Trauma‑Focused

ACT A Practitioner’s Guide to

Working with Mind, Body & Emotion Using
Acceptance & Commitment Therapy

RUSS HARRIS
“Trauma-Focused ACT is going to go down as one of the great contributions to the field of trauma-
informed care. Written in a highly accessible, practical style, Harris provides the acceptance and com-
mitment therapy (ACT) therapist with a comprehensive, step-by-step approach to working with
traumatized clients. The book is chock-full of tidbits of clinical advice that could only come from a
highly skilled therapist with loads of experience working with trauma. If you read this book from cover
to cover (and maybe read it again), you will have a complete sense of how to roll out, manage, and
complete a high-potency treatment with a traumatized client. There aren’t many books out there that
achieve this high ground, and this is one of them! Highly recommended.”
—Kirk Strosahl, PhD, cofounder of ACT, and coauthor of Brief Interventions
for Radical Change

“This beautifully written and intensely practical book offers a rich array of clinical insights and strate-
gies covering the many nuances and concerns that show up when working with various forms of
trauma from an ACT point of view. I consider it the ACT book for trauma, and a must-read for mental
health practitioners who are looking for a compassionate and transformative approach to helping their
clients heal old wounds and engage their lives now in ways that matter to them.”
—John P. Forsyth, PhD, coauthor of The Mindfulness and Acceptance Workbook for Anxiety
and Acceptance and Commitment Therapy for Anxiety Disorders

“Nobody writes with greater clarity and offers more concrete, useful, and innovative suggestions and
strategies than Russ Harris. This is the definitive book for treating trauma-related difficulties with
compassion, courage, and cutting-edge scientific tools.”
—Todd B. Kashdan, PhD, professor of psychology, and author of Curious?
and The Upside of Your Dark Side

“This book is a major milestone in understanding how ACT can support recovery from trauma. In this
comprehensive manual, Russ Harris provides rationales, exercises, and transcripts to give therapists
clear guidance on working effectively with the full range of problems associated with trauma. From
hypervigilance, reexperiencing, avoidance, freezing, and dissociation to responses of shame and guilt—
Trauma-Focused ACT provides numerous sensitive, respectful, and progressive ways to work with
clients. Written with warmth and compassion, this is the indispensable guide for using ACT to help
people with trauma.”
—Eric Morris, PhD, senior lecturer and psychology clinic director at La Trobe University,
and coauthor of Acceptance and Commitment Therapy for Psychosis Recovery
“We’ve known for a long time that psychological flexibility skills are very important in addressing
trauma, but we’ve had a harder time creating trauma-focused versions of ACT that can establish those
skills. This book helps fill that gap, from one of the clearest writers and most creative practitioners in
the ACT community. I learned something new in every subsection. Highly recommended.”
—Steven C. Hayes, PhD, Nevada Foundation Professor in the department of psychology
at the University of Nevada, Reno; and originator of ACT

“Another gem from Russ Harris. Trauma work can be daunting—fraught with anxiety and vulnerabil-
ity on the part of the therapist. By the end of the opening paragraph, you will feel your shoulders relax
and know you are in capable and compassionate hands. It’s all here: from the best, most accessible
description of the polyvagal theory you’ll find, to the careful construction of exposure hierarchies.
Even as you venture into especially challenging areas such as suicidality or moral injury, Russ Harris
provides a solid framework and proven strategies for helping clients with traumatic histories to live the
life they want and deserve. An absolute must for anyone doing this important work.”
—Chris McCurry, PhD, clinical psychologist, and author of Parenting Your Anxious Child
with Mindfulness and Acceptance

“This book is full of wonderful guidance on how to help those with post-traumatic stress disorder
(PTSD), and provided me with many new exercises and insights into this disorder. If you work in this
area, read this book.”
—Michael P. Twohig, professor at Utah State University, and coauthor of ACT in Steps

