ACT for Trauma: PTSD and Beyond

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

PTSD and Setting Targets for Committed Actions

By Sonja V. Batten, Ph.D.

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

Highlights

  • The target committed action should be measurable and specific enough.
  • The SMART framework is one way of thinking through the types of actions that are chosen.
  • The function of committed action should be understood through the lens of the client’s context.
  • The same behavior can function differently across clients or for the same client at different times.

 

Transcript

So hopefully, the client has now clarified values and a few domains, has identified broad valued areas where they’d like to make an effort to change. And so now, we’re at the point of setting targets for committed action.

So, in psychological treatment, committed actions occur when clients engage in clinically relevant behaviors that demonstrate improvement. And within ACT, something is clinically relevant if it’s tied to the person’s values.

References

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.

Because committed actions are always tied to individual values, they should always be selected by the client. Resist the urge to make those suggestions yourself. You can help shape them, but really you should try, at least, to let the client come up with the first round of potential committed actions. They will be much more likely to follow through on them than if you’re the one suggesting them.

And as I mentioned before, the size of the commitment doesn’t matter, only the direction.
 
References

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 as we think about setting specific targets, I’m going to talk about some ways to make them more specific. One thing is making sure that the commitment is measurable in some way.

You want to be able to objectively know afterward whether or not the person has been able to follow through on it. So you don’t want to set a target that is sort of obscure and abstract or theoretical.

References

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, an operational definition of the commitment precisely identifies the client’s specific measurable behaviors related to the presenting problem. It doesn’t need to be publicly observable. It can be that the client is the only one who will know whether or not it’s done, but it should be something that is measurable and specific so that they truly know if they’ve followed through on it or not.

Committed action is the most measurable of ACT processes.

References

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 are some potential dimensions that you could measure or specify a committed action on.

The first one is rate. So, that is how often or how quickly something is going to happen within a specific period of time. So, “I will call my parents once per week.” Once per week is the rate.

Or duration. That might be “I’m going to go for a walk for 10 minutes each day.” So the 10 minutes is the duration.

Or latency. That’s how long perhaps you’re going to wait before doing the behavior. So, “I will wait 5 minutes before checking my smartphone from the time I’m feeling like I want to check Facebook,” or something like that. “I’m going to wait 5 minutes before I actually pick up the phone.”

References

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.

Or intensity. That could be somebody is on a treadmill and they want to run at a speed of 4 miles per hour on the treadmill.

Or perseverance. That is how much the person actually follows through, even in the face of obstacles. Maybe the person has an exercise video that they want to be doing. And what they’ve noticed is that when it gets to a really hard part, they just turn off the video or they sit down. So perseverance would be, “When I get to that point that I want to turn off the video, I continue for 3 more minutes.” So that’s persevering even in the face of an obstacle.

References

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 as you and the client are assessing and planning goals for committed action, you can also use the framework of what are called SMART goals.

References

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 that means specific. And so those examples I was just giving, those give you ways of making a goal more specific. So, not just “I want to get more exercise,” but “I will walk for 10 minutes a day, 6 days a week.”

The M stands for measurable, which that example that I just gave also very much is.

Attainable. Again, that goes back to what I was talking about in the last video about making the smallest possible commitment, for example. Now, it doesn’t have to be the smallest possible commitment, but making a commitment that the person can actually attain so that you can build success of approximations of moving forward.

Relevant. In ACT, relevant means that it’s related to the person’s values.

And time-bound. Again, as I’ve talked about the examples, “I want to run 10 minutes a day for 5 days.” So, it’s time-bound and the 10 minutes is time-bound. Or “I want to call my parents once per week.” Or “I want to do any other thing once per day.” So again, giving it a time-bounding helps make it specific so that the person can plan and follow through on the commitment.

References

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 committed actions are intentions in the service of values. Values can be thought of as those verbally construed, global, desired life consequences.

But it’s not enough to simply have a measurable goal in order to be targeting what is the most appropriate next step for the client. Context and function also influence the understanding of committed actions.

References

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, for example, imagine that your client, Anna, has committed to run an average of 30 minutes per day in the service of her value of improving and maintaining her health.

So it’s values driven. It’s very easily measurable. But measurement doesn’t tell the whole story. I’d like you to imagine that she’s saying that she wants to run 30 minutes a day, an average of 30 minutes a day. And she’s talking to you about that in session.
 
References

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 think about how workable or effective that commitment is in each of the following scenarios.

She often reports that she wants to improve her health and she is overweight, abuses alcohol, and smokes 10 cigarettes a day. So, how workable or effective do you think that particular commitment of running 30 minutes a day is?

Or what about she’s 75 pounds overweight with significant knee pain?

Or she’s in treatment for panic attacks and her primary treatment goals are to improve anxiety management skills and find a new job.

References

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.

Or she’s a triathlete and typically runs 50 miles a week.

Or she’s 72 years old and hasn’t walked more than a mile at a time in over 5 years.

Or she made the commitment a few days after her sister, who is her chief rival, made the same commitment.

References

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 that points out that the context matters. You can follow all of the guidelines I just gave about SMART goals, and measurable, and all of those things, and the person’s context will also define whether or not this is relevant to treatment, whether or not this is a meaningful goal, whether or not this is an attainable goal, and whether or not this is actually in the service of moving forward or it’s functioning in some other way.

References

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 also have to understand committed action in the context of history, presenting complaint, goals, and values. And so now, I want you to imagine that she’s set that goal of running 30 minutes a day, on average, for the next week and she truly saw that as a relevant goal.

But what if she returns the next week and she tells you the following. She didn’t run because her physician advised her she should have a complete physical first. So, she didn’t follow through and that’s the reason. What do you think of that?

References

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.

Or she ran 30 minutes 1 day, skipped the next 5 days, and then ran for 3 hours on the seventh day. So, she met her target of an average of 30 minutes. But what’s that going to cause you to think about?

Or she reports that meeting her goal was easy because she usually runs 60 minutes a day.

Or she tells you she didn’t run 30 minutes the day after she came down with the flu.

References

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.

Or she tells you she didn’t run 30 minutes per day because she felt too depressed.

Or she tells you that even though she was late to work 3 times because of her early morning running, that she did keep her commitment. And this is in the context of her demonstrating her competence at work that’s important to her because she has a goal of being promoted in the coming year.

References

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.

Think about how each of those scenarios might lead you to respond in a different way in that following session. So it’s again not just about whether the goal is the right type of goal and it’s not just about whether they met it or not.

But context, function, history, all of those things feed into understanding the progress on those goals. Never forget that context is important.

References

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. When the client is ready to begin selecting and committing to values-based actions for change, there are several points to keep in mind to increase the likelihood of setting a goal that can actually be followed through on.

The target committed action should be measurable and specific enough so that it will be clear whether the commitment was met or not.

The SMART framework is one way of thinking through the types of actions that are chosen, picking commitment targets that are specific, measurable, attainable, relevant, and time-bound.

However, it is also important to make sure that the function of any given committed action is understood through the lens of the client’s current and historical context.

The same behavior can function very differently across clients or for the same client at different times.

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