Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems

by Victoria M. Follette, Jacqueline Pistorello

If you've experienced trauma—whether as a result of common life events like accidents or abusive personal relationships or extraordinary experiences like war or natural disasters—you may find that the pain and emotional unease you feel don't go away over time. In fact, they may get worse. But the trauma you experienced lies in the unchangeable past. Because of your strength and perseverance, you survived, and now the rest of your life stretches before you. How do you want to live it? Finding Life Beyond Trauma is about living life well after a traumatic event. It uses the powerful techniques of acceptance and commitment therapy (ACT) to help you take a different approach to painful feelings and chart a new course for a rich and meaningful life. First, you'll learn to accept the pain, sadness, and anxiety that can arise in connection to your trauma. By exploring mindfulness techniques, you'll be able to remain present with painful feelings and stop avoiding the thoughts and situations that bring them up. Instead of focusing on the past, you'll clarify what you want your life to be about right now and in the future. With your values clearly in mind, commit to actions that will express them in your life—guided by the powerful tools you'll find in this book.

Genres: Self Help, Mental Health, Nonfiction, Psychology, Ebooks, Social Work

265 pages, Paperback

First published June 1, 2007

Reviews

[Jeremy · Rating 3 out of 5]

Big Ideas:

+ Trauma MYTHS
- Traumatic experiences are uncommon
- If people were just stronger, they could get over trauma
- Every trauma survivor will need therapy
- Traumatic experiences mainly happen to women
- Men are rarely victims of sexual trauma
- The media exaggerate the frequency of trauma
- Abuse only happens in poor families
- Posttraumatic stress disorder is rare among military men and women
- Only really severely distressed people would benefit from help
- We have become a society of victims


+ Trauma stats
- Some studies estimate the prevalence of trauma in adults as high as 70% (Breslau 2002) (13)
- The rate of PTSD in the general population is estimated to be 8% (Kessler et al. 1995) (19)
- 4 to 16% of boys experience sexual trauma (Dong et al. 2003) (13)
- About one-third of individuals who develop PTSD do not recover from the trauma on their own (Kessler et al. 1995)


+ Trauma writing/narrative guidelines from James Pennebaker’s Writing to Heal (2004):
- Write 20 minutes per day (it’s okay to write more, but don’t exceed 40 minutes the first day)
- Write every day for 4 days in a row
- Write continuously for all 20 minutes; if you run out of new things to say, it’s okay to repeat things
- Write for yourself, not in letter format and with no intention to show the writing to anyone else
- Start with a low to medium intensity experience, not the highest intensity experience; pick something you are fully willing to write about now
- Begin now, and use the following questions to rate your writing each day after you have finished, using a scale of 1 to 100: 1. To what degree did you express your deepest thoughts and feelings? 2. To what degree are you having intense feelings? 3. To what degree was today’s writing valuable and meaningful for you?
- If this process is useful, you can repeat it for other experiencing, writing about each one for 4 days; if not useful, let it go and discontinue


+ Creative hopelessness
- The nature of internal pain is to come and go of its own accord (72)
- History and memory, like language, are additive, not subtractive (you can’t subtract the fact that 2+2=4 once you’ve learned it) (73)
- “Pain can help us to see new things in ourselves and in the world.” (85)


+ Experiential avoidance
- “If you can’t allow yourself to experience negative emotions and end up blocking them, then you will most likely block many of your positive emotions, too.” (34)
- “Most long-term outcomes of trauma, such as substance abuse, depression, suicidality, self-harming behaviors, and problems with relationships often arise as a result of efforts to try not to have feelings, memories, or thoughts associated with the trauma.” (87)


+ Willingness/Acceptance
- … is not appropriate or necessary for every situation, only when you choose it and when it helps you pursue something you value. In some situations, listening to discomfort and acting on it is key to survival (101)
- … is all or none, like jumping off a book or chair (101)
- … is an action, not a feeling (100)
- “What are you willing and able to do in your life in order to have the life you value?” (141)
- “Is whatever you do in response to these passengers working for you? If it isn’t, would you be 100 percent willing to do something different, even if it means making room for the possibility that several uncomfortable passengers yell at you while you drive the bus?” (202)