“A trademark of Russ Harris is his ability to break ACT down into language that’s clear, pragmatic,
and clinically useful, and to illustrate ideas with great practitioner-client dialogue. And Trauma-
Focused ACT is no exception. What jumped out at me with this book was how thoroughly it explores
the nuances of ACT in the context of trauma. If you are after guidance about how to use ACT in this
domain, then this book leaves no stone unturned.”
—Nic Hooper, senior lecturer of psychology at University of the West of England, and
author of The Unbreakable Student
“Trauma-Focused ACT is a great book. It speaks to therapists in a really accessible way, helping them
to understand trauma in a way that will be supremely useful to their clients. The book gives a wide
range of tools and strategies that are psychologically well-informed, compassionate, and based on solid
scientific evidence. The book integrates perspectives from neuroscience, psychology, and a number of
forms of evidence-based psychotherapy—all from within a coherent ACT framework. This book is an
essential resource for all therapists.”
—David Gillanders, head of clinical psychology at the University of Edinburgh

“Russ Harris has once more written a simple, practical, comprehensive, easy-to-follow, state-of-the-art
textbook that is an essential read for both novice and experienced clinicians. Each chapter is rich with
examples, transcripts, metaphors, worksheets, tips, and common pitfalls that enable the reader to both
deliver the intervention with confidence and gain a deeper understanding of the ACT model and
approach to trauma. Couching the whole approach in cutting-edge research adds to the value of this
book as a great resource and an absolute must-have in any clinician’s toolbox.”
—Maria Karekla, PhD, associate professor at University of Cyprus,
and coauthor of Cravings and Addictions

“I always appreciate Russ Harris’s books in their ability to clearly communicate concrete, practically
useful information on ACT in an accessible way that’s helpful for newer and more advanced practitio-
ners alike. This book achieves that once again, containing an impressive collection of insightful per-
spectives, tips, and exercises that are coherently integrated within an overarching model of delivering
trauma-focused ACT (TFACT). It provides a notably in-depth exploration of how ACT can be tai-
lored to individuals with trauma, including adaptations to common ACT exercises, strategies for over-
coming challenges, and integrating other relevant theories in this area.”
—Michael Levin, PhD, associate professor at Utah State University,
and coeditor of Innovations in Acceptance and Commitment Therapy

“Trauma-Focused ACT is essential reading for all ACT practitioners working with clients who have
experienced trauma. The book provides cutting-edge and up-to-date coverage of ACT theoretical
concepts and practical innovations for practitioners. Russ never fails to impress with his accessible yet
theoretically on-point exploration of the topic.”
—Louise McHugh, professor in the school of psychology at University College Dublin,
and coauthor of A Contextual Behavioral Science Guide to the Self
“Russ Harris’s ACT publications are renowned for being incredibly accessible and clinically useful. I
can honestly say that with Trauma-Focused ACT, Russ has outdone himself. At every step along the
journey, Russ generously offers modifications and practical tips to help us when things don’t go accord-
ing to plan, while keeping us grounded in the science of ACT. Trauma-Focused ACT is an important
clinical resource that truly honors the complexity of human suffering and the interpersonal therapeu-
tic endeavor.”
—Sheri Turrell, CPsych, peer-reviewed ACT trainer; coauthor of ACT for Adolescents
and The Mindfulness and Acceptance Workbook for Teen Anxiety; psychoanalyst; and
adjunct lecturer at the University of Toronto

“This is an excellent, comprehensive, contemporary, and instructive guide on how to conduct TFACT.
Importantly, consistent with the ACT framework, the TFACT approach is sensitively person-focused,
holistic, and open to incorporating empirically supported strategies from different therapy models.
Russ describes TFACT in a very accessible and practical way, with lots of illustrative therapist-client
transcripts, worksheets, and other useful clinical tools. This book will serve as an excellent resource
for clinicians at any level and from any theoretical orientation in their delivery of empowering support
to people whose lives are constrained by the pain of trauma.”
—Kenneth Pakenham, PhD, emeritus professor of clinical and health psychology at
The University of Queensland, and author of The Trauma Banquet

