What is meant by trauma?
The term “trauma” derives from the Greek and means “wound”. It can be defined as a psychological response to an event or a series of highly stressful or distressing events, which exceed the individual’s ability to face you.
These traumatic events They may include accidents, physical or emotional violence, natural catastrophes, wars, and other situations that threaten the life or psychological life or integrity of the individual.
A definition that reflects the current understanding of trauma as a complex phenomenon that involves a wide range of emotional and physical reactions, and underlines the importance of the context in which the traumatic event and the subjective perception of the individual occurs.
A definition in line also with what is reported by the World Health Organization (WHO, 2013): “The trauma derives from an event, a series of events or a set of circumstances that is experienced by an individual as physically or emotionally harmful or potentially lethal and that has long -lasting negative effects on the functioning and mental, physical, social, emotional or spiritual well -being of the“.
Symptoms related to a traumatic experience
The symptoms of antraumatic experience They may vary widely from person to person. However, it is possible to recognize some typically experienced by most people.
These can be of various kinds: emotional, cognitive, physical and behavioral (Bulli, 2024):
- Emotional symptoms: The emotions most experienced by people who have undergone a traumatic experience are usually anxiety, fear, sadness, anger, guilt and shame. However, the possibility that there may be emotional level can also be frequent, demonstrating disinterested and emotionally insensitive;
- Cognitive symptoms: mostly distinguished by experiences reactivating the traumatic event or sensations annexed to it (EG, flashbacks, intrusive thoughts). As well as the possible alteration of cognitive functions linked to attentive processes such as concentration and supervision (EG, difficulty concentration, hypervigilance) and memory (EG, recovery of memories, disorientation);
- Physical symptoms: linked to a possible alteration of the normal physiological functions of the individual, in particular of the sleep-wake (EG, insomnia, nightmare rhythm, disturbed sleep) and food (EG, nausea, gastrointestinal and digestive problems). Sensations of tiredness, fatigue, muscle tension, palpitations and tachycardia are also frequent;
- Behavioral symptoms: the behavioral manifestations that can be observed in front of traumatic experiences are multiple and vary very much depending on the function of the person. Among the most common we find: social isolation, exaggerated reactions, changes in their habits, self -destructive behaviors and, last but not least, avoidance.
These symptoms of course can vary in intensity and duration. Some people can experience symptoms immediately after the traumatic event, while others may not show them until months or even years later.
Trauma-Focused Act
The Trauma-Focused Act (Tfact) is an approach to making acceptance and commitment therapy (Act) based on compassion and focused on exposure.
The work on the last of the first reported behavioral symptoms is in fact a central aspect of this innovative therapeutic approach created and developed by Russ Harris (2021) in which there are three interconnected elements that apply to all the problems related to trauma: to live in the present, heal the past and build the future.
Live the present
Live the present It represents the most consistent part of the TFACT treatment. It materializes in helping patients under multiple aspects:
- Learn to take root and hit;
- Realize when they are no longer involved or dissociate themselves by bringing attention to the here and now;
- Connect with your body and with the sensations it transmits;
- Learn to manage the hyperactivation that debizes and the hypotivation that paralyzes;
- Raise from cognitions and emotions that are difficult to manage;
- Practice self-compression towards one’s suffering;
- Focus on what they do being completely involved in it;
- Stop rumination processes on the past and brooding on the future;
- Acquire a flexible and integrated sense of self;
- Concentrate, extend, maintain and shift attention according to needs;
- Practice an emotional regulation that is congruent with the Act principles;
- Being able to savor and appreciate positive experiences;
- Connect with your values by learning to live in line with them and acting accordingly.
Heal the past
In work for heal the past The way in which their past experiences have given birth to their current thoughts, emotions and behaviors is explored together with patients.
All this provides for contact with your “inner child” as well as exposure to traumatic memories, forgiveness and elaboration of mourning.
Build the future
Finally, in the part relating to build the future We aim for the actual “post-traumatic growth” of the person.
Objectives are outlined in line with their values as well as a real prevention plan of any repercussions.
Why the use of Act in trauma treatment?
From the creation of the acceptance and commitment Therapy in the mid -eighties by Steven C. Hayes, then further developed by his two co -founders Kirk Strosahl and Kelly Wilson (Hayes et al., 1999), more than 3000 studies have been published that demonstrate theeffectiveness in treatment of a wide variety of clinical conditions, from disturbances from post-traumatic stress, depressive and anxiety to the abuse of substances, shame and chronic pain (Boal and Murrell, 2016; Lang et al., 2017; Gloster et al., 2020; Luoma et al., 2012).
