ACT for Trauma: Making Room for the Past Without Living There

You've done the work of trying not to think about it. You stay busy, you avoid certain roads, songs, or conversations, and you tell yourself it's in the past. And yet the memory still shows up uninvited, and the effort of keeping it out has quietly made your life smaller.

If that sounds familiar, I want to introduce you to an approach that starts from a surprising place: what if the goal isn't to get rid of painful memories and feelings, but to change your relationship with them so they stop running your life? That's the heart of Acceptance and Commitment Therapy, or ACT, and it's one of the ways I help adults in San Francisco, Daly City, Pacifica, San Mateo, and across California heal from trauma through online therapy.

Key takeaways

  • ACT therapy for trauma helps you stop fighting painful memories and feelings so you can put your energy back into the life you want.

  • It targets avoidance, one of the main things that keeps trauma symptoms stuck.

  • Research on acceptance and commitment therapy for PTSD is promising but still growing; trauma-focused therapies like CPT, prolonged exposure, and EMDR have the strongest evidence.

  • ACT works well on its own for some people and alongside EMDR or other trauma-focused work for others.

  • ACT can be done effectively by secure video, which makes it accessible anywhere in California.

If you'd like to talk about whether this approach fits you, you can book a free 15-minute consultation or learn more about my practice at yourkindofhappy.org.

If you're in crisis, call or text 988 (Suicide & Crisis Lifeline).

What is ACT therapy?

Acceptance and Commitment Therapy (ACT, said like the word "act") is an evidence-based form of cognitive behavioral therapy that helps you make room for difficult thoughts and feelings instead of struggling with them, and then take action guided by what matters most to you.

Where some therapies focus on challenging or changing the content of your thoughts, ACT focuses on how you relate to them. The goal is something researchers call psychological flexibility: the ability to stay present with whatever is happening inside you and still choose behavior that moves your life forward.

ACT is built on six core processes, which I'll describe in plain language:

  • Acceptance: allowing feelings to be there without fighting them, which is different from liking them or approving of what happened.

  • Cognitive defusion: learning to notice thoughts as thoughts ("I'm having the thought that I'm not safe") rather than as commands or facts.

  • Being present: coming back to this moment, where your life is actually happening.

  • Self-as-context: recognizing that you are more than your story, your symptoms, or your worst day.

  • Values: getting clear on what you care about, such as the kind of parent, partner, friend, or person you want to be.

  • Committed action: taking small, concrete steps toward those values, even when discomfort comes along for the ride.

Why trauma keeps you stuck: the problem with avoidance

After something frightening or overwhelming happens, it makes complete sense to want distance from it. Avoidance is the brain's way of protecting you. In the short term, it works: skip the freeway, decline the party, change the subject, and the anxiety drops.

The trouble is what happens over months and years. Each time you avoid a reminder, your nervous system learns, "Good thing we got away; that was dangerous." The fear never gets a chance to update. Meanwhile, your world shrinks. People with PTSD often describe it this way: the trauma took one day, but the avoidance has taken years.

Avoidance is not only external, either. Many of us avoid on the inside, through numbing, staying constantly busy, drinking more than we'd like, scrolling until 1 a.m., or pushing memories away the moment they appear. Ironically, the harder we try not to think about something, the more it tends to come back. (Try not to picture a pink elephant on Ocean Beach right now. You're welcome.)

Avoidance is one of the hallmark symptom clusters of PTSD, alongside intrusive memories, negative changes in mood and beliefs, and feeling on edge. According to the VA's National Center for PTSD, about 6 out of every 100 people will have PTSD at some point in their lives, and many more live with trauma symptoms that never get a formal diagnosis.

How does ACT help with trauma and PTSD?

ACT goes straight at avoidance, but gently. Rather than forcing you to relive the worst moment of your life before you're ready, it builds the skills to approach difficult memories, sensations, and situations with more willingness and less struggle.

In practice, ACT therapy for trauma tends to help in a few specific ways:

It changes your relationship with intrusive thoughts

Trauma often leaves behind sticky, painful thoughts: "It was my fault." "I'm broken." "The world isn't safe." Defusion skills help you notice these thoughts without automatically believing or obeying them. You might practice saying, "My mind is telling me the 'I'm broken' story again." It sounds simple. Over time, it creates enough space that the thought no longer gets to make your decisions.

It makes room for feelings the body is holding

Trauma lives in the body as much as in memory. A tight chest, a jolt of adrenaline, a sudden wave of shame. ACT teaches you to notice these sensations with curiosity and to breathe with them rather than brace against them. I often blend this with somatic work, paying close attention to what the nervous system is doing so we can move at a pace that feels tolerable rather than overwhelming.

