John came to consult me for marital and work difficulties. He doesn’t recognize himself. He gets angry at his kids and wife, and just got fired from his work after a blowout at his boss. As we start working together, he tells me about a whole range of traumatic events he experienced some 20 years ago as he was doing humanitarian work in Africa. To this day, when he hears a helicopter, he reflexively ducks, feels his heart racing and breaks out in a cold sweat. However, he barely mentions it before shutting down and declaring he doesn’t want us to talk about it.

Like many people, John has experienced traumatic events. He’s part of the 10 to 20% who go on to have trouble with their trauma memories. Of those, many will seek to avoid reminders of the trauma: noises, places, etc. and some will get trapped in an avoidance cycle.

Amongst the effective treatments for post-traumatic stress are diverse forms of exposure to the trauma memory. This can reduce the distress caused by the memory. But many people are not willing to engage in exposure and some, like John, are not even willing to talk about the trauma memory.

It’s not having the memories that’s problematic for John. Many people have such memories. It’s how he relates to them and the discomfort they occasion. With ACT and the matrix, I could offer John a gentle way to ease his relationship with his trauma memories. The heart of our work was letting John choose whether to talk about his trauma memory.

At first I invited John to sort his experience and behaviors in the matrix. Bottom left what was painful to him, top left what he did in the reaction to it. He first sorted anger bottom left, and also the trauma memories. Top left he put getting angry, isolating, shouting at his wife and kids. When we looked at the right of his matrix, John sorted as who and what was important to him: his wife, his girls, himself, helping others and doing meaningful work. Top right, his toward moves were playing with his girls, being patient with them, sharing with his wife, and making a list of what he wanted from work. Soon John was able to notice his hooks, then thoughts, emotions and memories that showed up bottom left and pulled him to behave in ways he wouldn’t have chosen.

After some weeks, he was able to relate his anger to his trauma memories and how trying to avoid them had pushed him into a job he did not value. He also started noticing engaging in more toward moves with his wife and girls, and rethinking his relationship to work. He started looking for work that could move him in the direction of helping others to solve problems, which was his motivation for his earlier humanitarian work.

REFERENCES

General Public :

Follette, V. & Pistorello, J. (2007). Finding Life Beyond Trauma: Using Acceptance and Commitment Therapy to Heal from Post-Traumatic Stress and Trauma-Related Problems. Oakland, CA: New Harbinger.

Professionals:

Polk, K. L., & Burkhart, M. A. (2014). Something you can never forget: The matrix and PTSD. In K. Polk & B. Schoendorff (Eds.), The ACT matrix: A new approach to building psychological flexibility across settings and populations. Oakland, CA: New Harbinger.

Walser, R. D. & Westrup, D. (2007). Acceptance and commitment therapy for PTSD: A practitioner’s guide to using mindfulness and acceptance strategies. Oakland, CA: New Harbinger.