ACT for Trauma: PTSD and Beyond

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Last Updated Dec 8, 2022|

ACT for PTSD: How to Apply Mindfulness

By Sonja V. Batten, Ph.D.

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

Highlights

  • Being in contact with the present moment is difficult to instruct verbally.
  • There is an unlimited number of mindfulness exercises that can be designed.
  • Mindfulness exercises can include watching thoughts go by or interacting with an item focusing on each of the 5 senses.
  • Somatic exercises can be effective, although they may be triggering.
  • Therapists should proceed carefully with exercises focused on bodily sensations.

 

Transcript

The ability to focus in the present moment is fundamental to practicing almost all of the ACT skills that a trauma survivor will need for his or her recovery. But it’s not enough to just conceptually understand what mindfulness or present moment awareness are.
It’s a skill that has to be practiced so that the client can learn to discriminate when they are or are not in contact with the present moment. Again, this is one of those ACT processes that is difficult to explain just through verbal instructions. So, this is an area where the therapist will likely want to train the skill of mindfulness more explicitly during the session as well as providing between-session homework for the client.

References

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

Now, there are an infinite number of ways to practice mindfulness, whether it’s in the client’s imagination, through awareness of the 5 senses, or through body-focused mindfulness. In the next few minutes, I’ll provide examples of each of those modalities.

References

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

However, closed eyes mindfulness exercises, especially ones focused on the body, may be triggering for some trauma survivors.

So, I generally would not start off with the body-focused exercise in trauma treatment unless the client had already indicated that they were familiar with doing breathing exercises or something like yoga.

And even with imaginal exercises, I will always offer the client the option to do the exercise with their eyes open. I just suggest that if they’re going to keep their eyes open, that they look down toward the floor and allow their eyes to unfocus slightly, rather than trying to do an imaginal exercise while looking around the room or looking at me.

References

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

And at the beginning of most exercises, I usually ask the person to close their eyes or look down at the floor, you know, try and ground their feet on the floor, be in a comfortable position where they can sit comfortably without moving for a few minutes, and then start by taking 2 deep breaths, bringing their attention to the present moment. Then I move into the more specific exercise.

References

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

So here, I’ll start with one of my favorite imaginal exercises, which is called “Clouds in the Sky.” And so after getting them grounded and taking those 2 deep breaths, I might start something like this:

So, now that we’ve gotten grounded and centered here in the moment, I’d like to see if we can practice becoming mindful today of the range of thoughts that might go through our minds at any given time.

So if you’re willing, I’d like you to try to imagine that you’re looking up into the sky. It’s a bright blue sky. And first, you just become aware for a moment of that exact shade of blue.

References

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

And as you look up into the sky, you begin to see large fluffy clouds moving slowly from one edge of the sky across to the other side. And they keep coming one after another, moving across the sky. Just watch that sequence of events of the clouds moving for a moment.

And what I’d like to ask you to do now is to begin to become aware of whatever thoughts are popping into your head from moment to moment. And as you begin to mindfully become aware of those thoughts, I’d like you to picture taking each thought as it arises and placing it on a cloud and watching it go by.

References

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

Just take each thought as it comes up, place it on a cloud, and let it float to the other side of the sky and out of your field of vision. You might choose to represent each thought on the cloud with a word, a phrase, or an image. The form does not matter, just the process. So, try that for just a minute.
 
References

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

And if you find yourself becoming distracted from the exercise or thinking that you can’t do this, then as soon as you notice that, just take that thought and place it on a cloud.

Watch it go by and return to the process. You may have to do this over and over again, and that’s okay.

There’s no finish line. It’s just an opportunity to practice being mindful of your thoughts and to detach from them, rather than becoming hooked on them or buying into them. So I’ll pause here.

References

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

If I were doing that in session, I would let that go on. I would have the pauses be longer. I might have the person actually tell me how it’s going—whether they’re able to imagine the sky, how it’s going with the clouds, whether they’re getting distracted. But you can see generally how that flows.

References

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

And it’s important to note that the same exercise can be done with different imagery, like leaves floating down a stream, or boxes on a conveyor belt, or train cars on a train track, or little toy soldiers walking in line holding signs.

References

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

So the therapist can work over time to find imagery that may work best for each individual client.

References

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

And for those clients who may have difficulty labeling what it is they’re feeling, you may need to do some more shaping. And using a list of feeling words over time may help with getting labels for them to put on their thoughts and feelings as they go by.

References

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

Another type of simple mindfulness exercise that you can do is what I call 5 senses mindfulness.
And again, your 5 senses, in this case, are your sight, smell, touch, taste, and sound, assuming the person has all of these senses. And you can do 5 senses mindfulness with really any sort of object or thing that a person can hold or touch. So you can do it with a piece of food, for example.

A lot of times, people suggest a raisin or one of those small clementine oranges or something like that. Again, it doesn’t make any difference what the thing is. It can be a piece of chocolate, too.

References

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

And the only thing I would suggest, if you’re using a piece of food, is that you leave taste for last because, obviously, that’s the end of the object, or at least part of it.

So again, just sort of moving through each of those 5 senses, having them take, you know, 20, 30 seconds to just focus on mindful awareness of each of those senses.

References

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

Or you could do the same thing with lotion, you know. Somebody could have some lotion. You could look at the lotion, smell the lotion, touch it.

See if it makes sounds as you rub it between your fingers. Obviously, with some inanimate objects like lotion or other objects that have been sitting around, you may choose not to taste. That’s okay. There’s nothing magical about doing all 5 of the senses.

Or as I mentioned earlier in the course, you can also listen to a piece of music and practice, you know, specifically focusing on the sound part of the senses with that.

References

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

So, some key points.
Being in contact with the present moment is something that is difficult to fully instruct verbally. It’s definitely a process that is more effectively contacted through practice.

Fortunately, there is an unlimited number of mindfulness exercises that can be designed and they’re limited only by the creativity of the therapist and the client.

Common mindfulness exercises can include watching thoughts go by as clouds in the sky or leaves on a stream, or exercises where the client interacts with an item focusing on each of the 5 senses in turn.

Physical or somatic exercises can also be effective, although they may be triggering for some clients.

So the therapist should proceed carefully before embarking on exercises that include a focus on bodily sensations, especially with clients who are prone to dissociation or extreme avoidance.

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