Acceptance and Commitment Therapy (ACT) offers a unique approach to healing from trauma. Unlike traditional therapies that focus on symptom reduction, ACT helps people develop a new relationship with difficult thoughts and feelings. At California Healing Centers, we’ve seen how ACT can transform lives by helping individuals move toward what matters most while acknowledging painful experiences.
Trauma affects millions of Americans each year. According to the National Institute of Mental Health, about 6% of the U.S. population will experience PTSD at some point in their lives. Many more experience trauma without developing full PTSD. ACT provides tools to help people live meaningful lives even when carrying difficult memories.
In this article, I’ll explore how ACT works for trauma recovery, its core principles, and how it compares to other treatments. Whether you’re considering therapy options or simply want to understand this approach better, this overview will help you grasp the fundamentals of acceptance and commitment therapy for trauma.
PTSD (Post-Traumatic Stress Disorder) is a specific mental health condition that can develop after trauma exposure. According to the National Center for PTSD, about 7-8% of the population will experience PTSD at some point in their lives. However, not everyone who experiences trauma develops PTSD.
The key differences between trauma and PTSD include:
- Trauma: The event itself or the experience of that event
- PTSD: A specific diagnosis with symptoms like intrusive memories, avoidance, negative mood changes, and hyperarousal that persist for more than a month
- Complex Trauma: Results from repeated or prolonged trauma, especially during childhood, and can affect development and relationships
Understanding these distinctions helps clarify why certain approaches, including ACT, might work differently for various trauma responses.
Understanding acceptance and commitment therapy principles
For trauma survivors, this means that efforts to control, avoid, or eliminate painful memories and emotions often backfire, creating more suffering. Instead of fighting against these experiences, ACT teaches acceptance—not as resignation, but as an active embrace of reality that creates space for healing.
What makes ACT particularly helpful for trauma is its focus on living according to personal values even while experiencing difficult thoughts and feelings. This approach acknowledges that trauma can’t always be erased, but its impact on our lives can change dramatically.
Core principles of ACT
- Acceptance: Learning to make room for painful feelings, urges, and sensations without trying to fight them. For trauma survivors, this means acknowledging memories or flashbacks without struggling against them, which often reduces their power.
- Cognitive defusion: Developing the ability to observe thoughts rather than being caught up in them. When someone with trauma thinks “I’ll never be safe again,” defusion helps them recognize this as a thought, not necessarily reality.
- Mindful awareness: Practicing present-moment awareness helps trauma survivors who often get pulled into past memories or future worries. This skill anchors people to the here and now.
- Self-as-context: Recognizing that we are more than our thoughts, feelings, and experiences. This helps trauma survivors see that while they experienced trauma, they are not defined by it.
- Values: Identifying what truly matters in life provides direction for healing. Trauma often disconnects people from what they care about, and reconnecting with values can be powerful.
- Committed action: Taking steps toward a meaningful life, even when it’s uncomfortable. For trauma survivors, this might mean gradually engaging with avoided situations that align with personal values.
These principles work together to build psychological flexibility—the ability to stay present, open up to difficult experiences, and do what matters, even when it’s hard.
Why choose acceptance and commitment therapy for trauma recovery
One of ACT’s strengths is its focus on acceptance rather than control. Many trauma survivors spend enormous energy trying to avoid memories, feelings, or situations that remind them of trauma. While this avoidance makes sense as a short-term coping strategy, it often limits life and keeps trauma central.
Key benefits of ACT for trauma include:
- Reduces avoidance: ACT helps people notice and acknowledge painful memories without avoiding them, which supports emotional processing and reduces the power of triggers.
- Addresses shame and guilt: Instead of challenging or suppressing these emotions, ACT encourages people to observe them with self-compassion, creating space for healing.
- Works well with complex trauma: For those with layered trauma histories, ACT’s focus on values and present-moment awareness provides a framework for navigating complicated emotional landscapes.
- Complements other treatments: ACT can be integrated with other evidence-based approaches, including EMDR and cognitive therapies, enhancing overall outcomes.
A 2022 study from the University of Nevada found that 68% of participants with trauma-related symptoms showed clinically significant improvement after completing an 8-week ACT program. These improvements remained stable at a 6-month follow-up, suggesting lasting benefits.
Key strategies in ACT for PTSD and complex trauma
1. Mindfulness exercises for ACT trauma work
Mindfulness in ACT helps individuals notice their present experience without judgment. This skill is particularly valuable for trauma survivors who often disconnect from their bodies or get caught in cycles of rumination.
One popular ACT mindfulness exercise is “leaves on a stream.” In this practice, you imagine sitting beside a stream, watching leaves float by. As thoughts arise, you place each one on a leaf and watch it drift away. This creates distance from traumatic thoughts without trying to push them away.
Another helpful technique is the “5-4-3-2-1” grounding exercise:
* Notice 5 things you can see
* Notice 4 things you can touch
* Notice 3 things you can hear
* Notice 2 things you can smell
* Notice 1 thing you can taste
This exercise helps reconnect with the present moment when trauma memories feel overwhelming.
2. Values clarification in ACT for PTSD
Values work is central to ACT. It helps trauma survivors reconnect with what matters most to them, providing direction when symptoms feel overwhelming.
A common values exercise asks: “What do you want your life to stand for?” This question helps identify core values like connection, learning, or contribution. Once identified, these values guide action, even when difficult emotions are present.
For example, someone who values family connection might commit to calling a family member weekly, even when anxiety is present. This shifts focus from symptom reduction to living meaningfully despite symptoms.
