Trauma can change how we experience ourselves, our relationships, and the world around us. Experiences that once felt manageable may become overwhelming. Thoughts, memories, emotions, and physical sensations can begin to feel threatening, even when the original danger is no longer present.
For some people, trauma contributes to the development of post-traumatic stress disorder (PTSD). For others, its effects may appear through difficulties with emotional regulation, relationships, trust, identity, or a persistent sense of unsafety.
There is no single way that trauma affects people, and there is no single pathway to recovery.
In our latest collaboration with Jamie Gahagan, Registered Psychotherapist (Qualifying) from The Safe Space, we explore how Acceptance and Commitment Therapy (ACT) can support people navigating PTSD and trauma-related difficulties.
We also discuss Jamie’s Trauma Recovery Toolkit, which offers practical resources to support people in understanding and responding to trauma-related experiences.
But before exploring ACT, it’s important to acknowledge something fundamental: ACT is one approach among many, and effective trauma recovery does not need to look the same for everyone.
Understanding ACT Through a Trauma-Informed Lens
Acceptance and Commitment Therapy (ACT) is a behavioural therapy grounded in contextual behavioural science. Rather than focusing exclusively on reducing symptoms or changing the content of thoughts, ACT aims to develop psychological flexibility.
Psychological flexibility refers to our capacity to remain in contact with the present moment, including difficult internal experiences, while choosing actions guided by our values (Hayes et al., 2006).
This can be particularly relevant to trauma.
Following traumatic experiences, avoidance often becomes an understandable way of protecting ourselves from distress. Someone might avoid particular places, conversations, relationships, memories, or emotions because these experiences trigger fear, shame, or physiological arousal.
Avoidance is not inherently problematic. In genuinely unsafe situations, avoiding danger can be essential.
However, when avoidance becomes rigid and begins restricting someone’s ability to engage with meaningful aspects of life, it may contribute to ongoing difficulties.
Research has identified experiential avoidance as an important process associated with psychological distress, including trauma-related symptoms (Marx & Sloan, 2005).
ACT approaches these patterns with curiosity rather than judgment.
Instead of asking, “How do we get rid of these thoughts and feelings?” ACT might ask:
“When these experiences show up, how can we respond in ways that support safety, flexibility, and the life we want to build?”
ACT describes six interconnected processes that contribute to psychological flexibility.
The Six Core Processes of ACT in Trauma Recovery
1. Acceptance: Making Space for Difficult Experiences
Acceptance is one of the most frequently misunderstood components of ACT.
In this context, acceptance does not mean approving of what happened, forgiving someone who caused harm, tolerating ongoing mistreatment, or giving up on change.
Instead, acceptance involves developing a greater willingness to experience thoughts, emotions, memories, and bodily sensations when doing so is safe and serves a meaningful purpose.
For someone experiencing trauma-related distress, this might involve noticing fear without immediately needing to escape it, acknowledging grief without suppressing it, or allowing a difficult memory to be present without becoming completely consumed by attempts to control it.
This process may help reduce the struggle associated with experiential avoidance.
Where acceptance can help:
Acceptance may support individuals in responding more flexibly to trauma-related emotions and internal experiences, particularly when efforts to suppress or avoid those experiences have become restrictive (Hayes et al., 2006).
Important limitations:
Acceptance must never be confused with accepting abuse, discrimination, coercion, or unsafe circumstances.
For individuals experiencing ongoing harm, establishing safety and accessing appropriate support may be more important than increasing willingness to experience distress.
Additionally, encouraging someone to approach overwhelming internal experiences before they have adequate resources and support may contribute to dysregulation rather than flexibility.
Trauma-informed acceptance requires attention to context, pacing, consent, and the person’s capacity to remain engaged.
2. Cognitive Defusion: Changing Our Relationship With Thoughts
Trauma can profoundly influence how people interpret themselves and their experiences.
Thoughts such as:
“I’m not safe.”
“It was my fault.”
“I can’t trust anyone.”
“Something bad is going to happen.”
“I’m permanently damaged.”
may begin to feel like unquestionable truths.
ACT refers to cognitive fusion as the process through which thoughts exert excessive influence over our behaviour.
Cognitive defusion involves learning to notice thoughts as thoughts rather than automatically treating them as facts, commands, or accurate predictions.
For example, someone might begin noticing the difference between:
“I’m not safe.”
and
“I’m noticing that my mind is telling me I’m not safe.”
The purpose is not to convince someone that their thoughts are wrong. Instead, it is to create opportunities to respond with greater flexibility.
Where cognitive defusion can help:
Defusion may help individuals develop distance from self-critical beliefs, trauma-related interpretations, and rigid narratives about themselves.
Research examining ACT processes suggests that changing one’s relationship with internal experiences can contribute to psychological flexibility (Levin et al., 2012).
