We must embrace pain and burn it as fuel for our journey. ~ Kenji Miyazawa
At Uzazi Village in Kansas City, MO, three women found their voices, courageously sharing their stories of experiencing marginalization and trauma during pregnancy and childbirth. It was painful and at times heartbreaking to bear witness to their experiences. Common themes included a lack of agency in their pregnancy/childbirth, feeling “silenced” and unheard, feeling disrespected, dehumanized, coerced, and threatened by the behavior of the health care professionals. I learned that maternal mortality rate has been increasing in recent years, and U.S. is far behind other countries in terms of maternal mortality, particularly among African American women. According to the Centers for Disease Control (2017), nationally black women experience 44 deaths per 100,000 live births, compared to 13 for white women and 14 for women of other races. These three women have found their voices and are healing themselves and their families. Inspired by their stories, I began to reflect on the ubiquity and prevalence of trauma in its various forms and contexts in our culture.
Trauma Is A Public Health Crisis
Most everyone has experienced some type of trauma. Estimates vary, but the Adverse Childhood Experiences Study (ACES) by Felitti, et al. (1998) suggests that 75% of the population has experienced at least one traumatic event in their life. Other studies estimate up to 90% (Elliott, 1997). According to Pat Ogden, “Trauma refers to any threatening, overwhelming experiences that we cannot integrate… after such experiences, we are often left with a diminished sense of security with others and in the world, and a sense of feeling unsafe inside our own skin” (Treleaven, 2015). Trauma occurs in a variety of contexts and forms, including interpersonal, complex, developmental, generational, vicarious, and can impact any of us regardless of age, education, race, gender, sexual orientation, and socioeconomic status. It includes individual and collective experiences of discrimination, marginalization, and disenfranchisement.
Given the pervasiveness of individual and collective trauma, it seems reasonable to conclude that trauma can be conceptualized as a “public health crisis AND an unconscionable injustice” (Hakima Tafunzi Payne, Uzazi Village, 2018). The question for all of us is how do we navigate the storms in service of healing ourselves and our communities? Many trauma-informed professionals and organizations are making significant progress in using “the science of trauma, toxic stress and resiliency together with collective community wisdom to accelerate disruptive, sustainable change that leads to healing, well-being and equity” (Alive and Well Communities, 2018). Acceptance and Commitment Therapy/Training (ACT) may also contribute to current trauma-informed practices in promoting efforts to prevent and heal trauma as well as foster resiliency and wellness, individually and collectively.
ACT and Trauma-Informed Mindfulness
ACT is a mindfulness-based approach to understanding and changing behavior. In clinical contexts (over 100 random control trials as of the date of this writing), ACT has demonstrated empirical support/evidence base for a variety of clinical diagnoses, including severe substance abuse, depression, anxiety, post-traumatic stress disorder, psychosis, and chronic pain (Moran, 2016). As a behavioral intervention, ACT focuses on shifting the context, rather than the content, of our experiences. In addition to its clinical utility, ACT is also a useful approach for promoting wellness and social justice. Below are some ways ACT maps onto trauma-informed mindfulness:
- Contact with the Present Moment – In the face of distress and overwhelm, mindfully reconnecting with one’s present moment experience can be both grounding and empowering. “When you can’t control what’s happening, challenge yourself to choose how you respond to what’s happening. That’s where your power lies” (Deschene, 2012). In the wake of trauma, we frequently encounter triggers that can result in fight, flight, or freeze responses. Harnessing the power of mindfulness and reconnecting with the present moment empowers us to “Recognize what’s happening, without added commentary or judgment. It involves maintaining a moment by moment awareness of various aspects of our experience, including thoughts, body sensations, and feelings… that can help us be present with our inner world – even if what we find there is devastating” (Treleaven, 2018). Furthermore, responding mindfully in contact with the present moment allows us to respond to our internal and external environments in flexible and adaptive ways, rather than responding with rule-based, rigid, and reactive behaviors. With practice, responding in a flexible and mindful manner can result in an expanded window of affective tolerance, increasing emotional agility and distress tolerance.
- Acceptance (Willingness) – From an ACT perspective, acceptance (or willingness as we sometimes prefer due to misconceptions around the term acceptance) involves allowing the full range of natural emotions to be as they are, acknowledging and making space for them with curiosity and compassion, rather than trying to get rid of it, change it, or engaging in avoidance behaviors (David, 2016). Although evolutionarily speaking, our nervous systems are wired to avoid pain and seek pleasure, when applied to our internal experiences, this strategy is a rigged game that often keeps us stuck and compounds our suffering. Similar to the devil’s snare plant in the Harry Potter series, struggling or resistance to our internal experiences causes greater constriction and compounds suffering. ACT teaches us that when we experience pain, it is not a sign of personal weakness or defectiveness; instead, it can be a sign of neuroplasticity, growth, and healing.
