Acceptance and Commitment Therapy (ACT) for PTSD

sad man in therapy going through acceptance and commitment therapy
Getty/Photographer's choice/Peter Dazeley

A number of people have had success in using Acceptance and Commitment Therapy (ACT) for posttraumatic stress disorder (PTSD). If you are struggling with symptoms of PTSD, ACT for PTSD may be helpful. Learn about why this therapy can help and the five goals of treatment.

The Rationale Behind Acceptance and Commitment Therapy for PTSD

From an early age, we learn to label some feelings as bad and others as good. For example, sadness and anxiety are viewed as bad or negative emotions and happiness and joy as good or positive ones.

It's understandable, then, that we try to have a few painful feelings, and as many positive ones, as possible. In particular, when we feel emotional pain, we tend to try to get away from it, but this form of avoidance usually doesn't work well in the long run.

Avoidance doesn't work because emotional pain is a part of life. We can't really avoid it. Everyone at some point or another has painful feelings such as sadness, anxiety, or anger. 

How we choose to respond to painful feelings can be the difference between getting through the pain or keeping it going and making it worse.

In fact, trying to avoid or escape painful thoughts and feelings may be what leads to suffering and psychological disorders. For example, a person who's lived through a traumatic event may be constantly flooded by memories of the trauma as well as by anxiety and fear.

As a result, the person may try to get temporary relief through drugs or alcohol (self-medicating.) That may work in the short run, but in the long run, the alcohol or drugs will do nothing to relieve the pain. Instead, the pain is likely to get worse—and introduce a host of other problems.

What Can Be Done?

ACT is a behavioral treatment based on the idea that suffering comes not from feeling emotional pain but from our attempts to avoid that pain. ACT is used to treat PTSD and other mental health disorders.

The overall goal of ACT is to help people be both open and willing to experience their inner feelings while they focus attention, not on trying to escape or avoid pain (because this is impossible), but on living a meaningful life.

5 Goals of Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) for PTSD and other mental health disorders can be broken down into five goals. If you choose to have this therapy and pursue these goals, here's what you can expect to learn and achieve:

Recognizing That Trying to Escape Emotional Pain Will Never Work

ACT therapists call this goal creative hopelessness. It's met when you see that all the things you've been trying to do to avoid emotional pain do not work, and there will probably never be an effective way of completely removing emotional pain from your life.

Understanding That Control Is the Problem

A second goal of ACT is your understanding that your problems come not from the emotional pain itself but from your attempts to control or avoid it. In fact, from your ACT for PTSD, you may learn that trying to control emotional pain has the opposite effect: Besides potentially making the pain worse, you may spend so much time and energy trying to avoid it that you have none left for pursuing positive things in your life.

Viewing yourself as Separate From Your Thoughts

Our thoughts are very believable. A person who has experienced a traumatic event may have thoughts of being a bad person or "broken" or "damaged." However, although these thoughts may feel true, they are only thoughts. They are not a reflection of what is really true.

A third goal in ACT for PTSD is for people to learn to "take a step back" from their thoughts and not buy into them as truth. A thought is just a thought. It is not a reflection of who the person really is.

Stopping the Struggle

During your ACT for PTSD, you'll be encouraged to stop your tug-of-war with your thoughts and feelings. The goal is to let go of attempts to avoid or control your thoughts and feelings and, instead, to practice being both open and willing to experience thoughts and feelings for what they are and not what you think they are (for example, bad or dangerous).

Committing to Action

Avoiding emotional pain requires a huge amount of energy for people with PTSD. It can consume your life. As a result, you may not be placing much time or energy into living a meaningful and rewarding life. Therefore, the final goal of your ACT for PTSD is identifying areas of importance in your life (referred to as "values" in ACT) and increasing the time you spend doing things that are consistent with those values, no matter what emotions or thoughts may arise.

For example, a person who has experienced a sexual assault may fear or feel anxious about getting into relationships again, despite valuing closeness and intimacy.

In ACT, people are encouraged to engage in actions consistent with their values (for example, reconnecting with an old friend) while being open and willing to feel any anxiety that may arise as a result.

Not avoiding that anxiety keeps it from getting worse, and it will be less likely to get in the way of the person's pursuit of a meaningful life.

Choosing ACT Therapy for Your PTSD

Many therapists now specialize in ACT therapy (see below) but there are other methods of pursuing this therapy as well. From primary care clinics to day-long group workshops, to smartphone applications and telehealth options, there are many ways in which people with PTSD can pursue acceptance and commitment therapy.

Where Can I Learn More About ACT?

ACT has been found to be helpful for a number of people suffering from psychiatric disorders and is gaining in popularity. You can learn more about ACT, as well as therapists who specialize in ACT in your area, at the Association for Contextual Behavioral Science's website.

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By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.