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Posttraumatic stress disorder (PTSD) is used to describe a group of symptoms that may develop after someone is exposed to a traumatic experience, although many people may have multiple traumatic experiences. Of the three main groups of symptoms associated with PTSD, research suggests that avoidance of reminders and memories of the trauma is the most characteristic. Examples of avoidance include efforts to avoid experiences related to the trauma, having little interest in things that someone may have previously enjoyed, feeling detached, and feeling flat and unemotional. Research has found that avoidance is a better predictor of PTSD symptoms than trauma severity (Plumb, Orsillo, & Luterek, 2004).

In Acceptance and Commitment Therapy (ACT), an experiential treatment with a growing research base that falls within the cognitive-behavioral tradition, the term experiential avoidance is used as an umbrella term that includes various types of avoidance, including those related to PTSD. Experiential avoidance refers to attempts to avoid or alter painful unpleasant experiences, such as a thoughts, emotions, and bodily sensations. For people with PTSD, avoidance strategies may help to alleviate distress in the short-term but can cause long-term problems, such as through substance use and withdrawing from friends and family. Following trauma, avoidance strategies may initially be focused on activities and experiences that remind the trauma survivor of or are connected to the individual’s trauma; however, these strategies may be applied over time to non-trauma related events (Varra & Follette, 2005). By persistently engaging in avoidance, individuals with PTSD learn to associate safe situations with danger. A common metaphor used in ACT is feeding a tiger. We may begin to avoid little things to appease a growling tiger cub, but the more we avoid, the more we “feed” the cub until it grows into a big, snarling, scary tiger!

For these reasons, gold-standard PTSD treatments such as a Prolonged Exposure target avoidance. Through structured exercises that are developed collaboratively with clients, individuals with PTSD begin to learn that if they stay in a situation long enough, their distress may subside, and they may begin to once again experience it as safe. Gradually, trauma survivors claim their lives back. More recently, there is a small but growing literature on the use of Acceptance and Commitment Therapy in the treatment of trauma and PTSD (Batten & Hayes, 2005; Twohig, 2008; Walser & Westrup, 2007). ACT specifically targets experiential avoidance and teaches skills for learning to engage one’s life more flexibly and adaptively in order to live a meaningful existence. Trauma survivors stop “feeding the tiger” by letting go of avoidance as a coping strategy. Through safe, experiential exercises, trauma survivors begin to understand how their minds tell them there is danger when there is none. With this understanding, trauma survivors learn to strive towards goals that make their lives worth living, rather than pouring more energy into ineffective avoidance.

For more information about PTSD treatment and/or ACT, feel free to visit my website: http://www.portlandtraumatreatment.com

References

Batten, S. V., & Hayes, S. C. (2005). Acceptance and commitment therapy in the treatment of comorbid substance abuse and post-traumatic stress disorder: a case study. Clinical Case Studies, 4(3), 246.

Plumb, J. C., Orsillo, S. M., & Luterek, J. A. (2004). A preliminary test of the role of experiential avoidance in post-event functioning. Journal of Behavior Therapy and Experimental Psychiatry, 35, 245-257.

Twohig, M. P. (2009). Acceptance and Commitment Therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice, 16(3), 243-252.

Varra, A. A., & Follette, V. M. (2005). ACT with posttraumatic stress disorder. In S.C. Hayes & K. D. Strosahl (Eds.), A practical guide to acceptance and commitment therapy (pp. 133-152). New York: Springer Science + Business Media.

Walser, R. D., & Westrup, D. (2007). Acceptance and Commitment Therapy for the treatment of post-traumatic stress disorder and trauma-related problems: A practitioner's guide to using mindfulness & acceptance strategies. Oakland, CA: New Harbinger.