Check out this conversation I have with two of the world’s leading experts on the use of Acceptance and Commitment Therapy (ACT) for the treatment of trauma. Manualized approaches of Cognitive Behavioral Therapy (CBT) such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are engineered to be effective treatments for PTSD. While post-traumatic stress disorder can have diverse presentations, there is an even greater diversity of trauma reactions one can have. Prolonged Exposure is great at treating people who have a conditioned fear response after traumatic event, but what about people who have a different type of presentation? Acceptance and Commitment Therapy is inherently a case conceptualization based approach. While there are techniques in ACT, it is process-based approach that is rooted in the functional analysis of the client. The emphasis is on workability and fostering flexibility. For the interested reader/listener, I recently did a Blog interview for Academy of Cognitive & Behavioral Therapies on the common myths and misconceptions about CBT for trauma. You can watch that here. Though it is important to note that comparing ACT for trauma with manualized therapies for PTSD such as Cognitive Processing Therapy and Prolong Exposure is essentially comparing apples and oranges. It would be erroneous to think of CBT for trauma as being only Prolonged Exposure or Cognitive Processing Therapy. From its inception CBT was designed to be a case conceptualization based approach. Manualized protocols for specific conditions do exist and are important tools, but these tools are representations of the therapy and not the therapy itself. To learn more about how to create a good case conceptualization based approach to CBT, our Socratic questioning book has and elaborated section focusing on developing a good case conceptualization. And Scott Temple and Trent Codd wrote a fantastic book on a transdiagnostic and integrative approach to holistic CBT care. In this conversation, we talk about Robyn’s new book from Guilford You are Not Your Trauma which is a fantastic read and great clinical recommendation for anyone trying to incorporate elements of Acceptance and Commitment Therapy in the treatment of the effects of trauma. This conversation features Dr. Scott Waltman, Dr. Robyn Walser, and Dr. Carmella Tress discussing trauma, Acceptance and Commitment Therapy (ACT), and the nuances of clinical work. We cover some key themes: Trauma is often viewed through the narrow lens of PTSD criteria, which can exclude many individuals who have experienced significant life-altering events, such as racial trauma or ongoing harassment. They emphasize that trauma is not always a discrete event, and individuals can suffer significant impact without meeting traditional “Criterion A” diagnostic standards. Dr. Walser explains that ACT is a principle-based, transdiagnostic approach that focuses on increasing psychological flexibility. Rather than attempting to “fix” specific symptoms, ACT addresses how a person’s learning history impacts their current functioning and aims to reduce rigid avoidance behaviors that restrict a meaningful life. Dr. Tress highlights that trauma can cause individuals to fuse with their experiences, leading to a narrowed sense of identity. Both experts stress the importance of helping clients see they are not their trauma, and that they can hold painful memories while still living a life guided by their values. We expresses concern regarding the “dilution of innovation,” where clinicians may use techniques from ACT or CBT without understanding the underlying model. We warn that in the treatment of trauma, clinicians can engage in emotional avoidance, and that this can stem from a clinician’s own avoidance of painful material, leading to the use of shallow control strategies rather than genuine, compassionate engagement with the client’s process. Contrary to misconceptions, ACT does engage with cognitions as part of a behavioral model. Cognitions are viewed as behaviors and instead of attempting to restructure or repair thoughts, the goal is to help clients increase awareness and focus on deliberate actions. The goal is workability. ACT for trauma may also include exposure to trauma narration if there is a high level of avoidance going on. Exposure if after all highly ACT compatible, even if the way it is done might be slightly different from an ACT provider. The heart of the work, according to Dr. Walser, is cultivating flexibility to move through life even when faced with challenges. This involves recognizing that avoidance—while sometimes temporarily useful—often leads to a “numbed” existence; by being willing to experience the full range of emotions, clients can open themselves back up to joy and meaning. The conversation concludes with Dr. Walser sharing her new YouTube channel, which features short videos designed to complement her book, You Are Not Your Trauma. Check out these resources: This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit socraticmethodcbt.substack.com
