How Acceptance and Commitment Therapy Helps with Posttraumatic Stress
“As courage imperils life, fear protects it.” —Leonardo da Vinci
Da Vinci’s sentiment might not sound helpful to you. It doesn’t to me. In my view, courage expands life and fear shrinks it. But this isn’t how everyone sees it. At some point in their lives, about 25 million Americans (roughly 4 million more than the population of Florida) will experience posttraumatic stress (PTSD), and for them, fear may feel like a reasonable and necessary part of everyday life.
Posttraumatic stress can occur after exposure to an upsetting or frightening event such as actual or threatened death, serious injury, sexual violence, or a prolonged distressing experience. The emotional, behavioral, and psychological effects of posttraumatic stress can include depression, anxiety, sleep problems, and suicidality. Because of the debilitating impact of posttraumatic stress, some people are unable to work or engage in productive lives. Friendships and physical health can also suffer.
Posttraumatic symptoms can include the following:
- Distressing memories and dreams
- Flashbacks or feelings of detachment
- Intense psychological distress
- Physical reactions
- Excessive avoidance of or efforts to avoid distressing memories, feelings, thoughts, people, places, and events regarding or associated with the trauma event
- Distorted thoughts
- Fear, anger, sadness, disbelief, shame, horror, irritability
- Recklessness and self-destructive behavior
- Hypervigilance
- Sleep disturbances
People respond in different ways to these symptoms, and some recover more quickly than others. Effective coping methods are predictive of better outcomes. One method of coping is known as acceptance and commitment therapy (ACT).
Acceptance and commitment therapy involves taking action toward values with an acceptance of increased emotional and sometimes physical pain. ACT methods help improve mindful awareness of the present moment and of emotional pain, distorted thinking, and physiological distress. The six ACT domains include the following:
Present Moment
Posttraumatic stress symptoms can lead to excessive worry about the future or regret or sadness about the past. When we are caught in the past, we can get stuck on what is gone or unfixable. When focused on the fortune telling of the future, we can get stuck jumping to conclusions. Through engagement of one’s senses into the here and now, mindful awareness of the present moment helps mitigate these cognitive distortions.
Try it. Take a moment to feel your feet in your shoes or your clothes on your body. Notice the space between where the cloth meets the skin and focus in. Try to really feel your way through the moment. When you shifted focus, you may have experienced a softening of your thoughts.
Breath is also an important part of present-moment awareness. PTSD symptoms often involve an increased alertness and fight-or-flight responses. Using controlled and relaxed breathing techniques, the startle symptoms can be decreased and even stopped.
Identification of Values
One of the challenges of posttraumatic stress is the decreased connection with meaning. The emotional and physical hurt that results from the trauma can feel meaningless, and individuals dealing with PTSD often report the pain as pointless and cruel.
It is not uncommon to feel disconnected from one’s values following traumatic events. When we lose touch with the importance of our lives, including our role as parent, employee, or partner, we lose reason to push on. Viktor Frankl, in his seminal work Man’s Search for Meaning, put it best: “The man who knows the why of his life can bear any how.” Our “why” is defined through an examination of our values. Soldiers returning from combat may benefit from remembering they value being a teacher to their children. Teachers who fear returning to work could experience greater confidence if connected to the value of being a leader in their profession.
Commitment to Action
Values are maintained not in the mind, gut, or heart, but through action. A value is best felt through verbs and events. When a person is engaged in the event, it is sufficient to say they are living in their values. Value for physical health is evident in consistent attendance at the local gym. Value for music is witnessed not through a dream of becoming a famous musician, but through daily commitment to practicing on the piano.
When a person is dealing with posttraumatic stress, it is important to commit to actions to help them move toward their value. If a father finds it hard to appreciate his family because he can’t stop thinking about combat, he must put his energy into events that foster familial closeness, such as spending time with his children and taking his partner to dinner. After all, before the trauma, these were the events that gave life meaning and purpose.
Self-Observation
One of the hardest parts of dealing with posttraumatic stress is the constant bombardment of physical and emotional stress. The body is in a persistent state of alert, which can take a toll. For this reason, many individuals dealing with PTSD feel they are “broken” or “weak.” They may feel guilty about their inability to “beat” the symptoms.
An important skill in managing PTSD symptoms involves recognizing the mind and body are not you.
An important skill in managing PTSD symptoms involves recognizing the mind and body are not you. When we are able to step away from our cognitive and physical experiences, we become more compassionate and open to ourselves.
If our body is setting off alarms due to fears of bombs, death, or whatever, we would benefit from mentally looking at the body and noticing its sensations without judgment, because our experiences—both internal and external—do not have to be defined, only felt. This is not an easy process, but for the person dealing with posttraumatic stress, observing the self with curiosity and openness is an important step toward recovery.
Cognitive Defusion
Anyone who has gone through a frightening moment knows what inner turmoil feels like. It is hard to stop thinking about the stressful event. We replay the event in our head over and over again. The lover’s betrayal, the results of an important physical exam, or a lost puppy can all cause us to obsess. So what do we do?
Instead of trying to avoid the thought or find a better one, allow the thought to exist without taking ownership of it. Posttraumatic stress and negative thinking go hand-in-hand. If the mother is to reengage with her family or the police officer is to go back to work, they will likely have to do so with negative thoughts in their heads. By defusing from thoughts, we do two things. First, we disconnect from their truth. And second, we take away their power.
Acceptance
As light comes from heat and heat from pressure and friction, so does growth come from pain. Posttraumatic stress requires that the person exposes themselves to the unwanted distress. By facing fear, we allow our mind to create new, healthier symbols and definitions of what the fear represents. For this reason, we need to be willing to feel distress when moving toward our values.
Posttraumatic stress is a challenging condition to overcome. But like anything in life, it can and is overcome daily by people just like you and me. It starts with believing in yourself and remembering there is nothing wrong with being human. The part of us all that overcomes challenges is available to us every day. Humans are wonderfully adaptable. So take these skills and if you need them or someone you know could benefit from them, share them. The life we live is here and now, and if we trust movement and commit to what is important, then the valued future we seek is just a moment away.
If you want support in healing from posttraumatic stress, contact a licensed therapist who is trained in acceptance and commitment therapy.
References:
- American Psychiatric Association. (2013). Diagnostic and statisticalmanual of mental disorders (5th ed., text rev.). Washington, DC: Author.
- Frankl, V. (1984). Man’s search for meaning: An introduction to logotherapy. New York: Simon & Schuster.
- Hayes, S., & Strosahl, K. (2004). A practical guide to acceptance and commitment therapy. New York, NY: Springer.