ACT-Based Exposure and Cognitive Defusion for PTSD


Professor in the Department of Psychology at the University of Toledo

Key Points

  1. During exposure exercises, connecting Mark with his emotions nonjudgmentally was prioritized to prevent secondary emotional responses, especially shame.
  2. Prior to prolonged exposure exercises, he was trained in cognitive defusion and emotional willingness, using mindfulness and acceptance-based emotion regulation strategies.
  3. Skills employed during therapy included redefining judgments as thoughts, practicing mindfulness, and using repetition to defuse the emotional impact of judgmental thoughts.
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Emotional Connection

During exposure exercises it was vital for Mark to connect with and allow himself to experience, without judgment, any emotions that arose. The goal was to reduce the likelihood of secondary emotional responses. If exposure exercises merely provoked feelings of shame, they would not be beneficial. To prevent this, Mark needed to engage with his primary emotional experiences non-judgmentally.

Preliminary Training: Defusion and Willingness

Before beginning prolonged exposure exercises, then, Mark needed to be equipped with knowledge of and skills for cognitive defusion and emotional willingness. These were tools to reduce his attachment to judgmental thoughts and give him access to mindfulness and acceptance-based emotion regulation strategies. The skills that increased his ability to connect with emotions without the judgments tethered to secondary emotions included:

  1. Describing a thought as a thought: if Mark experienced a judgment about his anxiety, such as considering himself weak, the goal was to change his connection with that thought by defining it as just a thought. Saying “I am having the thought that I am weak” instead of “I am weak” gives the thought context and creates separation from the experience, reducing the potential shame response.
  2. Mindfulness strategies: for instance, visualizing a thought as a leaf floating down a stream, recognizing the continuous flow of thoughts through the mind. Such strategies were used at the beginning of every session to keep Mark connected and present.
  3. Repetition to defuse meaning: repeating a phrase like “I am weak” rapidly and continuously promotes cognitive defusion by turning a meaningful statement into a nonsense sound. Disconnecting the meaning from the phrase reduces the power of the thought to provoke a shame response.

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ACT-Based Exposure and Cognitive Defusion for PTSD