“ACT is a powerful therapeutic approach to working with trauma and its complex associated issues,
such as complicated grief, identity issues, and shame. Russ Harris has pulled together all the latest
cutting-edge research and practice into a manual that is broad and deep in its theoretical and practical
application. If you work with clients who experience trauma, then this is a must-buy for your bookshelf,
that you will find yourself constantly reaching for.”
—Joe Oliver, founder of Contextual Consulting, and coauthor of The Mindfulness
and Acceptance Workbook for Self-Esteem
“I am profoundly grateful for this book. Russ Harris has applied his masterful ability to make complex
ACT concepts highly accessible to the vitally important and often enigmatic treatment of trauma.
Filled with exercises, metaphors, and handouts, this book offers dozens of fresh tools for your practice.
The addition of the essential physiological factors which often accompany trauma is critical to the
understanding of its treatment and is sure to enrich your clinical conversations. Russ walks us through
dialogues with clients demonstrating a brilliant clinician’s understanding of the importance of weaving
compassion and dignity into sessions. He will leave you with little doubt that you can hold challenging
sessions with trauma survivors. If you work with clients with trauma, this is a must-read text.”
—M. Joann Wright, PhD, fellow of the Association of Contextual Behavioral Science,
peer-reviewed ACT trainer, and coauthor of Learning ACT for Group Treatment and
Experiencing ACT from the Inside Out

“As a psychotherapist, whether you work with traumatized patients or not, this book is for you. With
his usual simple but precise language, Russ Harris leads you through applying your ACT skills to
simple or complex trauma. This well-designed model—based on four flexible stages of intervention—
encourages therapists to apply ACT according to personal style, experience, and creativity.”
—Nanni Presti, professor at Kore University of Enna, Sicily

“Russ Harris did it again—gifting us a guide about a complex clinical issue, written in a simple yet
comprehensive way that distills the latest insights about trauma-focused clinical work. Trauma-Focused
ACT is unique in its wide applicability: It will give you a firm framework for your clinical work while
also leaving—and emphasizing—space and opportunities to flexibly adapt the framework to each of
your individual clients. For experienced ACT therapists, it will be a source of inspiration how to
further tweak and refine their trauma-focused work.”
—Valerie Kiel, psychologist, and peer-reviewed ACT trainer

“Russ Harris excels in making complicated stuff comprehensible. If you have experience with ACT for
some time and now want to start working with people who have experienced trauma, this book is for
you. If you have worked treating people who have experienced trauma and now want to start using
ACT, this book is for you. In a very structured yet flexible way, Russ Harris guides you through the
important aspects of trauma and the six core processes of ACT. The work comes to life with the many
case examples and dialogues that help you understand how to address important issues.”
—Jacqueline A-Tjak, PhD, clinical psychologist, and peer-reviewed ACT trainer
“This manuscript is an invaluable resource for clients wrestling with any form of traumatic experi-
ence—guiding them to get back into their life, move beyond trauma, and find themselves again. It’s
written with so much compassion and knowledge, and it’s full of resources that demonstrate—page by
page—how ACT can make a difference when working with trauma-related matters. If you’re a clini-
cian working with trauma, passionate about third-wave therapies, this is a must-read book!”
—Patricia E. Zurita Ona, PsyD, author of The ACT Workbook for Teens with OCD
and Acceptance and Commitment Therapy for Borderline Personality Disorder

“In the spirit of his go-to clinical text, ACT Made Simple, Russ Harris has produced another vital and
practical resource for clinicians working with trauma. Trauma-Focused ACT presents a user-friendly,
yet sophisticated, model of case conceptualization, treatment planning, and cutting-edge interven-
tions derived from ACT and informed by the latest science on trauma. Russ walks the reader through
countless case examples and clinical exchanges to help translate principles into practice, emphasizing
the safety and willingness of the client throughout the stages of therapy. Given the high prevalence
and varied manifestations of trauma across cultures and populations, this book is sure to be of great
value to clinicians.”
—Lou Lasprugato, marriage and family therapist, and peer-reviewed ACT trainer

“Russ Harris has an unusual ability to describe the work of ACT in a way that is both simple, clear,
and profound. He has shown this in his earlier books, and this one on treatment of trauma is yet
another example. The fact that he gives the concept of trauma a wide definition makes the book
highly relevant for most, if not all, therapists working with psychological suffering.”
—Niklas Törneke, MD, coauthor of Learning RFT and The ABCs of Human Behavior
 Contents

PART ONE: What Is “Trauma-Focused ACT”?