In addition to the bases and scientific evidence there are many other valid reasons to use the Act in the treatment of trauma problems (Harris, 2021). It is an approach:
- transdiagnosticthe TFACT being based on a restricted number of basic processes can be used flexible with all the diagnoses of the Diagnostic and statistical manual of mental disorder (DSM) and also in cases of comorbidity. A considerable advantage given that, as reported, the symptomatology with which trauma can manifest itself is very variable;
- based on exposureit turns out to be central within the TFACT helping the patient to expose himself to the mental and/or external content to himself considered difficult by learning new more flexible ways of reacting;
- interpersonaloffers numerous ways of working at an interpersonal level, also making use of the same therapeutic relationship, to provide the right attention to those interpersonal problems that are typically encountered in people who have undergone a trauma;
- integralnumerous theories converge within the TFACT and from them it is taken inspiration, including the Polivagal theory, that of attachment and inhibitory learning;
- based on compassioncompassion, and in particular self-compression, represents, together with the exposure, one of the two founding aspects of the therapy with the Tfact. It materializes in recognizing one’s suffering by learning to respond to oneself with authentic kindness;
- combined “from the bottom up” and “from top to bottom”in each session we try to combine both a “bottom-up” and “top-down” approach based on the patient’s needs and needs, learning to be flexible compared to them. In general, however, in Tfact it is used to orient the first sessions “from the bottom upwards”, that is, we work with the physical body, emotions, sensations, somatic awareness, autonomic activation and so on. Subsequently, the work is directed “from top to bottom”, focusing on psychological flexibility, on the values, on the definition of the objectives, on the planning of the actions to be carried out and on the resolution of the problems;
- fullin addition to being integrated with other models, allows you to have a useful reference base to work with many aspects related to both simple and complex trauma;
- briefTfact seems to work well also as a short therapy despite some types of trauma, however, require longer times.
There are therefore numerous reasons to decide to work with trauma through the use of Act.
Flexibility and possibility of integration in particular allow to adapt the approach to the patient’s needs and needs, managing to adapt the intervention in the most consonant and functional way to it.
Other therapeutic approaches for the treatment of trauma
In addition to the use of Act and the specific TFACT approach, there are several therapeutic approaches that have proven effective in trauma treatment. Among these we certainly find:
- Cognitive-behavioral therapy, based in particular on the gradual exposure to traumatic memories and situations avoided by the patient. With the aim of reducing the anxiety and fear associated with trauma as well as times to the modification of distorted thoughts and beliefs related to the traumatic event. Thus improving the understanding and perception of self, of others and of the world;
- Eye Movement Desensitization and Reprocessing (EMDR). Through the guided use of eye movements it helps the brain to rework traumatic memories, reducing their emotional intensity and integrating them more adaptively in memory;
- Sensomotor therapy, combining the therapy of the word with somatic techniques helps the person to rework the trauma through the body, recognizing and integrating the physical responses related to trauma;
- Therapy focused on compassion (CFT), in this therapy CBT techniques are combined with compassion practices aimed at helping the person to develop a kinder and more compassionate attitude towards themselves, reducing self-critical and improving emotional regulation;
- Dialectical-behavioral therapy (DBT), combines CBT techniques with mindfulness practices to improve emotional regulation and interpersonal skills;
- Group therapy, offering a safe and support environment helps people to share experiences allowing them to feel welcomed and then developed functional coping strategies.
Essential bibliography
- Boals, A., & Murrell, AR (2016). I AM Trauma: Experimentally Reducing Event Centrality and PTSD SYMPOMS in A Clinical Trial. Journal of Loss and Trauma, 21(6), 471-483.
- Bulli, F. (2024). Emergency psychology and humanitarian intervention with EMDR. Ipsic blog. https://www.ipsico.it/News/psicology-dellenting-e-umanitario-con-lemdr/.
- Gloster, AT, Walder, N., Levin, Me, Twohig, MP, & Karekla, M. (2020). The empirical status of Acceptance and Commitment Therapy: A Review of Meta-Aalyses. Journal of Contextual Behavoral Science, 18181-192.
- Harris, R. (2021). Trauma-Focused Act: a Practitioner’s Guide to Working with Mind, Body, and Emotion Using Acceptance and Commitment Therapy. New Harbinger Publications, Inc. Trad. It., Act and trauma: practical guide to work on mind, body and emotions with the Acceptance Commitment Therapy. Trento, Erickson, 2024.
- Hayes, SC, Strosahl, KD, & Wilson, Kg (1999). Acceptance and Commitment Therapy: an expertiential approach to behavior change. New York, NY: Guilford Press.
- Lang, Aj, Schnurr, PP, Jain, S., He, F., Walser, RD, Bolton, E., Beneddek, DM, Norman, SB, Sylvers, P., Flashman, L., Strauss, J., Raman, R., & Chard, km (2017). Randomized Controlled Trial of Acceptance and Commitment Therapy for Distress and Impairement in OEF/OIF/OND Veterans. Psychological trauma: Theory, Research, Practice, and Policy, 9(Suppl 1), 74-84.
- Louma, JB, Kohlenberg, BS, Hayes, SC, & Fletcher, L. (2012). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology, 80(1), 43-53.
- World Health Organization. (2013). Guidelines for the Management of Conditions Specificartly Related to Stress. Geneva: Who.
