Disorder:

  1. Direct or indirect experience (i.e., it happened to you or someone close to you; you witnessed it or were exposed to it)
  2. Psychological and neurobiological reactions
  3. Inability to cope with those reactions (i.e., experiential avoidance, PTSD, ongoing impairment in functioning)

Learn more about trauma here.

How Can Acceptance and Commitment Therapy (ACT) Help?

Acceptance and Commitment Therapy (ACT) is a cognitive behavioural therapy that is evidence-based in helping alleviate symptoms of PTSD. The six core processes in ACT may be particularly helpful to reduce the psychological rigidity that often accompanies trauma.

ACT Hexaflex and Triflex

ACT and Trauma Therapy

The ACT Hexaflex and Triflex outline how the six core processes in ACT are encompassed by three main factors that develop psychological flexibility; as much as we can, we try to be present, open up, and do what matters.

Mock Case Example:

*Note: the following case is completely fictitious and for the purposes of outlining trauma therapy using ACT. 

Sarah was in a car accident four years ago and lost a loved one. She also suffered from a physical injury, which required her to take two years off of work and learn how to walk again. For months following the accident, Sarah was not herself; she had little to no energy, poor sleep, nightmares and flashbacks, lost all interest in social events, and her concentration had been significantly impaired.

Throughout the course of therapy, Sarah worked with her therapist to remember who she was before the traumatic event. She also spent much of her time sharing her thoughts and feelings about how the accident impacted her, what she had lost, what she hated about the present, survivor's guilt, and her grief about her sister. Moreover, she often became upset and visibly overwhelmed when thinking about a future without her sister along with judgments and fears about falling behind her peers.

Sarah's therapist was collaborative in nature and often checked in with her to ensure they had mutual goals for therapy. Sarah's therapist was client-centered and flexible, meaning that she worked at the pace set by Sarah, provided guidance, clarification, and psycho-education when it was needed, and engaged Sarah in learning new ways of living her new normal.

VALUES - Sarah and her therapist worked on re-connecting with the things that mattered most to Sarah. She had always enjoyed physical activity and challenge. Sarah also began valuing her mental health and relationships more than ever before. When feeling lost, angry, and scared over the course of therapy, Sarah often anchored herself to the values that mattered most to her: perseverance for the sake of her family and rising to the challenges she faced. She knew her sister would've wanted her to keep spreading joy to others.

DEFUSION - Sarah faced many harsh self-judgments and worries throughout her treatment. She was frequently confronted with thoughts such as, "It should've been you," and "You're never going to be the same," and "Who's going to love you now?". Sarah's therapist helped her view these thoughts with a sense of curiosity, such that she was able to understand their function and allow them to arise without spending much time buying into them. This took Sarah a great deal of practice and she still struggles with it to some degree.

PRESENT MOMENT AWARENESS - Sarah's physical rehab took her much longer than she had anticipated. She would often lie awake at night worrying about when she would be fully recovered or when she could return to work. While Sarah wanted to return to work, she became easily overwhelmed and tearful at the thought of having to manage a cognitive load that was no longer manageable. Sarah started her mindfulness journey using guided meditations to help train her mind and increase her attention. Mindfulness allowed Sarah to minimize stress to the present and self-soothe.

ACCEPTANCE - Arguably one of Sarah's most challenging learnings in therapy was acceptance. Sarah had to work very hard to understand acceptance as a concept and practice. She actively resisted it, as she judged it as dismissive, invalidating, passive, and useless. She was angry, rightfully so. Eventually, she noticed how much her struggle to fight reality was contributing to her unhappiness. She experienced a great deal of grief in the process of radically accepting the fact that the accident had occurred.

SELF-AS-CONTEXT - Sarah was exposed to many different parts of herself following the accident. Those critical parts of her that had existed her entire life and were exacerbated by the accident, and those parts of her that could not tolerate uncertainty or things outside of her control. Self-compassion helped her access softer emotions that helped her grieve. It also allowed her to recognize her resilience and feel for the person that had been through what she had been through (herself). Through practice, self-reflection, and writing, Sarah strengthened the parts of her that were kind and enjoyed challenge to help her move towards the future.

COMMITTED ACTION - Sarah learned how to set realistic behavioural goals based on where she was at. She stopped focusing so much on her feelings and started focusing on how she showed up for herself, how she treated herself and others, and how she responded to pain. As much as she could, she focused on being present, opening up, and doing what matters.

 

Sounds simple enough, right? Yet, ideals don't leave room for the human condition. We're complex beings as it is, and trauma can intricately and significantly impact our brains. So please, be patient with yourself in your journey to being a healthier, happier you.

ACT Formulation of Trauma Therapy

ACT and Trauma Therapy

The diagram above illustrates the non-linear nature of most therapy. Therapy is often an artful dance between the past, present, and future; the past makes sense of the present, and the present informs what's important to change for the future.

Trauma therapy approaches differ in their content and structure. Prolonged Exposure (PE) for PTSD and Cognitive Processing Therapy (CPT) for PTSD are two manualized treatments. Trauma-informed ACT is more flexible in nature. Irrespective of approach, meta-analytic research has shown that the number one predictor of positive therapy outcomes is the therapeutic alliance - otherwise known as the relationship between the client and therapist.

Read more about what to expect from good trauma therapy here.

From an ACT-perspective, trauma therapy will entail three core components that help people:

  1. LIVE IN THE PRESENT
    • Dropping anchor
    • Mindfulness
    • Flexible perspective taking
    • Psycho-education
    • Emotion regulation and distress tolerance
  2. HEAL THE PAST
    • Defusion from painful memories
    • Choice point: identifying goals, values, and hooks
    • Compassionate and flexible exposure (in vivo and imaginal)
    • Reconnecting with the body
    • Creative hopelessness
    • Self-compassion
  3. BUILD THE FUTURE
    • Integration
    • Action planning
    • Clarifying values
    • Implementing new ways of thinking and being

Quick Memory Aid for Getting Present 

A - Acknowledge your thoughts, feelings, and physical sensations

C - Connect with your body

E - Engage with the world