Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems

334 Pages·2007·3.16 MB·English

by  Victoria M. Follette

Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering
psychological, financial, legal, or other professional services. If expert assistance or counseling is needed,
the services of a competent professional should be sought.
Permission to use the image La condition humaine granted by the National Gallery of Art.
Permission to use the image “Regular Division of the Plane IV (Horsemen)” granted by the M.C. Escher
Company.
Distributed in Canada by Raincoast Books Copyright © 2007 by Victoria Follette and Jacqueline Pistorello
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Acquired by Tesilya Hanauer; Cover design by Amy Shoup; Edited by Carole Honeychurch; Text design
by Tracy Carlson All Rights Reserved
Epub ISBN: 9781608823105
The Library of Congress has cataloged the print edition as: Follette, Victoria M.
Finding life beyond trauma : using acceptance and commitment therapy to heal from post-traumatic stress
and trauma-related problems / Victoria M. Follette and Jacqueline Pistorello.
p. cm.
ISBN-13: 978-1-57224-497-9
ISBN-10: 1-57224-497-6
1. Post-traumatic stress disorder—Treatment. 2. Psychic trauma—Treatment. 3. Acceptance and
commitment therapy. I. Pistorello, Jacqueline. II. Title.
RC552.P67F65 2007
616.85’21—dc22
2007013041
To my students and my clients, who teach me about life beyond
trauma every day.
—VF
To my mother, Maria Formolo Pistorello, whose lifelong commitment
to following one’s values served as the beacon of light in times of
uncertainty in my life.
—JP
Contents

Foreword: Finding a New Way Forward
Acknowledgments
Introduction
1. Understanding Trauma with Kate M. Iverson 9
2. Building a Safe Foundation with Mindfulness
3. Pain Versus Suffering
4. Control Is the Problem
5. Letting Go of the Struggle: Are You Willing?
6. Barriers to Acceptance
7. Finding Your True Self
8. Creating a Valued Life with Adria Pearson 165
9. Committed Action with Jennifer Plumb
10. Skills in Relationships: Staying Safe and Being True to
Yourself with Karen R. Murphy and Kate M. Iverson
11. Moving Forward in Your Life: Additional Resources with Kate
M. Iverson 255
References
Finding a New Way Forward

In the developed world, dying of starvation or thirst is rare enough to make
national news. If you think about it, that fact is a small indication of a larger
human reality. We have learned a great deal about how to control our external
world, and in parts of the world where we have resources to apply, we’ve come
to expect it as a matter of course.
When pain intrudes unexpectedly, that assumption is disrupted. Violent
attacks, tragic accidents, natural disasters, wars, sexual and emotional abuse, and
dozens of other such events show that the external world is not always
controllable, regardless of our knowledge and resources. These painful
challenges can suddenly shift the apparent arena of control from the external to
the internal world. The pain may have begun on the outside, but it lives on in the
inside, in the form of painful memories, difficult emotions, negative thoughts, or
unpleasant urges. Once there, people do what people do with painful memories,
difficult emotions, negative thoughts, or unpleasant urges. And that’s often a
problem.
Humans’ relative skill in controlling their external world often fails them
when applied to the world within. It is hard to get rid of painful memories,
reduce difficult emotions, or eliminate negative thoughts and urges. Indeed,
modern psychological research is showing us that part of what often turns pain
into trauma is the misapplication of some of the very skills we most trust in
controlling the world outside the skin—judging, planning, problem solving, and
controlling—to the world inside the skin.
The human mind is a problem-solving organ—it cannot help but do what it
does. When we look at our own pain, we initially cannot help but judge it,
anticipate it, reason with it, and try to get it to go away. And sometimes that may
even be useful—but for those picking up this book wanting help, I suspect it is
not. It is very likely you’ve already tried that. And if it produced everything you
want, you would not be picking up this book. You are looking for a new way
forward.
You have found one.
Until the secret of how the human mind works is revealed, it tends to do
what it has always done—like a pony who knows only one trick endlessly
performing it. But modern psychological research is also revealing that it is
possible to do truly new things with our memories, emotions, thoughts, and
urges than what problem-solving minds normally do. These mindfulness and
acceptance methods seem to allow us to move quickly in the direction of a life
we value without first waiting for the war inside us to be won.
This book will show you how to take that alternative path.
What you will find in these pages is an approach—Acceptance and
Commitment Therapy (ACT, said as a single word, not initials)—that takes the
view that your life is not a problem to be solved. A life is to be lived, with the
past exactly as it has been but with a future as broad as your most deeply held
values. Moving in that direction requires learning how to let go of some kinds of
problem solving. It means learning how to feel feelings as feelings, and thinking
thoughts as thoughts. This is a workbook, because it takes work to learn an
alternative path. Mere understanding is not enough. Minds cannot fully grasp
how to solve problems in a nonjudgmental way because solving problems
planfully and judgmentally is what minds do.
ACT allows us a new way forward when some of our most trusted skills are
no longer very effective. It offers suggestions for what to do when little we can
think of is very likely to be helpful. It gently points toward exciting alternatives
when seemingly nothing we can do will do.
The scientific evidence base for ACT in the areas of trauma, pain, anxiety,
and depression—areas most readers of this book will likely know something
about in personal terms—is growing rapidly. The body of evidence is not as
large as for some other more traditional approaches, so people who have never
worked on these problems with traditional cognitive behavioral or other more
fully empirically supported methods may wish to consider that. Nevertheless,
there is enough solid evidence that it seemed time to put this new way forward
into the hands of those who may benefit, especially those who need a fresh
approach.
I have known these two authors for many years. Victoria Follette is a
valued colleague and friend who first brought attention to the applicability of
acceptance and mindfulness to trauma, and Jacque Pistorello is not only one of
the best ACT therapists I know—she is also my dear wife. I suppose that means
I am not objective—but I did watch how this book came together and I know
how much care, compassion, and concern has gone into it. I am excited by the
possibility that many thousands will be helped.
You are in a unique position. If you are willing to be guided by your own
pain, it has purchased the openness to learning a new way forward. I’d like to
believe that is part of why fate and happenstance have placed this book in front
of you. You would have no reason to learn a new way if the old ways had
continued to work adequately. Two people I respect and trust a great deal will
walk with you through this learning process.
When you are ready, turn the page. It is time to begin to learn a new way.
—Steven C. Hayes, University of Nevada
Acknowledgments