+ Defusion
- Repeating problematic words out loud for 45 seconds
- Labeling thoughts as evaluations/judgments (subjective) and identifying a description (objective) that gives more information
- Find positive and negative evaluations for anything or anyone to show this can be arbitrarily done for anything
- Use AND instead of BUT (“Emotions and thoughts are not causes of our behavior, but rather co-occurring events.”) (131)
- I’m having the feeling of… I’m having the thought that…
- Replace “want to” with “willing to” (eg. “I am having the feeling of fear AND I’m willing to go to the store” rather than “I want to go to the store but I’m afraid”) (132)
- Speak of your mind as a separate entity
- Self-compassion is a leap of faith. “If it is based on reasons, it becomes about a story to defend instead of an opening to experience.” (137)
- Flexibly decide when to focus on workability rather than “right” and “wrong” (you can be right and miserable) (139)
- Flexibly decide when to focus on response-ability rather than blame (141)
- “Spending a lot of time worrying about the possibility of experiencing another trauma does not actually make us any safer in the long run. Instead, being immersed in our thoughts and out of contact with our environment may actually increase our risk. Additionally, living a very restricted life in the service of safety may keep us from pursuing valued goals”


+ Observing self
- “If you are overly committed to all the ways that you are good, you will be reminded at the same time of the ways in which you consider yourself to be bad.” (149)
- “There is a you there who is noticing that you are noticing.” (153)


+ Values
- “The reason to be present with your feelings is that by doing so, you have a better chance at creating a more meaningful life.” (166)
- “What if I only had one year to live? What, if anything, would I do differently?” (166)
- … “are chosen life directions… they are not right or wrong. They don’t need to be explained, defended, or argued about. They are not goals. They are not feelings. They are not what others want from you; they are what you want for yourself… They are not another reason for beating yourself up… Values are continuous; they are more about process than outcome. Values can give dignity and meaning to your life, even when the desired outcome is not reached… Although it might seem a trivial example, choosing your values is almost like choosing a favorite color… This is a subjective choice. It does not have to be defended.” (167-8) “True values feel invigorating and empowering (albeit sometimes very challenging).” (204)
- What do you want your life to be about? (“If nobody knew what you chose to pursue in your life and there were no internal barriers, such as fear or lack of confidence, what would you really want your life to stand for?”) (171)
- “Feelings cannot always be trusted to tell you the truth. Pay attention to them, but hold them lightly.” (170-1)
- Consider whether identified values are intrinsic or extrinsic (Exercise 8.2)
- “If only” statements often reveal underlying values (185)


+ Committed Action
- Persistence matters, change rarely happens in one try
- Public commitments help with accountability, even if just made to one other person
- Pick small and easy to measure goals
- Track/measure what you are doing
- Establish a larger pattern of “try to change, fail, and then try again” (193)
- If you keep breaking commitments, take a look at your values and see if the actions you have chosen are really not that important to you (aren’t really based on your true intrinsic values) (204)
- “There is dignity, self-respect, and vitality in living a valued life - even if the outcome is not what we had hoped for.” (205)
- As much as possible, “find the kernel of an internal barrier in the external barrier.” (210)


+ Forgiveness
- “We do not believe that trauma survivors always have to forgive other people… In ACT, we do look to forgiveness as a strategy when people seem stuck in inaction.” (214)


+ ACT vs. CBT
- Some therapy techniques “invite you to replace negative thoughts with positive ones... In ACT, and mindfulness in general, this is not considered helpful because the actual content of your passengers is not as important as the process of not getting hooked by the passengers on the bus.” (105)
- Rather than refer to thoughts as “positive” or “negative,” ACT uses the terms positively evaluated and negatively evaluated
- “If you find yourself following the passenger that says, ‘You’re the greatest’ now, chances are you’ll heed the passenger that says, ‘You’ll never amount to anything’ later.” (106)
- “In ACT, instead of changing what you experience (thoughts, feelings, memories), we focus on changing how you experience them.” (121)



Potent Quotables:

“The mystery of life is not a problem to be solved, but a reality to be experienced.” Zen saying

Being resilient does not mean that the trauma is not difficult and upsetting or that it doesn’t impact you… it simply means that despite these obstacles, you are willing and able to move forward in your life. (12)

[lyle · Rating 3 out of 5]

