ACT for Trauma: PTSD and Beyond

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

Exposure Treatment: Approaching Traumatic Memories From an ACT Perspective

By Sonja V. Batten, Ph.D.

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

Highlights

  • ACT incorporates exposure exercises with a focus on increasing psychological flexibility and valued living.
  • Private experiences and bodily sensations can be approached with willingness rather than avoidance.
  • Defusion methods change the response to troubling thoughts, and exposure practices help them move forward.
  • Exposure exercises can be any opportunity to practice approaching a situation that’s usually avoided.
  • Practicing willingness and defusion broadens the behavioral repertoire.

 

Transcript

The empirical evidence for the treatment of PTSD indicates that one of the most effective components of treatment for PTSD and other related anxiety disorders is exposure, whether in vivo or imaginal. The use of exposure therapy is in many ways consistent with an acceptance-based approach to treatment. And we will frequently use exposure exercises when working with traumatized clients.

Many of the methods of exposure used in acceptance-based approaches are conducted exactly as they are in other cognitive behavioral treatment packages, such as imaginal exposure exercises in which the client is asked to write about a memory of a specific traumatic event, repeating the description of this memory over and over, and even listening repeatedly to recordings of verbal accounts of the traumatic events.

References

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

However, the rationale used to describe exposure exercises from an acceptance standpoint differs significantly from the traditional rationale. Most importantly, we do not suggest that recounting the trauma multiple times will result in habituation or reduction of difficult private events as this rationale highlights exposure as another method aimed at experiential control.

References

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

Rather, we discuss the possibility that approaching instead of avoiding these traumatic memories and the associated thoughts and effects will change the content in which these private events are experienced and the nature of the relationship that the client has with these experiences.

Consequently, this change in context then allows for more behavioral flexibility and increased ability to make steps forward in valued directions.

References

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

Additionally, in vivo exposure is also conducted regularly as an integral part of acceptance-based therapy for PTSD, although the form of the exposure and the rationale may differ. For instance, a client may be encouraged to attend a party, which could be a previously avoided activity for that person, not with the purpose of habituating to anxiety in that situation, but with the explicit goal of engaging in a behavior that is consistent with the client’s value of developing and maintaining relationships.

References

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

You might also do interoceptive exposure for a trauma client who has panic-type symptoms when they are triggered by trauma reminders where the focus is on eliciting panicky feelings through traditional interoceptive triggers like spinning in a chair or hyperventilating, and then working on more flexible behaviors, even in the presence of feelings of panic.

Showing the person that they can do anything other than what they would normally do while having those sensations is progress. It could be reading a magazine article, carrying on an unrelated conversation with the therapist, or counting to 100 on their fingers.

References

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

In the end, the goal of exposure is the same as the overall goal of ACT: to increase psychological flexibility. ACT-inspired exposure aims to broaden the individual’s repertoire so that he can move forward in a variety of ways that may be more functional in any given situation than avoidance or freezing would be. In fact, for many individuals, each step forward can be seen as its own type of exposure exercise.

References

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

And in a broad sense, all of ACT can be conceptualized as serving an exposure function as it works to undermine avoidance across a variety of situations and experiences, not just those that are related to the traumatic event. This is one of the reasons that after an individual’s values have been clarified and identified, commitment exercises, both in session and out of session, are the central focus of much of therapy.
 
References

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

Some small changes may be made when doing formal ACT exposure exercises as compared to traditional exposure. For example, the therapist may ask the client to rate S-U-D-S, SUDs, subjective units of distress, throughout the exposure exercise, but it’s not for the purpose of seeing if the distress goes down over time. Instead, the focus is on mindful awareness of those symptoms throughout the process.

References

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

In addition, a more ACT-ified example of self-monitoring may be added to exposure in which a person is asked to give repeated ratings of levels of willingness to experience whatever happens to be present, either on a scale of 0 to 10, or 0 to 100, or whatever works for the person.

References

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

On a final note about application, exposure in ACT can be done either concurrently or sequentially. Exposure can be integrated throughout the course of treatment as long as values, willingness, and defusion have been introduced. Or a therapist could go through a general introduction to ACT all the way through, without much of a focus on the trauma, per se, and then move to a more formal exposure portion of treatment afterward.

There is no 1 right sequence. Again, this is one of those things that should be determined through the case conceptualization process, understanding the most pressing needs for that individual.

References

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

So, some key points. As with most effective treatments for PTSD and other anxiety disorders, ACT incorporates exposure exercises, but with a focus on increasing psychological flexibility and valued living rather than decreasing anxiety. In this ACT-based approach, individuals are shown that private experiences and bodily sensations can be approached with willingness rather than avoidance.

Defusion methods are used to change the characteristic response to troubling thoughts and exposure practices in and out of session. Help the individual with moving forward with a valued life, whether or not posttraumatic symptoms are present.

In ACT, exposure exercises can be any opportunity for an individual to practice approaching a situation or sensation that she characteristically attempts to avoid, control, or escape, instead practicing willingness and defusion in the service of broadening her behavioral repertoire in the presence of the avoided stimulus.

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