ACT for Trauma: PTSD and Beyond

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Last Updated Dec 8, 2022|

Avoidance and Control in ACT: Toward Psychological Flexibility

By Sonja V. Batten, Ph.D.

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

Highlights

  • Avoidance is a common way of responding to painful thoughts, feelings, and memories.
  • Toward the beginning of treatment, introduce the concept that trying to control these experiences related to the trauma is part of the problem.
  • The ACT therapist informs the client about how this approach to treatment is different.
  • Ask the client to commit to a specific number of sessions and then to judge whether their life is becoming more workable.

 

Transcript

Hello. In this session, I’m going to talk to you about the process of preparing the client to move from a focus on control and avoidance toward willingness.

As we’ve already discussed in previous modules, From an ACT perspective, many of the problems in living that bring clients to therapy are related to an unwillingness to experience their own thoughts, feelings, memories, and other private experiences.
 
And for trauma survivors, that refers specifically to an unwillingness to experience those private events that are related to the client’s traumatic event history.

And although it’s totally natural to avoid things that are experienced as unpleasant or painful, and this tendency is even more heightened when you’ve experienced a traumatic event, difficult experiences are a natural part of life and can’t be fully avoided.

References

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

So, one of the ways that an ACT therapist helps clients to move toward psychological flexibility is by introducing the possibility that this focus on internal control may itself be part of the problem that has led the person to seek treatment.

The idea is that by letting go of so much effort at controlling thoughts, feelings, memories, and other private events, the person is freed up to actually exert more control over their actual lives.

References

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

So, when introducing this concept, it can be especially useful to provide informed consent about the regular course of ACT treatment. And I’m not just talking about standard information about limits of confidentiality or the research support behind the approach or potential alternative treatments.

In addition to those things, the ACT therapist tries to explain what’s different about this treatment so that the client better understands what this approach entails.
 
So, here’s a sample of how I might introduce ACT to a client at this phase of treatment. I might say something like this:

References

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

You know, Before we really begin with the main work of this treatment, I’d like to tell you a little bit more about it.
You know, You’ve said you’ve been in therapy before and so I need to let you know that this approach is somewhat different from what you may have encountered with other therapists. In the type of therapy that I do, the focus is not on helping you to feel better, but instead to feel better.

References

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

I propose that if we can work on helping you to find a different way of responding when difficult thoughts and feelings show up, this may be more effective in helping you to move forward with your life than if we just focus on helping you to feel less sadness or less anxiety.

References

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

In fact, I think it’s likely that here, at first, those symptoms of sadness and anxiety may sometimes go up and sometimes go down, like waves in the ocean. What I’m suggesting is that we commit to a piece of work together for however long seems okay to you at first. Three sessions, 6 sessions, 10 session, whatever. And then, at that time, we take a look to see how things are going.

References

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

My request at that point will be that we take a look and assess whether we’re making progress, not by how you happen to be feeling in that moment—because we know those waves of feelings will vary from day to day and moment to moment—but by whether you have the sense that things are moving forward and that what we’re working on together has the potential to make a difference in how you live your life.
So, I would say something like that.

References

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

And some clients may have had enough experience with other modes of therapy to be ready to try something new. Others may have had the types of life experiences or exposure to spiritual traditions that have opened them already to an awareness that pain is part of life. For those individuals, they may actually feel immediately validated by a therapist who does not suggest that removing psychological distress is the ideal end state.

References

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

On the other hand, for other clients who are more caught up in the struggle with their own private experiences, the idea that someone may not need to change or reduce unpleasant private events in order to move forward with life may seem like it doesn’t make sense or may seem misguided. Either way, it’s okay.

References

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

The goal of introducing this topic is to begin to open up their way of thinking about how we might approach this work on trauma and to start to pique their interest.

By opening up through curiosity, the client can begin the process of opening up to their trauma history in a new way that isn’t based on avoidance.

References

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

So, to review the key points, avoidance is a common way of responding to painful thoughts, feelings, and memories. And this is often even more the case with people who have experienced a traumatic event.

Toward the beginning of treatment, it can be useful to introduce the concept that trying to control these private experiences related to the trauma is actually a core part of the problem of what is keeping them stuck.

And the ACT therapist works to inform the client about how this approach to treatment is different and asks the client to commit to a specific, predetermined number of sessions and then to judge whether their life is becoming more workable, rather than judging the progress of therapy by how the client may be feeling on a moment-to-moment basis.

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