- Defusion and Self as Context – Trauma survivors frequently identify with a conceptualized self that is unworthy, inadequate, or damaged. We tend to create stories or narratives of our experiences about why things happen to us, what our experiences mean about us, etc. ACT offers an alternative to this experience through the process of self as context. “When we are psychologically flexible, we no longer need to judge or evaluate the self [or parts of the self] as good or bad, because the self is seen as an experiential process rather than a concrete entity” (Tirch, 2018). Practicing defusion from the conceptualized self also facilitates the ability to practice dual awareness, a critical skill in the process of healing from trauma. According to Rothschild, developing the ability to pendulate between the experiencing self and the observing self can facilitate developing the ability to “witness their experience without becoming identified with it” (Treleaven, 2018).
- Values Authorship – Clarifying our values can help us navigate painful experiences and anchor our choices and behaviors. Integrating trauma-informed philosophy into our cultural practices will require us to be willing to challenge zero sum thinking, consider the implications of abundance vs. scarcity mentality, and examine our assumptions about individual differences. Implicit biases affect us all. No matter how consciously committed we are to fairness and equality, our internalized learning histories result in implicit biases about race, gender, age, sexual orientation, ethnicity, physical ability, etc. These biases often reside just below the level of consciousness. Our brains are evolutionarily wired to notice differences, and differences are often subconsciously equated with potential threats. Practicing mindfulness in service of values authorship and exploring our own implicit biases can be challenging, but can diminish the power of biases to impact our behavior. Furthermore, willingness to engage in this exploration can enhance our sense of common humanity, connection, and reduce the power of fear to influence our behavior and relationships.
- Committed Action – ACT requires willingness to engage in behavioral change, bringing one’s behavior in line with chosen values and overcoming barriers to wellness. The first step in proactively pursuing values congruent behavior may be to gain more clarity about your intrinsic values. Free resources for engaging in values authorship can be found at www.motivationalinterviewing.org or www.thegoodproject.org. Once you have identified the values that are most important, you can begin to translate values into goals and incremental action steps. There are a number of free or low cost trainings available locally to learn more about the trauma-informed movement, including Alive and Well Community’s Trauma Awareness Training (May 15, 5:30 – 7:30 PM) and our upcoming Trauma-Informed Mindfulness Training (May 19, 1:30 – 4:30 PM, details below). Finally, it’s important to realize that becoming trauma-informed is a process of continual inquiry and an ongoing dialogue. Identify the areas that align with your values and passion and join the conversation!
ACT, Trauma and Social Justice
The six core process of ACT as they relate to trauma, also map well onto a social justice framework. Trauma occurs in a cultural context (Treleaven, 2018). “We live inside of social and economic structures that are designed to respect and create safety and opportunity for some groups, while systematically disregarding others. Each of us has to do the internal and external work of becoming conscious of these different systems in order to conduct trauma sensitive work” (Treleaven, 2018). This will be difficult work that will require considerable self-compassion and self-care.
Sustainable paradigm shifts require the dialectic of both patience and progress/action, and often occur slowly in fits and starts (Magee, 2018). It is encouraging to see the efforts of many individuals and agencies over the past 20 years achieve progress in creating a paradigm shift away from pathologizing behavior toward seeing behavior as an attempt to communicate – away from “what’s wrong with you” toward “what happened to you.”
Implementing trauma-informed practices into our culture will require each of us to examine and own our contributions to perpetuating systems of inequality and oppression. This requires willingness to engage in difficult conversations with humility, to learn to tolerate and respect the perspectives of others even when they are different from our own, and to examine how we are socially constructing and defining power in our culture, and at what cost.
If you would like to learn more about how ACT can be integrated into mindfulness training, check out Angie’s upcoming seminars:
- Trauma Informed Care for Mindfulness Professionals (with Sydney Spears, PhD) Saturday May 19th, 2018 from 1:30-4:30 pm at Seeking Solace Yoga in Overland Park, KS. 3 CEUs are available for KS & MO licensed mental health professionals.
- Acceptance and Commitment Training (ACT) for Mindfulness Informed Professionals – Your ACT Toolkit June 29th, 2018 from 11:30 am – 1 pm in Kansas City, MO. 1.5 CEUs are available for KS & MO licensed mental health professionals.
If you would like to learn more about the work of Uzazi Village in improving health equity and anti-racism training, you can learn more about them at www.uzazivillage.org.
CDC (2017) Pregnancy Mortality Surveillance System
David, S. (2016). Emotional agility: Get unstuck, embrace change, and thrive in work and life.
Deschene, L. (2012). Tiny Buddha: Simple wisdom for life’s hard questions
Elliot, D.M. (1997). Traumatic events: Prevalence and delayed recall in the general population. Journal of Consulting and Clinical Psychology, 65, 811-820.
Felitti, et al. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventative Medicine, 14, 245-258.
Magee, R. (2018). When Mindfulness and Racism Intersect; Mindful.org podcast (Episode 7), March 21, 2018.
Moran, D.J. (2016). Acceptance and Commitment Therapy 2-Day Intensive ACT Training. PESI, Inc.
Ogden, P. (2015). Sensorimotor psychotherapy: Interventions for trauma and attachment.
Tirch, D. (2018). Twitter post @DennisTirchPhD dated April 27, 2018
Treleaven, D. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing.