Trauma is experienced by most people at some stage in their lives, and is often a key factor in the psychological challenges being faced by many of my clients who present to psychotherapy.
Whether it is the aftermath of natural disasters, war, violent and/or abusive relationships, childhood trauma, bullying, accidents or any other threatening experience, these experiences can have long-term psychological effects. The painful emotional reactions we experience in reaction to the trauma often leads to symptoms of PTSD, depression, anxiety, and so many other issues related to life functioning, interpersonal relationships, physical health, as well as a variety of behavioral problems such as substance abuse, self-harm and risk-taking behaviors.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) is a principle-based behavioral intervention that addresses human suffering from a mindful and compassionate perspective. While ACT has been applied to a wide variety of problems, it’s also well suited for treating PTSD.
Many sufferers or victims of trauma attempt to recover by trying to regain control over their distressing, painful responses to their intrusive thoughts and ongoing feelings of fear and sadness. Some of these attempts are helpful and bring temporary relief. However, most of these attempts to avoid emotions and thoughts often result in a furthering of the suffering. We call these attempts to avoid these painful, distressing and confronting thoughts, feelings and experiences ‘Experiential Avoidance’.
As an antidote to Experiential Avoidance, ACT seeks to reduce rigid attempts to control negative emotions by fostering acceptance through mindfulness and defusion techniques. ACT revitalizes client lives by defining personal values and committing to taking actions guided by those values. The ultimate goal in ACT is to support clients in recovery through increasing psychological and behavioral flexibility in the service of a more workable life. Let me explain …
The Rationale Behind Acceptance and Commitment Therapy for PTSD
As long as humankind has existed, we have learned to judge some feelings, thoughts and physical sensations as bad and others as good. For example, fear, pain, sadness, discomfort and anger are viewed as bad or threatening emotions, while happiness, pleasure and joy as good or positive ones.
When we experience these bad feelings, our instinctive drive to survive tells us that there must be some threat to our existence. That there is a problem. This activates our fight-or-flight response in order to escape or fix whatever the threat or problem is, to do whatever we can to avoid these bad feelings.
When we are experiencing the good feelings, it means we are safe and that we are flourishing. It’s understandable, then, that we avoid any situations, experiences, thoughts or feelings that tell us that we are under threat, and that we constantly try to escape these feelings and thoughts through experiencing the good, pleasant and comforting thoughts, feelings and experiences.
Avoidance Doesn’t Work
However, 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. These feelings and thoughts serve a purpose and your mind’s main purpose of protecting you and ensuring your survival, forces your mind to identify and anticipate any possible threats to your existence and to your physical and emotional safety. When your mind then identifies any possible threat, it will do everything in its power to inform you of this threat. It relies on the fact that it will cause you pain, fear, sadness or anger, to motivate you to fight, flight or freeze.
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, that 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.
ACT is a cognitive behavioural intervention based on the idea that psychological suffering comes not from feeling emotional pain but rather from our attempts to avoid that pain. The main objective of ACT is to help people be both open and willing to experience their inner painful feelings while they focus attention, not on trying to escape or avoid these painful thoughts, feelings or situations (because this is impossible), but on living a meaningful life through acting according to your own personal values.
The 5 Goals of Acceptance and Commitment Therapy
Acceptance and commitment therapy for PTSD and other mental health disorders can be broken down into five goals.
1 – Realizing that efforts to escape and avoid thoughts and feelings are futile
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, flashbacks, memories, nightmares, thoughts or feelings do not work, and there will probably never be an effective way of completely removing emotional pain from your life.
2 – Realizing that our efforts to “control thoughts, feelings and situations” are causing more problems
The 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.
3 – Viewing yourself as “separate from your thoughts and feelings”
We call this your “Observing Self”. A person who has experienced a traumatic event may have thoughts of being a bad person or “broken” or “damaged,” or that more terrible things are about to happen. Our thoughts are very believable. However, although these thoughts may feel true, they are only thoughts. The aim is to step out of your thoughts and see them as thoughts and to not buy into them as the truth. A thought is just a thought. It is not a reflection of who the person really is, of what the current situation is, or what will happen in the future.
4 – Drop the Battle (Acceptance)
The goal is to let go of attempts to avoid or control your thoughts and feelings and, instead, to practise 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). Can I give permission for my thoughts feelings and memories to be there, and to stop trying to escape, avoid or fix them? Can I allow myself to experience fear, flashbacks or memories of my trauma? That is what they are. It is not what is happening now or in the future, I do not have to engage in a battle to make it go away or to prevent it from happening.
5 – Committing to Values Guided Action
When you are engaging in efforts to avoid or escape your painful thoughts and feelings around your trauma, it uses a lot of your mental and sometimes physical energy.
As a result, you may not be placing much time or energy into living a meaningful and rewarding life. Therefore, the final goal of ACT for PTSD is identifying areas of importance in your life (referred to as “values”) 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 victim of an abusive relationship might avoid social interaction or engaging in an intimate relationship out of fear of re-experiencing the trauma, despite really valuing emotional closeness, connection, affection and intimacy. The aim is to get this victim to acknowledge the thoughts, feelings and memories for what they are, to accept or allow them to be there, but to engage in actions or behaviours that will allow this person to live a meaningful and fulfilling life where they get to experience these values.
If you have experienced trauma and:
- find yourself no longer living a fulfilling life;
- are no longer living according to your values;
- find yourself avoiding situations, thoughts, feelings and memories;
- feel you are detached and disconnected from your life, your goals and the things that really matter to you;
- you are engaging in behaviours to avoid or escape your feelings and thoughts and as a result experiencing more emotional suffering;
you do not have to continue in this battle. You can learn how to accept your thoughts, feelings and traumas, and to engage in a fulfilling life.
Author: Willem van den Berg, B SocSci (Psychology & Criminology), B SocSci (Hons) (Psych), MSc Clinical Psychology.
Willem van den Berg is a Brisbane Psychologist with a compassionate, positive and non-judgmental approach, working with individuals, couples and families. His therapeutic toolbox includes evidence-based therapies including Clinical Hypnotherapy (Medical Hypno-Analysis), CBT, ACT and Interpersonal Therapy. William is fluent in both English and Afrikaans.
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