1. The Many Masks of Trauma2
2. An ACT Model of Trauma8
3. Fight, Flight, Freeze, Flop23
4. Keeping It Safe30
5. The Choice Point40
6. The Journey Ahead54

PART TWO: Beginning Therapy

7. Firm Foundations60
8. Anchors Away72
9. Flexible Sessions95

PART THREE: Living in the Present

10. Slipping the Shackles of Fusion104
11. Heavy Lifting128
12. Leaving the Battlefield142
13. Making Contact, Making Room149
14. Self-Compassion178
15. Knowing What Matters193
16. Doing What Works214
17. Undermining Problematic Behavior230
18. Overcoming Barriers, Maintaining Change240
vi   Trauma-Focused ACT

19. When Things Go Wrong244

20. Compassionate, Flexible Exposure255
21. The Flexible Self272
22. Working with the Body279
23. Sleep, Self-Soothing, and Relaxation287
24. Working with Shame293
25. Moral Injury299
26. Suicidality304
27. Finding the Treasure310
28. Building Better Relationships315

PART FOUR: Healing the Past

29. Supporting the “Younger You”330
30. Exposure to Memories334
31. Grieving and Forgiving345

PART FIVE: Building the Future

32. The Path Ahead354
33. TFACT as a Brief Intervention360
34. Parting Words364
Acknowledgments367
Resources368
Further Training371
References373
Index379
 PART ONE

What Is
“Trauma-Focused
ACT”?
 CHAPTER ONE

The Many Masks of Trauma

“Trauma” is the Greek word for “wound,” and “psyche” is the Latin word for “soul.” From these ancient
words, we get both the clinical term “psychological trauma” and the poetic term “soul wound.” The
latter term seems to convey much better the deep anguish and suffering so commonly involved in
trauma. The pain from these wounds—physical, emotional, psychological, or spiritual—can impact
every area of human life, and the fallout is often devastating: shattered world views; a fractured sense
of self; loss of trust, security, or meaning; and the list goes on.
Soul wounds may occur at any age. For some, the trauma starts in childhood, at the hands of
abusive caregivers. For others, it’s not until adulthood that something tears their world apart. And
when these life-shattering events happen, they can affect anything and everything: relationships,
work, leisure, finances, physical health, mental health—even the very structure of the brain.
In acceptance and commitment therapy (ACT), we work intensively with every aspect of these
soul wounds: cognitions, emotions, memories, sensations, urges, physiological reactions, and the physi-
cal body itself. And at times we will find this work intensely challenging. Inevitably, it triggers our own
painful thoughts and feelings: perhaps anxiety, sadness, or guilt; perhaps frustration or disappoint-
ment; perhaps worry, self-doubt, or self-judgment. But when we make room for our own discomfort, dig
deep into our compassion, and create a sacred therapeutic space—a place where we stand side-by-side
with our clients, to help them heal their pasts, reclaim their lives, and build new futures—then our
work, though often stressful, is deeply rewarding.

What Is Trauma?
Somewhat surprisingly, while it’s easy to find a definition of posttraumatic stress disorder (PTSD), it’s
hard to find a clear definition of trauma. So to ensure we’re on the same page, I’m going to share my
own. (This isn’t the “right” or “best” definition; it’s just one that I trust works for our purposes.)
A “traumatic event” is one that involves a significant degree of actual or threatened physical or
psychological harm—to oneself or others. This can include everything from miscarriage to murder;
from divorce, death, and disaster to violence, rape, and torture; from accidents, injuries, and illnesses
to the medical or surgical treatments for those things. It may also include incidents where people insti-
gate, perpetrate, fail to prevent, or witness actions that violate or contradict their own moral code.
 The Many Masks of Trauma    3

A “trauma-related disorder” involves:

1. direct or indirect experience of traumatic events

2. distressing emotional, cognitive, and physiological reactions to that experience

