By Erika Fiorenza, Clinical Psychologist
Psychological distress is considered a normal and natural reaction to trauma. However, a small proportion of trauma survivors may go on to develop trauma associated disorders which have a significant impact on their functioning and quality of life. Individuals with Post Traumatic Stress Disorder (PTSD) often struggle with painful and unwanted memories, thoughts and feelings. They may, quite naturally, spend a lot of energy on avoiding or escaping these painful private experiences and situations or cues related to the trauma (Walser & Hayes, 2006). This avoidance is considered to be a core psychological process in both the development and maintenance of PTSD (Orsillo & Batten, 2005).
Acceptance and Commitment Therapy (ACT) is a behaviourally based and empirically validated intervention that is well suited to the treatment of PTSD. It targets decreasing experiential avoidance, including unwanted feelings, thoughts or memories, while increasing acceptance of these painful experiences in order to move in a valued direction.
Dr Robyn Walser, a leading expert on the use of ACT for PTSD, was recently in Australia conducting her training workshops. She highlights the paradox that can occur following a trauma. As clients do everything to avoid all the things related to the trauma, the trauma is always present. As such, the past becomes their future (Walser & Westrup, 2007). As she succinctly puts it: If you don’t want it, you’ve got it.
Dr Walser differentiates pain from suffering. She explains that it is the judgement, evaluation and avoidance of the pain that leads to suffering. “It is in this place that suffering occurs and grows” (Walser & Westrup, 2007).
ACT focuses on helping clients shift from a position of avoidance to one of acceptance and willingness. Acceptance can be defined as openness to internal experiences. To “willingly take what is offered… without protest or reaction” (Walser & Westrup, 2007). Acceptance does not suggest that the trauma was ‘okay’, but teaches an alternative to the usual response to pain by reducing the struggle with it.
Clients are taught to “decrease suffering by showing up to the natural response and letting it be what it is: a thought, a feeling, a memory…it is not a diminishing of experience, but a presence to and acknowledgement of it – a gentle observing” (Robyn D. Walser, 2015).
In the treatment of PTSD acceptance further suggests that individuals are more than their experience of the trauma. We are beings who experience, not beings who are the experienced (Robyn D. Walser, 2015). This position of acceptance helps broaden a survivor’s range of responses so that other meaningful outcomes can be pursued.
In ACT, acceptance is taught through a variety of mindfulness skills. Mindfulness creates a place from which acceptance is possible (Walser & Westrup, 2007). Mindfulness teaches clients to be aware in the moment, and be present to ongoing experiences. This is particularly relevant to individuals with PTSD who can be caught in the past, or worrying about the future.
Through mindfulness and acceptance, clients are taught to connect with their sense of self and move forward in the direction of their values. This is a crucial next step in acceptance as it emphasises taking action in the presence of painful and unwanted private experiences.
For more information on Erika and the team of Psychologists at Psychology Consultants, visit www.psychologyconsultants.com.au
Orsillo, S.M. & Batten, S.V., (2005). Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder. Behaviour Modification, 95, 95-129
Robyn. D. Walser http://www.tlconsultationservices.com
Walser, R.D. & Hayes, (2006), Acceptance and Commitment Therapy in the Treatment of Posttraumatic Stress Disorder. In V.M. Follette & J. I. Ruzek (eds.), Cognitive Behavioural Therapies Trauma. Guildford Press: New York
Walser, R. D. & Westrup, D., (2007). Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems. New Harbinger: Oakland, CA.
By Erika Fiorenza, Clinical Psychologist