3. Defusion techniques to address traumatic memories
Defusion techniques help create distance from painful thoughts without trying to eliminate them. For trauma survivors, these skills can be transformative.
One simple defusion technique involves adding the phrase “I’m having the thought that…” before difficult thoughts. So “I’m broken” becomes “I’m having the thought that I’m broken.” This small shift creates space between the person and the thought.
Another technique involves saying a troubling thought out loud repeatedly until it becomes just sounds, reducing its emotional impact. These approaches differ from exposure therapy by changing the relationship to thoughts rather than their content.
How ACT compares to other trauma-focused approaches
| Approach | Primary Focus | Key Techniques | Best For
|
| ACT for Trauma | Psychological flexibility | Mindfulness, values work, acceptance | Those struggling with avoidance or wanting to live well despite symptoms |
| Prolonged Exposure | Fear extinction | Trauma narrative, in vivo exposure | Those ready to directly process trauma memories |
| EMDR | Neural processing | Bilateral stimulation, memory processing | Those with specific traumatic memories causing distress |
| CPT | Changing beliefs | Cognitive restructuring, written narratives | Those with strong negative beliefs about self/world after trauma |
ACT might be preferred when:
* Previous exposure-based treatments felt too overwhelming
* The person wants to focus on living according to values while still experiencing symptoms
* Avoidance behaviors significantly limit quality of life
* The trauma is ongoing or cannot be directly processed (like chronic illness)
A 2023 meta-analysis published in the Journal of Anxiety Disorders found that ACT was particularly effective for trauma-related avoidance and quality of life improvements, while other approaches showed stronger effects for intrusive symptoms.
What the research shows about ACT and PTSD
- A 2023 study published by the National Institutes of Health found that among veterans with PTSD, ACT led to a 59% reduction in symptom severity over 12 weeks, compared to a 35% reduction in treatment-as-usual groups.
- A 2022 clinical trial from the University of Nevada showed that ACT was effective in reducing PTSD symptoms in over 60% of participants after 8 sessions, with improvements in psychological flexibility strongly predicting symptom reduction.
- A 2021 review analyzing 11 randomized controlled trials concluded that ACT had consistent, moderate effects in reducing PTSD symptoms across diverse populations, including civilians, veterans, and first responders.
These findings suggest that ACT offers a valuable approach for trauma recovery, particularly for improving quality of life and reducing avoidance behaviors that often maintain PTSD symptoms.
Is ACT right for you: Limitations and considerations
1. Who benefits most
ACT may be particularly helpful for people who:
* Experience chronic or repeated trauma
* Struggle with emotional avoidance or suppression
* Find themselves stuck in unhelpful thought patterns
* Want to improve functioning while still experiencing symptoms
* Value mindfulness-based approaches
Research suggests ACT works well across age groups, including adolescents and older adults. It’s also effective for those with co-occurring conditions like depression or anxiety alongside trauma.
2. Potential challenges
While ACT offers many benefits, it’s not ideal for everyone. Some potential challenges include:
- The abstract nature of some ACT concepts might be difficult for some people to grasp initially
- Those in acute crisis may need stabilization before engaging in ACT work
- People with severe dissociation might need additional grounding techniques
- Some individuals prefer more structured, symptom-focused approaches
These challenges can often be addressed by working with a skilled therapist who can adapt ACT principles to individual needs and readiness.
A compassionate path forward
Finding the right therapeutic approach is personal. What works well for one person might not be the best fit for another. ACT provides valuable tools for many trauma survivors, especially those who want to move forward without waiting for symptoms to completely disappear.
The journey of trauma recovery isn’t linear, and it often requires patience and self-compassion. Small steps toward valued living can create meaningful change over time, even when healing feels slow or uncertain.
Frequently asked questions about acceptance and commitment therapy Anxiety and Depression
Research shows ACT is comparable to other evidence-based trauma therapies for reducing PTSD symptoms, with particular strengths in improving quality of life and psychological flexibility. A 2021 meta-analysis found moderate to large effects across multiple studies.
Most people notice changes in their relationship with thoughts and feelings within 6-12 sessions, though deeper work may continue longer. ACT focuses on building skills that develop over time rather than promising quick symptom elimination.
Yes, ACT has been used successfully with individuals experiencing trauma alongside depression, anxiety, substance use, and other conditions. Its focus on psychological flexibility applies across various challenges.
No, ACT doesn’t require detailed trauma narratives. While some memory processing may occur, the focus is on changing your relationship with thoughts and feelings rather than extensively revisiting trauma.
Look for licensed mental health professionals with specific training in ACT and experience treating trauma. The Association for Contextual Behavioral Science (contextualscience.org) maintains a directory of ACT therapists, and many treatment centers now offer ACT-based programs.
At California Healing Centers, we understand that trauma recovery requires a personalized approach. Our team integrates evidence-based therapies like ACT with holistic care to support healing on all levels. We believe in creating a safe, supportive environment where clients can develop the skills and insights needed for lasting recovery. If you’d like to learn more about our trauma treatment programs or how ACT might help in your healing journey, we’re here to answer your questions and guide you toward the support you deserve.
National Center for PTSD. (2022). How Common is PTSD in Adults? U.S. Department of Veterans Affairs. https://www.ptsd.va.gov/understand/common/common_adults.asp
Thompson, B. L., & Waltz, J. (2021). Acceptance and Commitment Therapy for PTSD: A systematic review. Journal of Contextual Behavioral Science, 19, 172-183. https://www.sciencedirect.com/science/article/abs/pii/S2212144721000350
National Institute of Mental Health. (2023). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2021). Effectiveness of Acceptance and Commitment Therapy for veterans with PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 13(4), 421-428. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891024/