3. the inability to cope effectively with one’s own distressing reactions

In this book, whenever I use the word “trauma,” it’s short for “trauma-related disorder,” an umbrella
term for a vast number of problems resulting from trauma, including PTSD, drug and alcohol prob-
lems, relationship issues, depression, anxiety disorders, personality disorders, sleep disorders, moral
injury, chronic pain syndrome, sexual problems, aggression and violence, self-harming, suicidality,
complicated grief, attachment disorders, impulsivity, and more. (Indeed, a clear diagnosis of PTSD is
rare in comparison to the many other presentations of trauma.)
Many of these problems mask the trauma history that underpins them, leaving it deeply buried
and long forgotten. And although we talk of “simple” trauma (a reaction to one major traumatic event)
or “complex” trauma (relating to many traumatic events over a long period, often starting in child-
hood), there are many shades of gray between these extremes. However, no matter how simple or
complex trauma may be, it always involves three streams of symptoms, which continually flow in and
out of each other:

• Reexperiencing traumatic events: People reexperience traumatic events in a variety of ways,

including nightmares, flashbacks, rumination, and intrusive cognitions and emotions.

• Extremes of hyperarousal and hypoarousal: Later, we’ll explore these terms in depth; for
now, let’s keep it simple. With clients, rather than “hyperarousal,” we talk about “fight or
flight mode,” which gives rise to anger, irritability, fear, anxiety, hypervigilance, difficulty
sleeping, and poor concentration. Likewise, rather than “hypoarousal,” we talk about “freeze
or flop mode”: the immobilization and shutting down of the body, which fosters apathy, leth-
argy, disengagement, emotional numbing, and dissociative states.

• Psychological inflexibility: The overarching aim of ACT is to develop psychological flexibil-

ity: the ability to be present, focused on and engaged in what we’re doing; to open fully to our
experience, allowing our cognitions and emotions to be as they are in this moment; and to act
effectively, guided by our values. More simply: “be present, open up, and do what matters.”

The flipside of this is psychological inflexibility, which boils down to:

• cognitive fusion (our cognitions—including thoughts, images, memories, schemas, and
core beliefs—dominate our awareness and our actions)
• experiential avoidance (the ongoing attempt to avoid or get rid of unwanted cognitions,
emotions, sensations, and memories—even when doing so is problematic)
• remoteness from values (lack of clarity about or disconnection from our core values)
4   Trauma-Focused ACT

• unworkable action (ineffective patterns of behavior that tend to make life worse in the
long term, such as social withdrawal, self-harm, and excessive use of drugs)

• loss of contact with the present moment (distractibility, disengagement, and disconnection
from thoughts and feelings)

These three streams of symptoms—reexperiencing trauma, extremes of arousal, and psychological

inflexibility—overlap and reinforce each other in a myriad of complex ways, giving rise to a truly vast
range of clinical issues.

What Is Trauma-Focused ACT?

Trauma-focused ACT (TFACT) is neither a protocol nor a treatment for one specific disorder, such as
PTSD. It is a compassion-based, exposure-centered approach to doing ACT, which is (a) trauma-
informed: drawing upon relevant fields, such as evolutionary science, polyvagal theory, attachment
theory, and inhibitory learning theory; (b) trauma-aware: attuned to the possible role of trauma in a
wide range of clinical issues; and (c) trauma-sensitive: alert to the risks of experiential work, especially
mindfulness meditation.
TFACT has three interweaving strands that apply to all trauma-related issues: living in the
present, healing the past, and building the future.

Living in the present. This is the lion’s share of our work in TFACT. It includes helping clients learn
how to ground and center themselves; catch themselves disengaging or dissociating and bring their
attention back to the here and now; connect with and be “at home” in their body; overcome debilitat-
ing hyperarousal and paralyzing hypoarousal; unhook from difficult cognitions and emotions; practice
self-­compassion in response to their pain; focus on and engage in what they’re doing; interrupt dwell-
ing on the past and worrying about the future; access a flexible, integrated sense of self; narrow,
broaden, sustain, or shift attention as required; practice ACT-congruent emotion regulation; savor and
appreciate pleasurable experiences; and connect with, live by, and act on their values. And it also
includes skills training as required (e.g., assertiveness and communication skills) to enable values-
based living.

