Demystifying ACT: A Practical Guide for Therapists

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ACT Approach to Trauma & PTSD

By Sonja Batten, Ph.D.

This video is part of our upcoming online course about ACT for PTSD.

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 PTSD presentations