It reconnects you with what trauma took away

This is the part I love most. Trauma narrows life down to one question: "How do I stay safe?" ACT adds a second, equally important question: "What do I want my life to be about?" Clarifying your values gives you a reason to tolerate discomfort. You're not facing the hard stuff just because a therapist told you to; you're doing it because you want to coach your kid's soccer team again, or go back to the hiking trails above Pacifica, or feel close to your partner.

It turns insight into action

Committed action means small, doable steps. Driving one exit on the freeway. Saying yes to dinner with a friend. Sleeping with the door closed. Each step is chosen by you, connected to your values, and taken with whatever feelings show up. That repeated experience is what helps the nervous system learn that you can feel fear and still live your life.

A story from my practice

After 15 years of trauma work, the sentence I hear most often in a first session is some version of, "I just want it to stop." I understand that wish deeply. For a long time early in my career, I thought my job was to help people make the pain go away as fast as possible. What I've learned is that the fight against the pain is often what's exhausting people the most.

Here's a composite of clients I've worked with, with details changed to protect privacy. A man in his forties came to see me a couple of years after a serious car accident. Physically, he had recovered. But he had quietly rebuilt his whole life around never feeling that terror again. He took side streets that doubled his commute, stopped visiting family who lived across a bridge, and spent his evenings so wound up that sleep was hard to come by. "I'm fine," he told me, "as long as I don't think about it."

We didn't start by forcing him onto the freeway. We started with values. When I asked what he missed most, he didn't hesitate: Sunday dinners at his sister's house. Then we practiced noticing the "you'll crash again" thought and naming it, breathing through the surge of adrenaline in his chest, and taking tiny steps, first as a passenger, then a short stretch of highway, then the bridge. The fear didn't vanish on a schedule. What changed was that it stopped getting a vote. A few months in, he told me, "I was scared the whole way there, and it was the best dinner I've had in two years."

That's ACT in one sentence: the fear came along, and he went anyway.

A philosophical lens: "No feeling is final"

The poet Rainer Maria Rilke wrote a line I've shared with more than a few clients:

"Let everything happen to you: beauty and terror. Just keep going. No feeling is final."
— Rainer Maria Rilke, Book of Hours I, 59 (translated by Anita Barrows and Joanna Macy)

I love this because it captures what ACT asks of us. Not to like the terror, and not to pretend it didn't happen, but to stop organizing our entire lives around never feeling it again. Feelings rise and fall like the fog rolling in and out of the Golden Gate. They are real, and they are temporary. The life you build in between them is yours.

Does ACT work for trauma? What the research says

I want to be honest with you here, because I think you deserve the full picture.

The therapies with the strongest research support for PTSD are trauma-focused psychotherapies. The 2023 VA/DoD clinical practice guideline strongly recommends Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and EMDR, and suggests several others, including Present-Centered Therapy and Written Exposure Therapy. ACT is not currently on that list as a stand-alone PTSD treatment.

That said, the evidence for acceptance and commitment therapy in trauma is growing and encouraging:

  • A 2026 umbrella review in the International Journal of Psychology and Psychological Therapy compared CBT, ACT, and EMDR for PTSD across 13 systematic reviews. It described ACT as showing promising, moderate-to-large effects across different trauma populations, while noting the results were less consistent than for CBT approaches.

  • A randomized trial with post-9/11 veterans (Lang and colleagues, 2017) found that people receiving ACT improved on distress and functioning, though ACT was not clearly superior to the comparison therapy.

  • A 2021 review presented in BJPsych Open concluded that ACT is gaining a role in trauma treatment and is linked to greater psychological flexibility, while calling the evidence still limited.

So where does that leave you? In my experience, ACT is especially helpful when:

  • Avoidance and numbing are the biggest barriers in your life.

  • You've tried other approaches and felt stuck or overwhelmed by them.

  • You're not ready to dive into detailed trauma memories yet and need a foundation first.

  • Trauma has left you disconnected from meaning, purpose, or relationships.

  • You're dealing with trauma alongside anxiety, depression, chronic pain, or substance use.

For many people, the best plan is a combination. ACT skills often make EMDR or other trauma-focused work feel more manageable, because you already have tools for staying present when hard feelings come up. Part of my job is helping you figure out the right blend for you, not fitting you into a single model.

ACT vs. EMDR vs. CBT for trauma: what's the difference?

People often ask me which trauma therapy is "best." The honest answer is that it depends on you, your history, and what you're ready for. Here's a simple way to think about it:

  • Trauma-focused CBT (such as CPT): helps you identify and rethink the beliefs trauma left behind, like self-blame or "I can't trust anyone."

  • EMDR: helps the brain reprocess traumatic memories using bilateral stimulation, so the memory feels less charged and more like the past.

