ACT for Trauma: PTSD and Beyond

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Last Updated Dec 8, 2022|

Sequencing ACT Interventions for PTSD

By Sonja V. Batten, Ph.D.

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

Highlights

  • There is no one sequence to present ACT principles for all clients.
  • Common sequences begin either with creative hopelessness and control as the problem or values and committed action.
  • The sequence depends on the client’s presenting problems and what needs attention first.
  • The effects can cascade into forward momentum and client engagement.

 

Transcript

There’s no one particular sequence in which ACT concepts must be delivered. Even though many therapist manuals and treatment protocols may present the processes in the sequence in which they’re described here, there’s a distinct amount of variability in how the ACT tools and processes are presented and delivered across settings, presenting problems, and therapists.

There aren’t yet data to inform the question of whether it matters in which order the primary ACT concepts are presented.

References

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

The more competent and flexible an ACT therapist becomes, the less discrete the 6 processes may appear in a given course of treatment or even within a given session. Sometimes, it may be clear from the individualized case conceptualization which treatment targets are primary and should be addressed first, but at other times, the course is not so apparent.

References

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

One heuristic that may be helpful to newer ACT therapists is the following. For clients who present to treatment with significant levels of distress, appear tired of the struggle, or who clearly state that they wish to change something in their lives, the therapist may want to begin with creative hopelessness and present the ACT core processes beginning with creative hopelessness, control as the problem, defusion, and on further.

References

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

For clients who do not present with any immediate distress, appear emotionally shut down, don’t see any negative consequences for avoidance, or are in treatment because it’s mandatory for them, the therapist may want to begin to work with values and committed action. In this case, if avoidance or fusion is a significant problem, it will show itself to be a barrier to moving forward with action soon enough, and then the other processes of ACT can be engaged.

References

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

Regardless of the sequence in which these concepts are presented, the basic question to the client is, “Could you choose to be willing to try something different if it would mean that you could move your life forward in a way that means something to you?”

References

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

In addition to the sequence of processes, the beginning ACT therapist may also wonder how to know when to present one metaphor or exercise over another in a therapy session. It’s important to note that a multitude of ACT-consistent exercises and metaphors are described in this course and in every ACT book that you might encounter.

The ACT therapist should not feel compelled to cover every one of these metaphors or experiential exercises with every client. In fact, it may be much more useful to choose a few representative metaphors that seem to resonate with the client that can be referred to over and over as a form of shorthand within the therapeutic dyad.

References

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

Rigidly sticking to a defined set of interventions is likely to function more to unnecessarily increase the therapist’s comfort than to actually address the needs of the individual client. The ACT therapist should be encouraged to try a variety of metaphors and interventions over time and even to create new, novel ACT-consistent metaphors that are designed to meet the needs and interests of a given client or set of clients.

References

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

If your client is really into music, see if you can come up with a music metaphor. If they’re really into cooking, see if you can come up with a cooking metaphor. If they ride motorcycles, you can do one focused on motorcycles. It doesn’t matter what the content is.

And in fact, the more that you can create metaphors that are designed to convey the ACT concepts in ways that the client can actually relate to, the more they’re likely to stick.
 
References

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

The primary reason that metaphors are proposed to be effective within ACT is because they call to mind concepts that are already familiar to the client and further apply them to the world of private events and behaviors. So if the therapist truly understands the principles behind ACT and can create metaphors that resonate with the client’s lived experience, you know, sporting metaphors for the athlete or building metaphors for the carpenter, these metaphors will be likely to have more significance, stick better, and have more impact for the client.

References

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

So, some key points. There is no one sequence that should guide the order in which ACT principles would be presented for all clients. This is where your individualized case conceptualization will come in. Common sequences involve beginning either with creative hopelessness and control as the problem or values and committed action.

There is no one right answer. It depends entirely on your assessment of what has contributed to the client’s presenting problems and, therefore, needs attention first so that the effects can cascade into forward momentum and client engagement.

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