Behavioral Therapy to Help You Live a Valued Life
Eating Recovery Center’s Adult Services embraces Acceptance and Commitment Therapy as a valuable treatment intervention. Also known by the acronym ACT, it is a third generation behavioral therapy that moves away from the notion of changing cognitions and toward how people can live a valued life in the presence of negative thoughts and feelings. The goal of ACT is to help patients create a rich and meaningful life while accepting the pain that inevitably goes with it. In the words of Russ Harris, MD, a founder of ACT:
In ACT, we start from the assumption that the normal psychological processes of a normal human mind readily become destructive, and sooner or later they create psychological suffering for all of us. ACT speculates that the root of this suffering is human language itself.
In a sense, ACT regards the mind as a double-edged sword. It does many things well—it allows us to speak, sing, paint, dream and imagine—but if we don’t learn how to handle it effectively, it can hurt us. Therefore, working within this framework to help patients accept their thoughts and feelings, choose a valued direction for their lives and take action toward that end not only facilitates insight, but can be a powerful catalyst for meaningful behavioral change in the treatment environment.
ACT swiftly and effectively addresses the major maintaining factors of an eating disorder, including rigidity, inability to see the big picture, isolation and most importantly, emotional avoidance. The men and women struggling with eating disorders are masters of avoiding pain and controlling the natural disappointment of life. These patients often have very painful thoughts about sad and traumatic experiences on their minds, and they judge themselves harshly as a result. Eating disordered adults desperately want their treatment team to subtract those feelings, but the mind doesn’t subtract, it only adds.
ACT is about teaching patients to accept that humans have very little control over what comes to mind. Because of how minds work, even the happiest of people will have significant pain in their lives. We can have a memory that pulls us out of the moment, or we can begin to worry about something in the future that keeps us from experiencing and enjoying the moment we are in. The mind is good at jumping into the past, or worrying about the future. ACT teaches patients to be aware of the ways that minds work, and how to tolerate whatever shows up in our minds, instead of struggling to keep painful thoughts, feelings and sensations out of the mind. Most patients are working to avoid having anything upsetting and painful from showing up in their minds.
ACT in the Treatment of Trauma
Trauma is common, with about 60 percent of adults in the United States experiencing at least one trauma in their life. People experience a range of reactions following trauma, and while most people recover given a little time, a small but significant number go on to develop more serious problems, like Post Traumatic Stress Disorder (PTSD).
ACT specifically includes each of the components of PTSD treatment that are known to have the most effective outcomes, including psycho-education, anxiety management and exposure/tolerance/acceptance work. Dr. Steven Hayes, one of the founders of ACT, notes a special relationship between Acceptance and Commitment Therapy and trauma recovery. Dr. Hayes states:
Bad things do happen to good people. It does not have to be for a reason. Often, things are beyond our control. Trauma survivors know how deeply this reaches. ACT helps people learn to let go of the “we are in control” when that is no longer working. Instead it walks through the process needed to come into the present moment, and to still care, and to move toward the lives we want to live. ACT creates a way to help trauma survivors to be themselves, to be present, and to care, without first trying to create some kind of order of the mix of thoughts, feelings and traumatic experience they leave behind.
PTSD limits and narrows people’s lives in many ways. Trauma sufferers are most likely working hard to avoid anything that might “trigger” the thoughts, feeling or memories of their experiences, and avoidance behaviors can often spiral into evasion of many other things that aren’t directly related to the trauma. Many people, including those suffering from anorexia, bulimia, EDNOS and binge eating disorder, turn to numbing, addictive processes to try to be free of past painful experiences. While these harmful practices might give short term relief to the sufferings, untimely addictive processes add to the suffering problem, causing people to lose connection with the life they want and value.
Trauma recovery means being able to be fully involved in a life that is rich with value rather than one ruled by past painful experiences and avoidance strategies, no matter what thoughts or feelings or body sensations show up in the mind. ACT processes are designed to help people learn how to take committed actions toward the life they want for themselves.
ACT and Trauma at Eating Recovery Center: The Course of Recovery
From the ACT perspective, people are not broken—rather, they are stuck. No one is taught the skills necessary to be able to tolerate pain and function after a traumatic event. ACT is focused on helping people change their relationship with the difficult emotions so their lives are not ruled by them and they are free to make the choices toward their valued lives. At Eating Recovery Center, the trauma recovery process is based in ACT processes and includes the following components:
Medical and Nutritional Stability: Simply put, no one has the ability to do the hard work of trauma recovery without this basic platform.
Values Work: Identifying values and valued life directions is a key part of trauma work. Values serve as a compass for people’s lives, helping to understand why change is necessary, even when it feels overwhelmingly difficult. People who have had traumatic experiences can be at risk of never focusing on or having developed an idea of what they value. Values work sheds light on the big picture, as opposed to the everyday small experiences which can fill our lives and steal our time.
Mindfulness Skills: Mindfulness means being able to be present, as opposed to slipping into thinking about the past, or jumping ahead to worrying about what is next in the future. Gaining the skills to not turn to old addictive coping methods to manage the moment when having flashbacks or becoming flooded by emotion when
discussing trauma is critical to trauma recovery.
Grounding, Safety and Containment Skills: This set of skills allows the trauma sufferer to be able to tolerate that which shows up in her or his mind. These skills provide the “outlet” for painful feelings so that individuals do not become so overwhelmed that they turn to old behaviors to numb out and avoid emotions.
Exposure Work: Cognitive and exposure-based treatments have empirical evidence of the best outcomes for treatment of trauma. Together with their clinicians, patients work to slowly tolerate exposure to the feared things so that they may learn to accept these things instead of being ruled by them.
Cognitive Work: The ability to be able to “think about how we think” is a key part of trauma recovery. Patients cultivate the ability to examine their thoughts and perceptions, and learn to notice how their minds work, which thoughts show up and how they react.
Psycho-Educational Work: Patients learn how the brain functions, including how they are wired and have been programmed into beliefs about themselves and others over the years. The brain likes to judge, evaluate, compare and make connections, and these simple mental processes can cause trouble until they are understood and managed.