Important limitations:
Not all trauma-related thoughts are inaccurate.
For individuals experiencing ongoing violence, discrimination, or unsafe relationships, concerns about danger may reflect real environmental conditions.
Defusion should never be used to dismiss legitimate threats or encourage people to question accurate perceptions of harm.
The goal is not to teach someone that they are safe when they are not. It is to support their ability to distinguish between current circumstances, learned threat responses, and the choices available to them.
3. Present-Moment Awareness: Reconnecting With the Here and Now
Trauma can disrupt our relationship with the present moment.
Some people experience intrusive memories or flashbacks that make past events feel as though they are happening again.
Others experience hypervigilance, constantly scanning their environment for possible threats.
Still others may experience dissociation, emotional numbing, or a sense of disconnection from their bodies and surroundings.
Present-moment awareness involves intentionally noticing what is happening here and now, with openness and flexibility.
In ACT, this process is not simply about relaxation. It is about developing the ability to direct and shift attention in ways that support effective responding.
Where present-moment awareness can help:
Grounding practices, sensory awareness, and mindful attention may help some individuals distinguish between trauma-related memories and their current environment.
Mindfulness-based approaches have demonstrated potential benefits for PTSD symptoms, although findings vary across interventions and populations (Boyd et al., 2018).
Important limitations:
Mindfulness is not universally calming.
For some trauma survivors, closing their eyes, focusing on their breathing, or attending closely to bodily sensations may increase distress, trigger traumatic memories, or intensify dissociation.
Trauma-sensitive approaches emphasize choice and flexibility.
Someone might prefer keeping their eyes open, noticing objects in the room, listening to environmental sounds, or engaging in gentle movement.
Present-moment awareness should be an invitation, not a demand.
4. Self-as-Context: Recognizing That We Are More Than Our Experiences
Trauma can influence how people understand themselves.
Someone who has experienced abuse, violence, or betrayal may begin identifying primarily through what happened to them.
They may come to see themselves as damaged, powerless, unworthy, or fundamentally different from who they were before.
ACT introduces the process of self-as-context, sometimes described as the observing self.
This involves developing the ability to notice thoughts, emotions, memories, and identities without being entirely defined by them.
A person can recognize:
“I am experiencing fear.”
without concluding:
“I am a fearful person.”
Similarly, someone can acknowledge that trauma has shaped their experiences without reducing their identity to trauma alone.
Where self-as-context can help:
This process may support greater flexibility in how individuals relate to trauma-related self-beliefs and identity narratives.
Self-as-context is a central component of ACT’s model of psychological flexibility (Hayes et al., 2006).
Important limitations:
Self-as-context can be abstract and difficult to understand, particularly when someone is experiencing dissociation or difficulties with their sense of self.
Exercises emphasizing separation from thoughts, emotions, or bodily experiences may not be appropriate for everyone.
It is also important not to minimize the ways trauma genuinely changes people.
Healing does not require returning to a previous version of oneself or pretending that traumatic experiences have had no lasting impact.
5. Values: Reconnecting With What Matters
Trauma can narrow someone’s world.
Activities that once brought meaning may become difficult. Relationships may feel unsafe. Personal goals may be overshadowed by efforts to manage distress.
Values work offers an opportunity to explore what matters beyond the immediate demands of trauma-related symptoms.
In ACT, values are freely chosen qualities of action rather than achievements or expectations imposed by others.
Examples might include compassion, connection, curiosity, autonomy, creativity, or contribution.
For someone recovering from trauma, values exploration might involve asking:
What kind of relationships do I want to cultivate?
What does safety mean to me?
How do I want to treat myself when things are difficult?
What parts of my life would I like to reconnect with?
What matters to me beyond what I have experienced?
Where values can help:
Values can provide direction when distress makes it difficult to determine what comes next.
Rather than requiring symptoms to disappear before engaging in meaningful activities, ACT supports people in identifying ways to move toward valued living while responding flexibly to internal experiences (Hayes et al., 2006).
Important limitations:
Values work can become problematic when it is disconnected from someone’s actual circumstances.
A person experiencing poverty, housing insecurity, discrimination, disability-related barriers, or ongoing interpersonal harm may face significant restrictions on their available choices.
It would be inappropriate to suggest that someone can overcome structural barriers simply by making more values-consistent decisions.
Values should support autonomy and meaningful choice, not create additional pressure to function, forgive, reconcile, or demonstrate resilience.
6. Committed Action: Taking Meaningful Steps Forward
Committed action involves developing patterns of behaviour that align with personal values.
For trauma survivors, this might include reconnecting with supportive relationships, establishing boundaries, returning to meaningful activities, seeking professional support, or gradually approaching situations that have become associated with fear.
Importantly, committed action does not mean pushing through distress at any cost.