Healing the past. Here we explore with clients how their past has shaped their present thoughts, feel-
ings, and behaviors and actively work with past-oriented cognitions and the emotions that go with
them. This includes “inner child” work, exposure to traumatic memories, forgiveness, and grieving.

Building the future. Here we use values-based goal setting, including relapse-prevention plans, to
help clients plan and prepare for the future. Ideally, we’re aiming for “posttraumatic growth”: growing
and changing in positive ways through the ordeals of the past, and applying the strengths, insights, and
wisdom gained along the way, to build a better future.
 The Many Masks of Trauma    5

Why Use Trauma-Focused ACT?

Acceptance and commitment therapy was created in the mid-eighties by Steven C. Hayes, Professor of
Psychology at the University of Reno, Nevada, and further developed by his two cofounders, Kirk
Strosahl and Kelly Wilson. Since that time, over 3,000 published studies—including more than 600
randomized controlled trials—have shown ACT’s effectiveness with a wide range of clinical issues,
from PTSD, depression, and anxiety disorders to substance use, shame, and chronic pain (Boals &
Murrell, 2016; Lang et al., 2017; Gloster et al., 2020; Luoma et al., 2012).
Of particular note is some recent research by the World Health Organization (WHO). Since 2016,
the WHO has been rolling out ACT programs in refugee camps around the world, and in 2020 its first
randomized controlled trial was published in The Lancet (Tol et al., 2020). The results were impressive.
The participants were South Sudanese women in a Ugandan refugee camp. Most of them had experi-
enced repeated gender-based violence, as well as the horrors of warfare and the ongoing stress of living
in a camp of 250,000 refugees. Yet just ten hours of ACT, delivered in a group program run by lay facili-
tators, resulted in significant reductions in both PTSD and depression.
However, aside from the evidence base, there are several other good reasons to use ACT for
trauma-related issues.

A transdiagnostic approach. TFACT is a transdiagnostic model based on a small number of core

processes that we can flexibly use with all diagnoses in the Diagnostic and Statistical Manual of Mental
Disorders (DSM), including co-occurring disorders. For example, we could work with a client experi-
encing chronic pain, PTSD, and alcohol problems—and simultaneously target all those issues using
the same few core ACT processes. Given that trauma presents in so many ways and comorbidity is
common, such versatility is handy.

An exposure-based approach. TFACT includes exposure as a core element. In layperson’s terms,

exposure basically means deliberately making contact with “difficult stuff” to learn new, more helpful
ways of responding to it. Inside our body, “difficult stuff” may include memories, thoughts, images,
feelings, impulses, sensations, urges, emotions, numbness, and physiological reactions. Outside our
body, “difficult stuff” may include people, places, objects, events, or activities. Prior to exposure, this
“difficult stuff” ­triggers self-defeating patterns of behavior, but during exposure, clients learn new,
more flexible, life-­enhancing ways of responding.

An interpersonal approach. TFACT offers many ways to work at an interpersonal level—including

an explicit focus on what is happening in the therapeutic relationship. This is good news, given that
interpersonal problems are so common in trauma.

An integrative approach. As we travel through the world of TFACT, we’ll explore a number of differ-
ent theories that integrate well with it, including polyvagal theory, attachment theory, and inhibitory
learning theory. (But don’t worry—we won’t get bogged down in the minutiae; we’ll explore these
theories from a practical perspective: light on technical jargon, heavy on clinical application.)
6   Trauma-Focused ACT

A compassion-based approach. Self-compassion is an integral part of TFACT—an essential aspect

of all work with trauma. This ability to acknowledge our own pain and suffering and respond to our-
selves with genuine kindness is fundamental for healing and recovery and a powerful antidote to
shame.

A combined “bottom-up” and “top-down” approach. Early sessions of TFACT are typically “bottom
up” in their emphasis: working with the physical body, emotions, feelings, sensations, somatic aware-
ness, autonomic arousal, and so on. Later sessions are typically more “top-down”: focusing more on
cognitive flexibility, values, goal setting, action planning, and problem solving. However, most sessions
include both approaches; the proportion of each varies from session to session, flexibly tailored to the
needs and responses of each unique client.

