Treating Trauma with Contextual Behavioral Therapy

I remember the first time I was introduced to Acceptance Commitment Therapy (ACT). I do not remember really being taught about it in school. I read it and, on the name alone, thought, “sign me up!”  The idea that it was okay to feel what was going on, discuss the feelings, and to learn how to work through those feelings made so much sense to me. Working with trauma for most of my career, I thought this could be something I could incorporate into my daily life. 

A major part of what drew me to these interventions was the idea of acceptance. That word is such a huge thing to include because at this point, we are learning so much about how the brain works and have only scratched at the surface.

Dialectical Behavior Therapy (DBT) was something I had learned in school. I felt like the idea was great, DBT works to change thought processes through mindfulness, acceptance, and emotional regulation, but it was too rigid with specific rules and pathways. Due to these strict rules, I felt DBT was missing something that I could use in my practice. I had always gotten ACT as an idea and concept, although in practice it often involved clinicians being passive. On the other hand, DBT was too rigid and required accountability.

I was fortunate enough to participate in a fellowship through University of Chicago and Paul Holmes where I learned about Contextual Behavior Therapy (CBT). This is a third wave of intervention that works to combine both DBT and ACT. For me as a clinician, CBT revealed new opportunities.    

Often, in traditional therapy, the emotions related to trauma are overlooked. It becomes more about oversimplifying one’s struggles, i.e. don’t be in an abusive relationship, control flashbacks and triggers. CBT focuses on just not thinking a certain way, it involves work to do and tries to change that thinking. The combination of ACT and DBT works more to accept those thoughts and work on how to identify or improve them. This is different since it does not put the blame on one’s thoughts but works to identify how the thoughts work. 

Traditional talk therapy also involves focusing on the trauma in detail. While it is important to understand the trauma, it is also important not to retraumatize. This is the importance of working and practicing mindfulness together.

Treating trauma with act and dbt

Trauma can is it change a person, from how one perceives the world to their relationships. With the combination of ACT and DBT, those changes are examined. The reasons for flashbacks and triggers are examined, as well as their choices are examined through a safe and nonjudgmental lens. The combination of those two modalities lends a more balanced approach.   

Trauma can lead to uncertainty, the person experiencing the trauma may not be able to trust others or may feel like they cannot trust themselves. Trauma survivors who do not trust themselves may not listen to their body. This is a protective defense since they feel the one time they were able to trust themselves; something bad happened. Not listening and trusting themselves is their way to protect themselves from another traumatic experience. Although this strategy may appear effective, however it can also lead to many problems. For example, when things go wrong, which is a part of life, they lack the tools and resources to handle the problem. They also protect themselves so much that they miss out on experiences or relationships. In my practice, I have found that the combination of ACT and DBT truly concentrates on listening to your body.

With the use of a combination of ACT and DBT, I have been able to talk to clients about their trauma, discussing how it is affecting them and where it is felt both physically and mentally. We also spend a lot of time discussing the safety and changes that have occurred in order to explain that the situation does not have to repeat itself. Our eventual goal is the ability to be present. I have had clients who discuss how they have a new joy in their “self-care” because they no longer view it as “I’m supposed to be doing this,” but instead “I like this.”  

I also incorporate mindfulness, particularly focusing on the tools and the words each person uses, into my practice, which is key for trauma survivors. The nature of trauma is that the person experiencing it loses control over a situation and mindfulness involves regaining control. Clients are empowered by working with their clinician to gain control. It is natural for all humans to play the “What if” game after experiencing trauma, to think about all the things we could have done differently, the signs we could have or should have seen. What we can do with the use of this of treatments to address the truth: nothing can change the past. Using these tools, the focus turns to realize that the past cannot be changed, but the future is still open. This allows the clinician and client to concentrate on accepting current situations and working towards being the best version of oneself now, while realizing that the future is still undecided and filled with possibility. 

Trauma happens to all of us as part of the natural circle of life. It is completely normal to spend time in the space of wondering what could have been done differently. The key to effective therapy for trauma survivors is not going through the sordid details, but of acknowledging the feelings, rephrasing thoughts, and focusing on the present. The combination of ACT and DBT allows for openness working with trauma survivors, but also the awareness of and pay more attention to the treatment. I feel this truly empowers people to know what they think and be their true self. These methods allow me as a clinician to serve as a guide in this journey. 

Resources and Additional Reading

Follette, V., Palm, K.M. & Pearson, A.N. Mindfulness and trauma: implications for treatment. J Rat-Emo Cognitive-Behav Ther 24, 45–61 (2006).

Jennings, J. L., & Apsche, J. A. (2014). The evolution of a fundamentally mindfulness-based treatment methodology: From DBT and ACT to MDT and beyond. International Journal of Behavioral Consultation and Therapy, 9(2), 1-3.

Overcoming Trauma and PTSD: A Workbook Integrating Skills from ACT, DBT, and CBT by Sheela Raja

This month’s blog post was written by our Trauma Specialist, Laura Valiukenas, MSW, LCSW.

Leave a Reply