It involves flexible, intentional action that considers the person’s needs, circumstances, and capacity.
Where committed action can help:
Committed action may support individuals in rebuilding participation in meaningful areas of life that have become restricted by trauma-related avoidance.
Behavioural approaches that involve gradually approaching avoided situations can be particularly relevant to PTSD treatment, although ACT-based committed action is not equivalent to a structured trauma-focused exposure protocol.
Important limitations:
There is a difference between approaching something that feels unsafe because of a past experience and entering a situation that is genuinely unsafe in the present.
Committed action should never require someone to remain in harmful relationships, abandon protective boundaries, or expose themselves to danger.
Progress may involve rest, asking for support, establishing distance, or changing one’s environment.
Sometimes, the most values-consistent action is choosing not to engage.
What Does the Research Say About ACT for PTSD?
Although ACT offers a useful framework for understanding trauma-related difficulties, it is important to distinguish theoretical relevance from demonstrated treatment effectiveness.
Research investigating ACT for PTSD has produced promising findings, including improvements in psychological flexibility and trauma-related symptoms in some clinical studies.
For example, Meyer et al. (2018) examined ACT for veterans experiencing PTSD and found encouraging outcomes, while also identifying important limitations in the evidence.
However, the ACT-specific evidence base remains less established than that of several trauma-focused psychotherapies.
Small sample sizes, differences in treatment protocols, limited comparison groups, and variation in study quality make it difficult to draw definitive conclusions about ACT’s effectiveness relative to established PTSD treatments.
ACT should therefore not be presented as a universally effective intervention or as a replacement for treatments with stronger evidence.
Its potential value may lie in its emphasis on psychological flexibility, experiential avoidance, values, and meaningful engagement with life.
For some individuals, ACT may be an appropriate therapeutic approach. For others, it may be useful as a complementary framework alongside other evidence-based interventions.
Trauma Recovery Is Not One-Size-Fits-All
One of the most important principles of trauma-informed practice is recognizing that people have different needs, preferences, histories, cultural contexts, and understandings of healing.
ACT is not the only effective approach to addressing PTSD and trauma-related difficulties.
Several other interventions have substantial research supporting their effectiveness.
Prolonged Exposure Therapy (PE)
Prolonged Exposure Therapy is a structured, trauma-focused cognitive behavioural treatment for PTSD.
PE supports individuals in gradually approaching trauma-related memories and situations that have become associated with fear or avoidance.
Through repeated, supported engagement, individuals may develop new learning about trauma-related memories, emotions, and perceived threats.
PE has a substantial evidence base and is recommended in major clinical practice guidelines for PTSD (American Psychological Association [APA], 2017; U.S. Department of Veterans Affairs & Department of Defense [VA/DoD], 2023).
Unlike ACT, PE directly targets trauma-related avoidance through a structured exposure-based treatment protocol.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is another established psychotherapy for PTSD.
It involves recalling aspects of traumatic experiences while engaging in bilateral stimulation, commonly through guided eye movements.
EMDR aims to support the processing of traumatic memories and reduce associated distress.
Research supports EMDR as an effective treatment for PTSD, and it is recommended in major clinical practice guidelines (VA/DoD, 2023).
There remains debate about the specific mechanisms responsible for its effectiveness, including the contribution of bilateral stimulation.
However, uncertainty about mechanisms does not negate the evidence supporting EMDR as a PTSD treatment.
Cognitive Processing Therapy (CPT)
Cognitive Processing Therapy is a trauma-focused cognitive behavioural intervention that helps individuals examine how traumatic experiences have influenced beliefs about themselves, others, and the world.
It often addresses themes such as safety, trust, power, control, esteem, and intimacy.
CPT has strong empirical support and is recommended as a first-line psychotherapy for PTSD in major clinical guidelines (VA/DoD, 2023).
While ACT emphasizes changing one’s relationship with thoughts, CPT more directly examines and modifies trauma-related beliefs.
Both may be useful, but they operate through different therapeutic strategies.
Land-Based and Culturally Grounded Healing
Trauma recovery must also be understood beyond Western models of individual psychotherapy.
For many Indigenous Peoples, healing is inseparable from relationships with Land, community, culture, language, spirituality, and collective identity.
Land-based healing initiatives may involve reconnecting with traditional practices, cultural teachings, intergenerational relationships, and responsibilities to the natural world.
These approaches can support identity, belonging, cultural continuity, and well-being while addressing the ongoing impacts of colonialism.
Research examining Indigenous land-based healing emphasizes the importance of culturally grounded approaches that recognize relationships among people, Land, and community (Redvers, 2020).
However, it is important not to position Indigenous healing practices simply as alternative techniques within Western psychotherapy.
They may reflect distinct understandings of health, relationality, knowledge, and healing.
