ACT with Trauma: Natalie Glaser and Dr Russ Harris in conversation.
Welcome to another episode of 10 minute mode. Today, Sydney City Psychology founder and clinical psychologist, Natalie Glaser, speaks with Dr. Russ Harris. Russ as a medical practitioner and psychotherapist who is well-known for his work with acceptance and commitment therapy, also known as ACT. Russ has run over 800 workshops training in ACT. He has also authored numerous ACT textbooks. Enjoy.
Natalie: Hi
Russ: Russ. Hi Nat. Thanks for inviting
Natalie: me back. You are very welcome. Thank you very much for joining us on 10 Minute Mood. Today I thought we would take a dive into ACT with trauma. It seems to be a hot topic at the moment and I thought people might be interested in hearing from you about an ACT perspective on how we work with trauma.
Russ: It’s worth saying that in clinical practice when people go and see a therapist, counsellor, psychologist, or whatever, it’s very, very rare that someone rocks up with a neat presentation of PTSD, post-traumatic stress disorder.
That’s very rare. People usually present to therapy with other trauma related issues. Drugs, alcohol, sexual problems, relationship problems, interpersonal issues, depression, anxiety, and so forth. And often the kind of trauma history or trauma background is buried and only becomes apparent later.
I hear a lot of my clients asking me often, is this trauma? Is that trauma, does this count as trauma? So what are your thoughts on what trauma actually is?
A few years back, I wrote , a textbook Trauma Focused ACT, and I was looking through the research, trying to actually get a good definition of trauma in the research papers and the textbooks out there.
Russ: And it’s almost impossible to find one.
I would put it like this. A traumatic event is an event where there is actual or perceived great risk or threat to yourself, or to others. So it may be that you really are in danger – something terrible is about to happen or is happening, or it may be perceived. And significant risk to your health and wellbeing or of others.
So this may be physical or psychological or both. So that’s a traumatic event.
What happens then is that people have completely normal, natural, emotional and psychological responses to that traumatic event. You know, painful emotions and difficult thoughts and feelings and body reactions like a fight or flight response, or in very threatening situations, a sort of freeze shutdown response. And that’s a completely normal reaction to a traumatic event.
Natalie: What then creates a trauma related disorder is a third step, which is that people respond inflexibly to those normal, emotional, cognitive and psychological reactions to the traumatic event. People respond with fusion, experiential avoidance, loss of contact with the present moments, and these other responses that we can talk about.
So , there are a number of different ways that people can get help with trauma. If someone was going to see a mental health professional like a psychologist who uses Acceptance and Commitment Therapy, what would they be doing in those sessions?
Russ: Certainly from a therapist perspective, the question is, well, what happened? What kind of thoughts and feelings showed up? And how are you handling the thoughts and feelings that show up in response to this?
Natalie: You mentioned earlier the concepts of fusion and experiential avoidance.
Russ: Sure. Fusion is a jargonistic term really, meaning you are dominated by your thoughts, dominated by your cognition. By thoughts, I include images and memories.
They dominate your awareness, they dominate your actions. Usually in a manner that is problematic. So if you are worrying, ruminating, obsessing, catastrophizing, if you’re getting jerked around by beliefs like “I’m not good enough”, “I’m bad”, “the future is hopeless” – these are all examples of what we call fusion.
Your thoughts dominate your awareness. So it’s very hard to be present or focus on what you’re doing. They dominate your actions. They jerk you around like a puppet on a string. They pull you out of your life.
Another way that fusion presents is that you become dominated by very rigid rules.
You know, I have to do this and I mustn’t do that, and I have to do it this way, and I can’t do it that way. A good example is unhealthy perfectionism- “I have to do it perfectly and get it right, otherwise there’s no point doing it at all”.
Experiential avoidance is an offshoot of fusion.
If these difficult thoughts, feelings, emotions, memories, urges, sensations – we can call these things collectively private experiences -the stuff that shows up inside you that no one else knows about unless you share it with them. If you fuse with the idea that these thoughts and feelings are: bad, awful, horrible, unbearable, there’s something wrong with me for having them, I can’t have a good life unless I get rid of this stuff that’s showing up inside me… then what happens is you get pulled into an agenda of trying very hard to avoid and get rid of all that difficult stuff that’s showing up inside you. And that agenda of trying to get rid of unwanted thoughts and feelings is called experiential avoidance.