“Let’s imagine the following scenario. We come to you and say, “Guess what? We have a million dollars to give to you if you can perform one task. All you have to do to get the million is to remember the three letters we mention. We will repeat them only three times, and you will need to remember them—and then we’ll give you a million dollars! Are you ready? Are you completely ready to hear these three letters that may make a difference in your finances forever? Here are the letters: a, b, c. The letters are a, b, and c.” What are the letters? Can you say them aloud? Can you recall them? The letters are a, b, c. Now, what are the letters? Can you say them aloud? Now, if we come to you in an hour and ask you to repeat these letters, do you think you’ll remember them? What about in a day? What about in a week? What are the letters? Now let’s try a different experiment. As you can well imagine, we do not actually have one million dollars to give you. It was a trick. So, we will now make a different request of you: Whatever you do, do not think of the letters we just told you. What are the letters? What did your mind come up with? Check and see, even if you wrote out different letters than the ones we talked about before. How do you know that these aren’t those letters? You do because, in your mind, you are saying, for example “d, e, and f are not a, b, and c,” which means that in your mind the thought of “The letters are a, b, c” is still there. Try really, really, really hard not to think of the letters as a, b, c. Can you honestly do it? Probably not, right? Isn’t this interesting? After something gets into our heads, it hardly ever gets out when we are trying to get it out. It’s easy enough to inadvertently forget what we learn in class or something on our to-do list; however, the very attempt to try to forget something makes it more memorable (Wegner 1994). So, there is no way of displacing the thought “The letters are a, b, and c” with other thoughts such as “The letters are now d, e, and f” or “I should forget the letters a, b, and c.” When you try, you simply end up with three thoughts in your head about the letters a, b, and c. We can only add more things to our brains; we’re unable to deliberately take anything out. It just can’t be done.”

“It is important that we come back to the idea of avoidance again and how it can sometimes lead to more problems. If you have experienced a traumatic event, you may have a thought like “There must be something wrong with me; these things don’t happen to other people that I know.” In ACT, we take the approach that:

There is nothing wrong with you.
You are a complete person who has everything you need to lead a complete and full life.
You are not broken.
You do not need to be fixed.

What you may need is to learn or relearn skills that can help keep you safe, with mindfulness as a foundation. We choose to call the strategies discussed in this chapter skills because we believe that they are not things that most of us are simply born with but instead things that we learn over the course of our development. As we pointed out in chapter 2, some of us may never have had the opportunity to learn these skills for reasons that were out of our control. For example, if you grew up in a home where you were neglected, ignored, or abused, you may not have learned some of these skills. Or, you may have grown up in a family that simply didn’t emphasize or teach you these skills. Or, you may have been in family or social environments that taught you other behaviors that took their place, such as ignoring your feelings, substance use, isolation, or some other form of avoidance. This latter situation is often the case in abusive or alcoholic families, but it happens in other families as well. While you are not to blame for things that happened to you in the past, you have the ability to respond (response-ability) now in the most effective way to help empower you to live your life fully.”

[Julia · Rating 3 out of 5]

I can't remember when I read this...sometime last year, I think. This book hasn't altered my clinical work dramatically, I would say, since the connections between ACT and trauma in my mind were already pretty clear, but it's a nice workbook for patients and I do use it regularly. I wish there was a little more data on ACT for trauma, but I think it'll trickle in over time. The main thing I wish the author attended to with a bit more care is how to do mindfulness-based work with people who really struggle with hyperarousal and/or dissociation.

[Ashley Hamm · Rating 3 out of 5]

As a therapist, I’d recommend this book to someone who has done some trauma healing work and exploration already - I think it doesn’t have enough focus on the way trauma can affect your automatic responses (like hypervigilance, dissociation, nightmares, etc.) I think it has a lot of great info on on getting unstuck and moving forward after trauma, such as identifying your values, moving past self-shaming, and improving relationships.

[nks · Rating 3 out of 5]

Though I initially picked up this book in order to learn some things about a character I am writing, it ended up having a lot of interesting insights into the human mind that I think almost anyone could find helpful. A little slow at times, but easy to follow and understand.

[M]

Time will tell if I ever get through this one... but I have positive feedback for the sections I have worked through so far.

[T · Rating 1 out of 5]

This workbook is very poorly written and unhelpful. It was sexist, used outdated language, was patronizing and unsympathetic to those who’ve experienced trauma. Despite three honest tries, I could not continue using it.

[Vee · Rating 5 out of 5]

Excellent resource. Learned a lot while going through this book. Definitely recommend.

[Kavish · Rating 4 out of 5]

Good book to learn ACT especially the exercises.