We would like to thank a number of individuals who have contributed to this
book. Several authors have allowed us to either reproduce some of their original
exercises in this volume or to adapt them to the specific aims of this book. These
are Steven C. Hayes and Spencer Smith, James Pennebaker, Michael Addis and
Chris Martell, J. T. Blackledge, and Joseph Ciarrochi. Robyn Walser, Kelly
Wilson, and Sonja Batten have helped hone our thinking about the application of
ACT to trauma treatment. We would also like to acknowledge others whose
work has either inspired us or provided the foundation for some of the elements
in this book. Many trauma researchers have had an important influence over the
years. Pam Alexander, John Briere, Christine Courtois, Chris Brewin, Judith
Herman, Patricia Resick, Edna Foa, Terry Keane, and Josef Ruzek are just a few
of the people who paved the way for us and helped us to find our own path. The
teachings of individuals from the mindfulness traditions, such as Kabat-Zinn,
Pema Chodron, and Thich Nhat Hahn, along with other local resources, have
been valuable in many ways. Marsha Linehan, Robert Kohlenberg, and Neil
Jacobson also were essential teachers who helped define the new wave in
behavior therapy. Our appreciation and gratitude also go to our students Adria
Pearson, Jennifer Plumb, and Karen Murphy for their assistance in developing
some of the chapters in this book. Special thanks goes to another one of our
students, Kate M. Iverson, who wrote for this book and also provided
encouragement and support when deadlines were looming. Emily Neilan was
wonderful in helping us with formatting and a number of technical tasks.
We could not have written this book without the support of two groups of
people. First, we are indebted to the international network of ACT researchers
and therapists who have helped us along this path and whose work provided the
foundation for this book. Second, we will always remain grateful to our clients
who have been willing to share their lives with us and who have taught us so
much.
Finally, we would like to thank New Harbinger for giving us this
opportunity and Tesilya Hanauer and Carole Honeychurch for all of their efforts
and support in making this book happen.
I am grateful to Steve Hayes for his mentorship and for allowing me to be part of
the ACT work. Thank you to Jacque—I would not have attempted this book
without you. Thank you to all the students who taught me so much along the
way and continue to influence my work. I appreciate the ongoing advice and
support of William Follette. Most especially I am thankful to the many clients
and research participants who informed this work. This book is meant to share
what you have taught me with other survivors. Special thanks go to my friends
Sandy, Alyson, Anne, and Patty for all their support over the years.
—V.F.
I would like to thank Victoria Follette for inviting me to cowrite this book and
for teaching me to treat the impact of trauma and to bear witness to my clients’
pain with compassion and respect. Many, many thanks go to my husband,
Steven C. Hayes, for his unwavering support and patience, for taking care of our
child during many weekends and evenings so that I could write, and for
introducing me to ACT seventeen years ago—an experience that changed my
life in many different ways. I would also like to thank a number of friends and
family who, through their emotional or instrumental support, allowed me to
write this book: Neiva Pistorello, Inge Skeans, Laura Vargas, Elza Major,
Catherine Armstrong, Erin Oksol, Nancy Taylor, and Duane Varble.
—J.P.