Trauma-Focused ACT Therapy Session Note

Session Overview / Presenting Concerns

• Client (Sarah Jenkins, DOB: 14/05/1988, NHS: 482 910 3847) attended for session 6 of trauma-focused ACT for PTSD following a serious RTA 8 months ago.
• Reported increased hypervigilance and intrusive memories this week, triggered by walking past a busy dual carriageway on 18/05/2026.
• Concordant with sertraline (Lustral®) 100 mg PO OD; reports mild GI upset initially, now resolved. Sleep remains fragmented (approx. 5 hrs/night).

ACT Hexaflex Components

Acceptance

• Explored experiential avoidance regarding driving and roadside environments.
• Introduced the "Tug-of-War with a Monster" metaphor to illustrate the exhaustion caused by struggling against trauma-related anxiety.
• Client practised "dropping the rope" when somatic symptoms of panic (tachycardia, chest tightness) emerged during the session, allowing the sensations to be present without attempting to suppress them.

Defusion

• Addressed fused threat cognitions regarding imminent danger near traffic.
• Utilised the "I am having the thought that..." cognitive defusion exercise.
• Client successfully shifted from stating "I'm going to get hit again" to "I'm noticing I'm having the thought that I'm going to get hit again."
• Client remarked, "It feels less like a guaranteed prediction when I just label it as my brain trying to protect me."

Contact with the Present Moment

• Guided a 5-minute "Dropping Anchor" (ACE: Acknowledge, Come back into the body, Engage) exercise when the client became visibly distressed and mildly dissociative discussing the RTA.
• Client pressed feet firmly into the floor and named five visible objects in the room.
• Attention stabilised; respiratory rate slowed and client reported feeling grounded in the clinic room.

Self-as-Context

• Not covered or not applicable this session

Values

• Revisited core values in the domain of family and social connection.
• Client emphasised wanting to be a reliable, present aunt to her niece, noting that avoidance of travel has prevented her from attending family gatherings.

Committed Action

• Agreed on a graded, values-aligned behavioural experiment for the coming week.
• Client will travel as a passenger on a short, 10-minute local bus journey with her sister on 23/05/2026 to visit her niece, applying anchoring techniques if panic arises.

Additional Interventions / Home Practice

• Provided audio recording of the 5-minute "Dropping Anchor" exercise for daily practice (target: once daily and PRN when triggered).
• Client to log instances of noticing and naming fused thoughts using a brief diary sheet.

Therapist Reflection / Next Steps

• Client demonstrated good engagement with defusion and grounding techniques despite high baseline arousal today.
• Experiential avoidance remains a primary barrier to functional recovery, though willingness to experience discomfort in the service of family values is increasing.
• Next session (28/05/2026 at 14:00): Review outcome of the passenger bus journey, reinforce Acceptance and Defusion skills, and introduce Self-as-Context ("Sky and Weather" metaphor) to address trauma-related shifts in self-identity.