ACT Treatment Targets for PTSD

By Sonja Batten, Ph.D.

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

Highlights

  • ACT for PTSD has good results in outpatient and residential settings in both individual and group therapy formats.
  • Individuals may be good candidates for ACT if they:
    • Haven’t responded to traditional PTSD treatments, or
    • Aren’t willing to engage in exposure-based treatment.

 

Transcript

So now, we’ll go into a little bit more detail about treatment settings and the specific types of clients who might benefit from ACT with PTSD or other posttraumatic problems. ACT has been used with trauma survivors in a variety of different treatment settings. The majority of treatment will be an outpatient individual therapy setting, but group treatment can also be really useful for skills acquisition and application, learning from each other, learning that you’re not alone.
And ACT has also been used successfully in a residential treatment setting. In fact, I oversaw a program that used ACT for the treatment of comorbid ACT and substance use disorders. And we had really good data showing that it was effective in a residential group-based treatment setting as well.

References

Batten, S. V., DeViva, J. C., Santanello, A. P., Morris, L. J., Benson, P. R., & Mann, M. A. (2009). Acceptance and commitment therapy for comorbid PTSD and substance use disorders. In J. T. Blackledge, J. Ciarrochi, & F. P. Deane (Eds.), Acceptance and commitment therapy: Contemporary theory, research and practice (p. 311–328). Australian Academic Press.

So, when we want to think about which clients are a good fit for ACT for PTSD, if you think about what I’ve talked about so far—so for example, where experiential avoidance is seen as a core problem. So if you’re working with a client where avoidance truly is a significant component of their clinical presentation, that could be a clue that ACT might be a good fit for them.

Or somebody who hasn’t responded fully to an existing evidence-based treatment. Maybe there’s some component that ACT would have to address their problems that another traditional treatment hasn’t been able to target. Or, as I described, people who aren’t willing to do traditional exposure-based treatments. ACT certainly can include exposure, but it doesn’t have to. So that can be a clue.

References

Batten, S. V., & Hayes, S. C. (2005). Acceptance and commitment therapy in the treatment of comorbid substance abuse and post-traumatic stress disorder: A case study. Clinical Case Studies, 4(3), 246–262.
Orsillo, S. M., & Batten, S. V. (2005). Acceptance and commitment therapy in the treatment of posttraumatic stress disorder. Behavior Modification, 29(1), 95–129.

If somebody is really not willing to talk about the past, you can actually do ACT and work on these processes that are contributing to the problems in their current life without necessarily having to go back and rehash the past.
And individuals who have multiple comorbidities, when those comorbidities can be also conceptualized from an avoidance-based analysis, then those individuals may respond well to ACT.

References

Batten, S. V., & Hayes, S. C. (2005). Acceptance and commitment therapy in the treatment of comorbid substance abuse and post-traumatic stress disorder: A case study. Clinical Case Studies, 4(3), 246–262.
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 when we think about what the treatment targets may be in ACT for posttraumatic problems in living, it can be, for example, skills acquisition. And I mean that broadly.

So, it could be mindfulness skills. So, working with people over time on developing a variety of different ways of engaging in mindfulness and connection to the present moment.

It can be interpersonal effectiveness skills, like truly social skills training, that can be part of ACT.

And emotional functioning skills. So, for example, using some skills, for example, from dialectical behavior therapy about being able to label emotions and, even know the emotions that you’re experiencing. Those sorts of skills are really important.

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.

Also, exposure to previously avoided private events. So, we may focus on anxiety. We may focus on trauma memories. We may focus on a variety of experiences in the person’s life that they may have been avoiding. And that sort of exposure—whether it’s specifically overtly related to the trauma or not—it can be a core component of ACT.

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.

Clarification of life values and goals is really important. When you’re working with a trauma survivor who’s maybe become really disconnected from the things that are truly important to them deep down, we actually include a very clear focus on identifying the individual’s values in a variety of different domains. So, interpersonal, employment, education, family, self-care. Looking at all of these different areas of life and what’s important to them and what goals the person wants to set for him or herself.

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 with all of those goals, you’re always going to run into barriers. So, working on the identification of those barriers to implementation and having those become the focus of treatment.

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 over time, just really increasing behavior toward the client’s own values and goals that they determined are important to them, not to somebody else in their life or some cultural influence, but what’s important to them as an individual.

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 we really believe that ACT adds to the field because it allows us to address the limitations of existing treatments while still incorporating those key ingredients, like all of those things that I’ve just talked about, that are effective.

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.

Some key points: ACT for posttraumatic problems in living has been applied in outpatient and residential settings in both individual and group therapy formats with good results. And individuals may be good candidates for ACT if they haven’t responded to traditional PTSD treatments or they aren’t willing to engage in exposure-based treatment.

More ACT for PTSD presentations