  • ACT: helps you stop struggling with painful memories and feelings, loosen the grip of difficult thoughts, and move toward a values-based life.

These approaches aren't rivals. I'm trained in several, and I regularly draw on more than one, depending on what a person needs at different stages of healing.

What to expect from ACT therapy for trauma online

I see California clients by secure video, which means you can do this work from a quiet room at home in San Mateo, on a lunch break in San Francisco, or wherever you feel most comfortable. Many people find that being in their own space makes it easier to settle in.

A typical course of ACT for trauma might look like this:

  1. Getting to know you: your history, what brings you in, what you've tried, and what you'd like to be different. We'll talk about safety and pacing first.

  2. Mapping the struggle: noticing what you avoid, what it costs you, and what your mind tends to tell you.

  3. Building skills: practicing presence, defusion, and making room for feelings, often with short exercises you can use between sessions.

  4. Clarifying values: identifying what matters most to you, in your own words.

  5. Taking action: stepping toward those values gradually, at a pace you choose, and adding trauma-focused processing like EMDR if and when it makes sense.

Sessions are collaborative. You will never be pushed into a memory you're not ready to face. My practice is currently private pay, and I do not bill insurance; I can provide a superbill you may be able to submit for out-of-network reimbursement.

Curious whether ACT is a good fit? Schedule a free 15-minute consultation, or if you're ready to begin, book a full therapy session.

A small ACT practice you can try today

Here's an exercise I teach often. It takes about two minutes.

  1. Notice: Pause and name what's showing up. "I'm noticing tightness in my chest. I'm having the thought that something bad will happen."

  2. Make room: Breathe slowly into the place in your body where you feel it most. Imagine giving the feeling a little more space, the way you'd loosen a too-tight belt.

  3. Expand: Widen your attention to include five things you can see and the feeling of your feet on the floor. The feeling is still there, and so is the rest of the room.

  4. Choose: Ask, "What's one small thing I could do right now that matters to me?" Then do it, even if it's just texting a friend back.

As a father of four, I can tell you my own mind is a bit like the radio in a minivan full of kids: I don't always get to choose the station, and sometimes it's playing something loud and unpleasant. ACT doesn't promise you control of the radio. It helps you keep your hands on the wheel and keep driving toward where you actually want to go.

Frequently asked questions

Is ACT good for PTSD?

ACT shows promising results for PTSD and trauma symptoms, especially avoidance, numbing, and loss of meaning. The strongest research support for PTSD is still for trauma-focused therapies like CPT, prolonged exposure, and EMDR, so ACT is often used alongside them or as a foundation before memory-focused work.

Do I have to talk about my trauma in detail in ACT?

Not necessarily, and not right away. ACT focuses more on how you relate to memories and feelings now than on retelling every detail. Some people choose to process specific memories later, sometimes with EMDR, once they feel more grounded.

How long does ACT therapy for trauma take?

It varies. Some people notice meaningful changes within 8 to 16 sessions, while those with complex or long-standing trauma often benefit from longer work. We'll check in regularly on what's helping and adjust together.

Can ACT be done online?

Yes. ACT translates well to secure video, and many people find it easier to practice skills from home. I provide therapy by video to adults anywhere in California, including San Francisco, Daly City, Pacifica, and San Mateo.

Is acceptance the same as giving up?

No. Acceptance in ACT means dropping the exhausting struggle with feelings you can't control so you have energy for what you can control: your actions. It's not approving of what happened or resigning yourself to suffering.

You don't have to wait for the pain to leave before your life begins

If trauma has been running the show, it may feel like you have to get rid of the memories before you can really live. ACT offers a different path: making room for what you've been through, loosening its grip, and stepping back into a life that reflects who you are. You don't have to do it alone.

Visit yourkindofhappy.org to learn more, book a free 15-minute consultation, or schedule a full therapy session when you're ready.

About the author

Dr. Matthew McKeithan, Psy.D., is a licensed clinical psychologist in South Carolina and California with 15 years of experience working with trauma. He provides integrative, trauma-focused care for adults, including veterans and first responders, drawing on approaches such as ACT, EMDR, somatic work, and CBT. His practice, Your Kind of Happy, is family owned and operated, and he is a husband and father of four. Dr. McKeithan sees California clients by secure video (Zoom) anywhere in the state.

Serving the San Francisco Bay Area: San Francisco, Daly City, Pacifica, San Mateo, and clients throughout California by telehealth.

This article is for educational purposes and is not a substitute for individual diagnosis or treatment. If you're in crisis, call or text 988 (Suicide & Crisis Lifeline).

Sources

Matt McKeithantrauma, PTSD, ACT, acceptance and commitment therapy, online therapy California