You’re trying to avoid those unwanted private experiences. And of course everybody is experientially avoidant to some degree. You know, everyone wants to feel good. No one wants to feel bad. We’ve all got zillions of ways of pushing away unwanted thoughts and feelings to get a bit of relief. And a little bit of experiential avoidance is not a problem at all.
But high levels of experiential avoidance are extremely toxic and pathological.
You are putting a lot of time and effort and energy into trying to avoid unwanted thoughts and feelings, as is commonly the place in trauma related disorders. Because obviously you don’t like these feelings, you don’t like these memories, you don’t like the thoughts that are associated with all of that trauma. Of course. It makes perfect sense that you try very hard to avoid and get rid of it.
But there are paradoxical effects with this.
Trying very hard to avoid and get rid of unwanted thoughts, feelings, emotions, memories has rebound effects. It doesn’t actually get rid of them. They come back with greater and greater frequency and intensity over time.
I often use the analogy that it’s like trying to hold a ball under the water. After a while your arm gets tired and when you release, you know, that ball just comes popping back up again to the surface, with a lot of energy.
Absolutely.
So the kind of double whammy of fusion and experiential avoidance basically turns normal emotional and cognitive reactions to traumatic events into a disorder.
And what an ACT therapist can do is basically give you new tools and techniques and strategies to take the power and impact out of all those difficult thoughts and feelings. So they no longer jerk you around and pull you into problematic or self-defeating patterns of behaviour.
Russ: It gives you a lot more freedom to choose the sorts of things you do with your time and energy. And what an ACT therapist can do is help you tune into your values, the sort of person you want to be, and how you want to treat yourself and others, and what you want to put out into the world. And use your values to guide your actions. So you do things that take you towards the sort of life that you want to build towards, the sorts of relationships that you want. Help you to make choices that improve your health and wellbeing, rather than the opposite.
Natalie: You mentioned in the beginning that it’s an understandable reaction. You know, when people are exposed to a traumatic event or a perceived traumatic event, they’re going to feel uncomfortable. It’s not that they have those feelings and thoughts, it’s how they respond to them.
Russ: Yeah, exactly.
One of the problems that we can find with trauma related disorders is that because people have been through such a severe trauma, or through repeated cumulative trauma, is that now they’ve got these fight, flight, and freeze responses over and over and over again. And the fight flight responses feed into anger and fear and anxiety and frustration and losing your temper. The freeze responses easily feed into apathy and lethargy and low mood and low motivation. What an ACT therapist would do would be to teach you skills so that you can recognize those reactions in yourself and do something to ensure that you can take control of your actions and your movements, and respond more effectively to the thoughts and feelings and emotions that show up in those states. So that you can act effectively and do things that help you build the life you want. Rather than just being jerked around by those basic nervous system reactions.
Natalie: I know in your work, and in mine, we’ve had great success in being able to support people to learn those skills. To live well with the difficulties that they’ve been through.
There is help out there. There is a lot that they can do to help themselves live the life that they want to
Russ: live.
It’s not easy. It’s not like there’s some quick fix. You snap your fingers and do a bit of positive thinking and it’s all done.
It is learning a whole new skillset. It’s learning a whole new set of psychological skills.
And like anything that requires practice. But if people are willing to invest time and energy and practice, these skills can make a huge difference to their life for sure. Yeah, it can.
Natalie: Absolutely.
And I know you’ve got some ACT with Trauma training coming up for clinicians.
Is that right?
Russ: My textbook is called Trauma-Focused ACT, and I run workshops in Trauma Focused ACT. I also have an online training in trauma focused ACT that people can access on psychwire.com
Natalie: If people haven’t experienced Russ’s training in person or online as yet, I highly and strongly encourage it.
They’re all brilliant. And thank you Russ, again, very much for your time. Yes, it’s lovely to see
Russ: you. Well, thank you. Thank you. Lovely to see you.