A comprehensive approach. TFACT is a rich, multilayered, holistic approach for working compre-
hensively with all aspects of simple or complex trauma. Within this book you’ll learn principles and
processes for working with addiction, interpersonal problems, insomnia, self-harm, suicidality, emotion
dysregulation, flashbacks, traumatic memories, dissociative states, a fractured sense of self…and a
whole lot more. However, you don’t have to be an ACT purist; if you wish to include resources from
other models, such as eye-movement desensitization and reprocessing (EMDR) or prolonged exposure,
you can! As we’ll explore later, TFACT blends well with other models.

A brief approach. The demand for brief therapy is rapidly growing, and practitioners face the ever-
growing challenge of how to optimize outcomes with as few treatment sessions as possible. Fortunately,
TFACT works well as a brief therapy. Most of the book assumes standard therapy sessions of fifty
minutes, with an average of ten to twelve per client. Of course, some clients do need long-term therapy,
extending over years, but the majority respond well in shorter time frames. Chapter thirty-three,
“TFACT as a Brief Intervention,” covers how to do TFACT in settings where you only have a few ses-
sions, which may even be as short as thirty minutes.

How to Use This Book

In writing this book, I assume you already know something about ACT: that you’ve done at least a
beginners’ level training or read an introductory textbook. Therefore, I have not included accounts of
how ACT was developed or in-depth descriptions of basic theory. So if you’re brand new to ACT, you
will be able to pick it up as you go—but I recommend you first read the whole book, cover to cover,
before using it. (This is because the core ACT processes are interdependent, so if you don’t have a
grasp of the whole model and the way these processes interact, you’ll likely get stuck.) And then, if you
like the approach, immediately work through an introductory level ACT textbook to build up the
essential foundational knowledge that isn’t covered here.
(On that note, I assume many readers have already read my own introductory level textbook, ACT
Made Simple (Harris, 2019), so I’ve done my best to minimize overlap. Inevitably, there is some, but
there’s also a whole lot of brand-new stuff: many new topics, tools, techniques, and methods for working
 The Many Masks of Trauma    7

flexibly with function and process. And where I’ve revisited a favorite practice, such as “dropping
anchor,” I’ve taken it in a new direction with a clear trauma focus.)

I’ve written a free e-book called Trauma-Focused ACT—The Extra Bits, which you
EXTRA can download from the “Free Resources” page on http://www.ImLearningACT.
BIT com. There you’ll find links to all the worksheets and handouts featured in this
book, as well as scripts for exercises and metaphors, YouTube videos, and MP3
audio recordings. In most chapters, you’ll find an “Extra Bits” box like this one,
which lists all the free materials in the corresponding chapter of the e-book. For
example, in chapter one of Extra Bits, you’ll find a PDF on “ACT and Telehealth,”
which shows you how to adapt everything in this textbook for both audiovisual and
audio-only telehealth.

Structure
There are five parts to the book. Part one, “What Is ‘Trauma-Focused ACT’?” explores what
trauma is and how to conceptualize and work with it from an ACT perspective. Part two, “Beginning
Therapy,” covers the first two sessions, with an emphasis on setting up for maximal effectiveness and
safety. Parts three, four, and five cover the three interweaving strands of TFACT: “Living in the
Present,” “Healing the Past,” and “Building the Future.”

Adapt Everything
As you go through this book, please adapt and modify everything to suit your way of working.
That includes metaphors, scripts, worksheets, exercises, tools, techniques—everything! If you can
think of a different way to say or do something that would work better for you and your clients, then
go for it. Tap into your creativity; draw upon your experience; make it your own.

Curiosity and Openness

The TFACT approach has many commonalities with other models of trauma therapy—but also
significant differences. So please bring an attitude of curiosity and openness to your learning. If you
read something here that goes against your previous training, don’t automatically dismiss it, but don’t
automatically take it on board, either. Instead, open to it; consider it; question it. Maybe it has a place
in your way of working—or maybe it doesn’t. No model is perfect; all have strengths and weaknesses;
so take what’s useful from this one, and leave anything that’s not. And keep in mind the words of Carl
Jung: “Learn your theories as well as you can, but put them aside when you touch the miracle of the
living soul.”