Trauma Focused ACT: A Practitioner’s Guide to Working with Mind, Body, and Emotion Using Acceptance and Commitment Therapy
ACT is the acronym for “acceptance and commitment therapy.” It’s a therapy that’s evidence supported. That’s a big deal. Trauma Focused ACT: A Practitioner’s Guide to Working with Mind, Body, and Emotion Using Acceptance and Commitment Therapy is designed as a guide for using this proven technique with trauma patients. The author, Russ Harris, offers a different book that’s more focused on the fundamentals of ACT without the specialization towards patients with trauma, but I chose this work because I wanted to see what could be done before a traumatic experience developed into a mental health problem. How can we stop the trauma from eating away at a person?
Psychological Flexibility
Harris explains that the overarching goal of ACT is psychological flexibility. He provides a four-part framework: be present, fully open to experience, allowing (thoughts and feelings), and value-guided. While this is a fine framework, I’d suggest that the key is learning how to respond instead of reacting. (See The Book of Joy for more.) It’s about bringing more agency into our day-to-day living. (See Conflict Resolved? For more about agency and its impact.)
Things change when you have a choice. Without choice you have no personal agency. You can have no sense that you have influence on your world and your future. The truth is that we always have a choice to make about how we respond to situations. There are cases when it’s not possible to change the circumstances but changing how we respond makes all the difference.
Trauma Focused
What makes trauma focused ACT different is the integration of trauma related components, including polyvagal theory, attachment theory, and inhibitory learning theory. It’s about understanding the impacts of trauma on physical and mental health. It’s being aware that working in general may trigger trauma reactions at any time.
Being trauma focused also means that we need to heal past hurts (see Hurtful, Hurt, Hurting), be present in the present (see Resilient), and build the future. In The Time Paradox, Phillip Zimbardo explains that we each have different perspectives – or approaches to time. What trauma-focused ACT seeks to do is to give us the flexibility to view time using different lenses.
Defusion and Fusion
The goal suggested by ACT is defusion (de-fusion) from our thoughts. Instead of acting on them immediately, to “step back” and evaluate them. This key factor gives us the agency in our response. We can act as Neo in The Matrix, where we investigate thoughts outside of being hurt or disturbed by them. (See also A Way of Being for more.) By stepping back and evaluating our thoughts and emotions, we gain power over them.
The opposite, unhealthy view is to fuse our thoughts and beliefs. We can believe that life sucks and is pointless. (See the nihilist view in The Blank Slate.) We can believe that the world is unsafe and evil. (See The Marketing of Evil as an example.) We can believe that people are untrustworthy. (See The Lucifer Effect.) We can even believe that we’re unworthy of love. (See Compassion and Self-Hate.)
These fusions prevent us from seeing the opposite is also true. There are parts of life that are pointless – and some amazing moments. The world is, at times, unsafe. Other times, it’s incredibly supportive and helpful. People will betray us, but the decision to trust is worth it. (See Trust => Vulnerability => Intimacy, Revisited for more.) It’s even hard to see the amazing parts of ourselves when we’re consumed by a sense of unlovability and shame. (See The Gifts of Imperfection for more.)
The book often uses the term “unhooking” to refer to the removal of automatic and complete views of truth. Unhooking creates spaces for other ideas, thoughts, and approaches.
Avoidance
One of the key challenges with trauma – and the part that causes event escalation – is avoidance. When we avoid the root of the problem, we’re forced to find larger and more complicated workarounds that ultimately consume more time and energy than directly addressing the problem. Van Der Kolk in The Body Keeps the Score explains the value of short-term avoidance through compartmentalization and the long-term toll that compartmentalization can take.
One of the most important aspects of trauma-focused anything is in creating space where people feel safe enough to confront their trauma gradually instead of using avoidance tactics.
Listening
The starting point in any therapy – including ACT – is listening. Before we can expect that someone will listen to us, they’ve got to believe that we understand at some level. Motivational Interviewing is powerful in this respect. It creates an intentional space for a therapeutic alliance to form. (See The Heart and Soul of Change for more on therapeutic alliance.)
Despite the power of listening, it’s not necessary for someone to share their complete story with you in an initial conversation – after all, you are, in fact, a stranger. Rather than insisting on hearing the story, the key is to create space where the other person can share their story if they desire to. There’s no requirement or expectation – just an opportunity.
Dropping Anchor
When emotions start to become overwhelming, Harris recommends a technique he calls “dropping anchor,” which isn’t designed to control the overwhelming emotions but to stabilize a person until they subside. It includes three key factors:
- A – Acknowledge your inner world.
- C – Connect with your body.
- E – Engage in what you’re doing.
This approach fully recognizes what’s going on in the current moment and allows the cognition or emotion to pass in its own time rather than trying to control it.
