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J Contemp Psychother (2013) 43:133140 DOI 10.1007/s10879-013-9233-0
ORIGINAL PAPER
Using Acceptance and Commitment Therapy to Guide Exposure-Based Interventions for Posttraumatic Stress Disorder
Brian L. Thompson Jason B. Luoma
Jenna T. LeJeune
Published online: 13 March 2013 Springer Science+Business Media New York 2013
Abstract Exposure is considered one of the most effective interventions for PTSD. There is a large body of research for the use of imaginal and in vivo exposure in the treatment of PTSD, with prolonged exposure (PE) therapy being the most researched example. Acceptance and commitment therapy (ACT) has sometimes been called an exposure-based treatment, but how exposure is implemented in ACT for PTSD has not been well articulated. Although support for the use of ACT in PTSD treatment is limited to a handful of case studies and open trials, research suggests ACT is particularly useful in exibly targeting avoidance behaviorarguably the most important process in the continued maintenance of PTSD symptoms. The purpose of this paper is to explore the use of exposure within ACT in PTSD treatment. Through an overview of PE and ACT, and with the use of case examples, we describe how ACT principles and techniques may inform exposure-based treatments for PTSD in order to create more exible approaches. In addition, understanding exposure within an ACT framework may also contribute to clarifying processes of change.
Keywords Posttraumatic stress disorder Exposure
Acceptance and commitment therapy Prolonged exposure
Exposure involves deliberate and repeated contact with cues that evoke a fear response while simultaneously engaging in behavior that is incongruent with escape or avoidance (Moscovitch et al. 2009). Through decades of research, exposure remains one of the mostif not the
mostimportant components in cognitive-behavioral approaches to anxiety disorders. Additionally, exposure is an important component in most treatments of posttraumatic stress disorder (PTSD; Institute of Medicine 2007).
Although exposure therapy is a gold standard treatment for PTSD, not everyone benets from exposure therapy. Controlled studies of exposure therapy for PTSD indicate dropout rates ranging from 20.5 to 32 % (Hembree et al. 2003; van Minnen et al. 2002), and only about 60 % of people with PTSD respond well to exposure therapy when dened by post-treatment outcome scores below specic cutoffs for PTSD symptoms and depressive symptoms (Foa et al. 1999; Hagenaars et...