Their value should not be measured exclusively through Western clinical outcomes or reduced to whether they decrease PTSD symptoms.
Land-based initiatives must be understood within their specific cultural, community, and governance contexts.
They should not be generalized across Indigenous Nations or appropriated into clinical practice without appropriate relationships, permissions, and accountability.
Movement-Based and Body-Oriented Approaches
Trauma can affect physiological arousal, bodily awareness, and a person’s sense of connection with their body.
Movement-based approaches may provide opportunities to explore physical awareness, agency, regulation, and connection.
Examples include trauma-sensitive yoga, walking, dance, and other forms of intentional movement.
Research suggests that yoga and related mind-body interventions may provide benefits for some individuals experiencing PTSD symptoms (Gallegos et al., 2017).
However, the evidence varies considerably across interventions, and movement-based approaches should not automatically be considered equivalent to established trauma-focused psychotherapies.
Movement is also not inherently safe or accessible for everyone.
For some people, body-focused activities can evoke distress, discomfort, or traumatic associations.
Choice, accessibility, consent, and individual preference remain essential.
Integrating ACT With Other Approaches
ACT does not need to exist in isolation.
Its processes may complement other therapeutic interventions by supporting individuals in developing flexible relationships with difficult internal experiences.
For example, values clarification may help someone identify why engaging in trauma-focused treatment matters to them.
Present-moment awareness may support attention to current circumstances.
Cognitive defusion may help individuals notice trauma-related thoughts without automatically organizing their behaviour around them.
Acceptance may support willingness to experience manageable distress in service of meaningful goals.
However, combining therapeutic approaches requires clinical judgment.
Not every technique is appropriate for every person, and integrating interventions should not compromise the structure or effectiveness of established treatments.
A trauma-informed approach involves collaborative assessment, informed consent, cultural responsiveness, attention to safety, and ongoing evaluation of what is and is not helping.
Jamie Gahagan’s Trauma Recovery Toolkit
As part of our collaboration, Jamie Gahagan, Registered Psychotherapist (Qualifying) from The Safe Space, shares her Trauma Recovery Toolkit.
Practical resources can provide opportunities for individuals to explore strategies for navigating difficult experiences, developing awareness, and identifying approaches that feel supportive.
Resources such as these may be useful alongside psychotherapy or as part of a broader process of learning about trauma and recovery.
Importantly, no toolkit can replace individualized assessment or treatment when these are needed.
Explore Jamie’s Trauma Recovery Toolkit → https://tinyurl.com/traumarecoverytoolkit
Watch Our Conversation: ACT for PTSD & Trauma →
Why This Matters
Trauma recovery is not about becoming unaffected by what happened.
It is also not about learning to tolerate circumstances that continue to cause harm.
Recovery may involve developing a greater sense of safety, reconnecting with relationships, rebuilding autonomy, processing traumatic experiences, reclaiming identity, or finding meaningful ways to engage with life.
For some people, this happens through structured trauma-focused psychotherapy.
For others, healing also involves community, cultural practices, relationships with Land, movement, creativity, or collective forms of support.
Often, recovery involves several of these pathways.
ACT contributes an important perspective by asking how we can develop flexibility in responding to difficult experiences while moving toward what matters.
But psychological flexibility does not eliminate the need for safety, resources, supportive relationships, or systemic change.
People should not have to become more psychologically flexible in order to endure preventable harm.
Ultimately, trauma-informed practice is not about finding one intervention that works for everyone.
It is about understanding the person, respecting their autonomy, recognizing the contexts shaping their experiences, and collaboratively identifying approaches that support their well-being.
There is no single correct way to heal.
And healing should never require someone to abandon their boundaries, identity, culture, or sense of self.
References
American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults.
Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 43(1), 7–25. https://doi.org/10.1503/jpn.170021
Gallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017). Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clinical Psychology Review, 58, 115–124. https://doi.org/10.1016/j.cpr.2017.10.004
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43(4), 741–756. https://doi.org/10.1016/j.beth.2012.05.003
Marx, B. P., & Sloan, D. M. (2005). Peritraumatic dissociation and experiential avoidance as predictors of posttraumatic stress symptomatology. Behaviour Research and Therapy, 43(5), 569–583. https://doi.org/10.1016/j.brat.2004.04.004
Meyer, E. C., Walser, R. D., Hermann, B. A., La Bash, H., DeBeer, B. B., Morissette, S. B., Kimbrel, N. A., Kwak, D., & Schnurr, P. P. (2018). Acceptance and commitment therapy for co-occurring posttraumatic stress disorder and alcohol use disorders in veterans: Pilot treatment outcomes. Journal of Traumatic Stress, 31(5), 781–789.
Redvers, N. (2020). The land is a healer: Perspectives on land-based healing from Indigenous practitioners in northern Canada. *International Journal of Indigenous Health, 15