Normalization
Being different from others or abnormal has a powerful force behind it. It’s one of the things that makes adolescence difficult. Teenagers are caught between the need to be an individual and unique (see Childhood and Society) and the need to conform and to be a part of the group. We’re social animals who have dominated the planet because of our ability to work together – and that requires, to some degree, that we’re like others. (See The Righteous Mind.)
Normalization is, therefore, a powerful tool to help people work through trauma. It’s a way of helping them understand they’re not alone. It’s a way to help them understand that their feelings and thoughts are reasonable given what they’ve been through. Too many people who have been through trauma are concerned about whether their thoughts are reasonable or not.
Getting Rid of Thoughts
One of the normal things is a desire to get rid of unwanted thoughts. Paradoxically, the best way to combat unwanted thoughts is to allow them. By trying to block them, we give them more attention and more power. (See White Bears and Other Unwanted Thoughts.) If we practice mindful or meditation techniques of observing and acknowledging the thought, it will go away on its own. (See Altered Traits.) The desire to get rid of unwanted thoughts paradoxically prohibits people from doing so. It’s a Chinese finger trap of mental orientation.
Pain Signals
Painful thoughts and emotions contain valuable information. (See Compelled to Control for more.) It is hard to believe that in the moment. But often times, when we look back at our lives, we can see that some of the times of deepest pain taught us something or changed the direction of our lives in ways that have been important and powerful for us. (See Extreme Productivity for an example.) ACT treats pain as an ally, not an enemy.
Here and Now
There’s an odd interaction that happens between the current moment – the here and now – and the desired future. Sometimes, the future seems like it’s too far off or unlikely, and it becomes necessary to find strength in the here and now. Of course, we’d all love to have the resolve to leave the marshmallow on the table for the promise of two, like the children in the Stanford preschool in The Marshmallow Test. However, they knew that the delay had to come to an end. At the very least, they’d get to leave with their parent at the end of the day.
Kotter, in Leading Change, makes the point that you need to build on small wins. If you want to sustain an effort over the long-term, it’s necessary to receive reinforcement and support. That means seeing some value in the current moment.
Adrift Without Values
Living a life when you don’t know what you value is like trying to pilot a boat without a rudder. You can’t control where you’re going – and that’s frightening. Too many people don’t have a sense for what they value. Luckily, there are lots of ways to discover what’s important to you – what you value. You can look towards Values in Action, Gallup’s CliftonStrengths, and other frameworks that help you discover your interests and values. (Like the REISS Motivational Profile summarized in Who Am I?)
Harris explains that we all have values, but many of us don’t know what those values are. I’d concur. Too few people realize what’s important to them, and as a result, they’re not sure how to navigate after a trauma – or through life in general.
Adulting
Around here, we call it “adulting.” That is, doing the thing you know is the right thing even when there are other things that we want to do. It might be paying a bill instead of spending money on a night out, or it could be a hard but necessary conversation. Adulting isn’t something that people want to do – but it can be the right thing to do. The problem is that without a sense of what you value, it’s hard to know which hard things you need to do. We value truthfulness even when it means upsetting another person. In the end, we know it’s better, even if it’s not easy in the moment.
Planting a Tree
A Chinese proverb says that “The best time to plant a tree was twenty years ago; the second-best time is now.” It’s a gentle reminder that you can’t change the past, you can only work with the present and remember the future gains. Viewing time as a long arc allows you to accept that the first draft of anything is, as Earnest Hemmingway said, “shit.” Ed Catmull in Creativity, Inc. explains a similar perspective of the first drafts of the Pixar movies that we have fallen in love with. The process refines the idea.
Similarly, we set an initial set of values, and as we live them, we can adjust them. The more we adjust, the more they’ll fit us perfectly.
More than the Trauma
One of the risks in working too much on trauma is that people will begin to see everything in their life as the trauma – or trauma-connected. It’s important to recognize that everyone – even those who have survived the most horrific sustained traumas – is more than their trauma. Humans are amazing, diverse individuals who cannot be reduced to a single dimension.
Compassionate to the Child
In cases of severe trauma, sometimes people find it difficult to be compassionate to themselves as they are today. They reason that they’ve seen, done, and experienced too much. They believe, incorrectly, that they’re beyond repair. In these cases, it’s often possible to speak and interact compassionately with their younger selves – the person they were before all the traumas. Gradually, they realize that they are still this same person.
Failure
Failure when helping people with trauma isn’t an option – it’s a fact. What we know is that when we’re interacting with people who have been traumatized, we’re going to accidentally trigger them. We’re going to say the “wrong” thing. We’re going to be imperfect. The good news is that we can still be helpful – in a non-clinical or clinical way – if we’re willing to step into the space and try. We don’t have to be a therapist to learn more about Trauma Focused ACT.