ACT for Trauma: PTSD and Beyond

Earn 8.25 CE/CMEs - Care for Clients with Trauma Issues Without Exposure Treatment

ACT for PTSD: Choosing Committed Actions

By Sonja V. Batten, Ph.D.

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

Highlights

  • Once values have been reintroduced, make new commitments to moving the person’s life forward.
  • There’s no one right place to start with focused committed action work.
  • It’s up to the client to choose where they’ll expend their effort.
  • The client can identify the areas that are most important.

 

Transcript

So now, you’ve revisited values clarification perhaps in a more concrete way than you did earlier in therapy. And so we’re going to talk now about choosing committed actions to flow from those values.

In general, ACT therapists rate committed action as a very important component of therapy. In fact, Dr. DJ Moran did a survey of ACT therapists several years ago asking, “In your opinion and in general, which of these 6 domains would you most want to see change after delivering ACT?” and then listed the 6 major processes of ACT. And the response was that 50% of ACT therapists said that they would rate committed action most highly in terms of what they would want to see after delivering ACT. Next was self-as-context at 16%, acceptance at 13%, defusion and contact with the present moment at 8%, and values at 4%. And that may be because of the way the question was worded that they were not looking for values to change after delivering ACT.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

But really, ACT therapists are about action. We’re about changing things, moving the person’s life forward in ways that are important to them.

And so it is not surprising that 50% of ACT therapists thought that committed action was the thing that would most show progress after a successful course of ACT. And in that survey, commitment was also rated as the most objectively measured domain.
 
References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

Thus, after an individual’s values have been clarified and identified, commitment exercises, both in session and as out-of-session homework, are the central focus of the rest of therapy.

However, even if all of the domains of valued living were rated as highly important, one can’t begin working on everything all at once.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

So the therapist and client can work together to choose 2 or 3 high-priority areas to start with and begin to identify goals there.

So, here are some ways that you can think about choosing committed actions. You could start with which behaviors the person most wants to change. You could start with which changes will lead to the most changes in other areas.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

You could start with which domain is the most important. You could start with the domain that has the largest discrepancy between importance and current effectiveness.

So, there’s not a right answer. Any of those places can be a good place to start. You just got to pick somewhere to start and so you can choose any of those rationales.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And here’s a tip. Try to target behaviors that are related to increasing or adding valued behaviors, not decreasing or stopping unwanted behaviors.

It’s much easier to focus on having the person do something than it is to focus on having the person not do something.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And really, simply avoiding doing undesirable behaviors from an ACT philosophy doesn’t really contribute to creating a life worth living. It may help sort of not make things worse, but what we’re trying to be about in ACT is generating, creating, moving forward, making a life bigger and stronger.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And so a question that you might want to ask if somebody is having a hard time identifying something they’d like to do more of and is instead focusing on the thing they want to do less of, you could ask, “What would you be able to do with your time and energy if you weren’t doing that thing that you want to decrease?”

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And I’m not saying that you can’t set a goal like “I want to stop smoking” or “I want to reduce smoking by 50%.” You can set these goals. I would just try to make sure that that’s not the only kind of goal that you’re setting.

So if the person wants to stop smoking, then you could go ahead and set that as a goal. But let’s think about also what it is that they would like to be doing more of. Would they like to be reading more or going for more walks? Or if they weren’t smoking, what would they be able to do more of? Like would they be able to exercise? Would they be able to spend more time with family?

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And as you’re choosing committed actions, the size of the chosen behavior doesn’t matter. The execution of a committed action of any magnitude is a marker of success. Not every commitment needs to be a grand proclamation of ultimate progress.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

Small committed actions can become part of larger patterns of committed actions. And small actions may also help prepare the person for larger committed actions.

And sometimes when I have somebody who’s really stuck and is feeling a lot of anxiety about whether they’re going to be able to change, I ask them to think about, “What is the absolute smallest thing that you could do? Like the absolute smallest thing?”

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And so if somebody were focusing on that they wanted to exercise more, maybe the absolute smallest thing they could do is walk up and down the stairs 1 extra time a day. So it’s something we know that just walking up and down the stairs 1 extra time a day is not going to change that person’s overall level of fitness.

And there is something therapeutic about choosing a commitment and following through with it.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

And so if we can focus on something that is actually bite-size, that the person actually can bite off, chew, and do that week, then that helps build success. It helps move the person toward their values. It helps them understand that process of doing things that are in the direction of their values. And it’s something they can actually do and they can build as a success.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

I talked earlier about growing the muscle of commitment and doing the things that you say you’re going to do. And so choosing the absolute smallest thing you can do in the service of a value can be really interesting and sort of takes some of the weight off of that heavy feeling for people who are really struggling. Perhaps, they haven’t followed through on commitments before.

References

Batten, S. V. (2011). Essentials of acceptance and commitment therapy. SAGE Publications Ltd.

Moran, D. J., Bach, P. A., & Batten, S. V. (2018). Committed action in practice: A clinician’s guide to assessing, planning, and supporting change in your client. New Harbinger Publications.

So, some key points. Once values have been reintroduced, then it’s time to begin making new commitments to moving the person’s life forward. There is no one right place to start with focused committed action work. The therapist and client can work together to identify a few different options.

And then eventually, it’s up to the client to choose where he or she wishes to expend their effort. This may be on commitments relevant to healing and rebuilding following a trauma or it can be focused on actions that have absolutely nothing to do with trauma recovery. It’s up to the client to identify the areas that are most important or perhaps most likely to build initial success.

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