Mark needed to recognize the counterproductive effects of his avoidance behavior, especially how it exacerbated his symptoms and generalized his fear response to various stimuli. Dr. Tull enabled his understanding of these paradoxical consequences early in treatment, alongside psychoeducation on PTSD, while working to avoid any increase in Mark’s feelings of shame. The therapist drew an analogy to natural human responses – such as pulling away from a hot stove – to highlight the universality of the instinct to avoid pain, including emotional pain, thereby normalizing and validating Mark’s reactions.
Paradoxical Consequences
However, a paradox arose when avoidance strategies that gave Mark short-term relief ultimately intensified his distress and aggravated his PTSD symptoms. His emotional reactions became increasingly frequent and severe. His confidence in his ability to handle his emotions dwindled, leading to a low tolerance for any level of anxiety or guilt.
This emotional avoidance not only increased Mark’s distress but also negatively impacted his personal relationships, his confidence in his ability to return to work, and his sleep patterns. These effects demonstrate the high long-term cost of momentary relief brought about by avoidance.
Use of Metaphors
Dr. Tull used metaphors during treatment to convey such paradoxical consequences more effectively. One such metaphor involved a tug-of-war with a monstrous embodiment of Mark’s unwanted internal experiences. Despite his efforts to win the battle by pulling the ‘monster’ into a chasm, it always pulled back harder, representing the futility of trying to avoid internal experiences.
The solution Dr. Tull proposed was not about winning the impossible battle, but recognizing the futility of the struggle and ‘dropping the rope’. Though this approach means acknowledging the presence of emotional pain, it frees up time and effort to focus on meaningful and more effective living.
Willingness vs Unwillingness
As part of the process, Dr. Tull encouraged Mark to monitor instances when he chose unwillingness over willingness, and to evaluate the resulting costs. The concept of willingness and unwillingness was presented as behavior; one can feel very unwilling but still choose to act willingly.
The goal was to help Mark recognize the detrimental outcomes of being unwilling and the benefits associated with willingness. This process formed a critical part of his journey toward understanding and managing his emotions.
Addressing Negative Emotions
Working on Mark’s negative beliefs about emotions was another central aspect of therapy. Dr. Tull described emotions as a communication channel between the environment and the brain, providing valuable information about how to react in different situations.
When these emotions are suppressed or viewed as harmful, the body tends to intensify the emotional response to ensure the message gets through. However, if one is willing to examine these emotions, they usually dissipate after the message is received, reducing their intensity.
Control of Behavior
Even in the face of intense emotions or unpleasant thoughts, Dr. Tull reassured Mark of his control over his behavior. While he could not control his thoughts or emotions, he could control his actions. The focus was on guiding him to manage his emotional distress and other internal experiences effectively. As Mark learned to act contrary to intense emotions and urges to avoid, his self-efficacy increased.
Looking for practical everyday tools? These print-friendly handouts are just what you need. Click on the following links to download the PDFs:
1- Willingness vs Avoidance in ACT for PTSD
This guide offers therapists a summary of important points in acceptance and commitment therapy (ACT) when treating clients with PTSD. ACT emphasizes the significance of stressing willingness over avoidance in therapeutic interventions. It reminds therapists of the paradoxical outcomes when clients prioritize avoidance behaviors, even those that offer short-term relief. Metaphorical tools are introduced to simplify these complex emotions and reactions, emphasizing the value of embracing rather than evading emotional pain. This summary can help therapists focus on important issues when treating clients with PTSD.
Instructions
This handout summarizes important points to keep in mind when using ACT for PTSD in your clinical practice. Begin by familiarizing yourself with the content to ensure a smooth integration into your sessions. Emphasize the importance of willingness over avoidance, using the provided metaphors to simplify these concepts for clients. Remember to gauge your client’s readiness before introducing new ideas, as the shift from avoidance to willingness can be emotionally taxing. Encourage them to reflect on instances of avoidance in their daily lives and the potential benefits of adopting a willingness-based approach. As you progress through the sessions, be sure to provide consistent validation and support, creating a safe environment for exploration and growth.
2- Understanding and Addressing Trauma: Insights Into Emotional Distress and Coping Strategies
This handout summarizes how clients deal with the emotional disturbance triggered by traumatic events, disrupting both professional and personal spheres of life. It sheds light on the existence of unsustainable coping mechanisms like substance use and avoidance which, although temporarily providing relief, culminate in more long-term distress. Social isolation, even amidst a supportive network, and the emergence of physiological symptoms, intensify emotional struggles. The handout outlines ineffective coping strategies and the impacts of trauma on social interactions and physiological well-being.
Instructions
This handout is for those facing client responses to trauma. Therapists may wish to integrate the insights outlined on coping mechanisms, emotional impact, and social dynamics into their therapeutic approach, tailoring interventions to address the unique challenges presented by each client. The nuanced exploration of avoidance behaviors and self-perception will aid in formulating strategies to foster resilience and enhance emotion regulation. Emphasizing the significance of sustainable coping strategies and the interplay between emotional and physiological symptoms will contribute to a holistic experience for clients dealing with the aftermath of trauma.