Utilization of Third-Generation Clinical Approaches in Trauma-Informed Care and Practice

Öz

This article examines the use of third-generation clinical approaches within the framework of trauma-informed care in social work practice. This study employed the review method to examine the basic principles of third-generation clinical approaches, findings from field studies, and clinical practice examples. Third-generation approaches can provide a rich framework to strengthen trauma-informed care in a way that supports traditional trauma interventions, which are more holistic, process-oriented, and client-centered interventions. Mindfulness therapy helps individuals safely remain present in the moment, reduce overreaction and trauma avoidance, and accept their traumatic experiences without judgment. Compassion-focused therapies support individuals' self-compassion, self-soothing, and emotion regulation skills, especially in cases of intense shame and self-criticism. Acceptance and commitment therapy encourages individuals to interact with their distressing thoughts and feelings by accepting them as mental processes without experiencing experiential avoidance or cognitive fusion, while also encouraging psychological flexibility by guiding them to act in line with their values. This study presents evidence-based techniques from these three approaches, aiming to empower individuals who have been exposed to trauma. In addition, we also discussed the applicability of these interventions in various systems and institutional settings such as mental health services, child protection, schools, and prisons. Literature findings indicate that incorporating third-generation clinical approaches into trauma-informed care and practices supports the process of healing from trauma. Expanding evidence-based practice based on third-generation clinical approaches and increasing clinical training for social workers may contribute to the delivery of more effective interventions in trauma-informed care systems.

Anahtar Kelimeler

• Trauma-informed care
• Compassion focused therapy
• Mindfulness
• Acceptance and commitment therapy
• Third-generation approaches

Travma Bilgili Bakım ve Uygulamalarında Üçüncü Kuşak Klinik Yaklaşımların Kullanımı

Öz

Bu makale sosyal hizmet uygulamalarında travma bilgili bakım çerçevesinde üçüncü kuşak klinik yaklaşımların kullanımını ele almaktadır. Bu çalışmada derleme yöntemi kullanılarak üçüncü kuşak klinik yaklaşımların temel prensipleri, alan çalışmalarının bulguları ve klinik uygulama örnekleri incelenmiştir. Üçüncü kuşak yaklaşımlar daha bütüncül, süreç odaklı ve müracaatçı merkezli müdahaleler olması bakımından geleneksel travma müdahalelerini destekleyecek şekilde travma bilgili bakımı güçlendirmek için zengin bir çerçeve sunabilir. Bilinçli farkındalık terapisi, bireylerin güvenli bir şekilde anda kalmalarına, aşırı tepkiselliği ve travmadan kaçınmayı azaltmalarına ve travmatik deneyimlerini yargılamadan kabul etmelerine yardımcı olur. Şefkat odaklı terapiler, özellikle utanç ve öz eleştiri yoğunluklu vakalarda, bireylerin öz şefkat, kendini yatıştırma ve duygu düzenleme becerilerini destekler. Kabul ve kararlılık terapisi ise bireyleri sıkıntılı düşünceleri ve duygularıyla deneyimsel kaçınma veya bilişsel kaynaşma yaşamadan zihinsel süreçler olarak kabul ederek etkileşime girmeye teşvik ederken, aynı zamanda değerleriyle uyumlu olarak eyleme geçmeye yönlendirerek psikolojik esnekliği teşvik eder. Bu çalışma kapsamında travmaya maruz kalan kişileri güçlendirmek için bu üç yaklaşımdan kanıta dayalı teknikler sunulmaktadır. Ayrıca, bu müdahalelerin ruh sağlığı hizmetleri, çocuk koruma, okullar ve cezaevleri gibi çeşitli sistemlerde ve kurumsal ortamlarda uygulanabilirliği tartışılmaktadır. Literatür bulguları üçüncü kuşak klinik yaklaşımların travma bilgili bakım ve uygulamalarına entegre edilmesinin travmadan iyileşme sürecini desteklediğini göstermektedir. Üçüncü kuşak klinik yaklaşımları temel alan kanıta dayalı uygulamaların genişletilmesi ve sosyal hizmet uzmanlarına yönelik klinik eğitimlerin artırılması, travma bilgili bakım sistemlerinde daha etkili müdahaleler sunulmasına katkı sağlayabilir.

Anahtar Kelimeler

• Travma bilgili bakım
• Üçüncü kuşak klinik yaklaşımlar
• Şefkat odaklı terapi
• Bilinçli farkındalık
• Kabul ve kararlılık terapisi

Kaynakça

1. Åkerblom, S., Nilsson, T., Stacke, S., Peppler Jönsson, I., & Nordin, L. (2024). Internet-based acceptance and commitment therapy for transdiagnostic treatment of comorbid posttraumatic stress disorder and chronic pain: A development pilot study. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001663
2. Ackerman, C. & Nash, J. (2017). What Is MBCT? + 28 Mindfulness-Based Cognitive Therapy Tools. https://positivepsychology.com/mbct-mindfulness-based-cognitive-therapy/
3. Aktepe, İ., & Tolan, Ö. (2020). Bilinçli farkındalık: güncel bir gözden geçirme. Psikiyatride Güncel Yaklaşımlar, 12(4), 534-561. https://doi.org/10.18863/pgy.692250
4. Ashfield, E., Chan, C., & Lee, D. (2021). Building ‘a compassionate armour’: The journey to develop strength and self‐compassion in a group treatment for complex post‐traumatic stress disorder. Psychology and Psychotherapy: Theory, Research and Practice, 94, 286-303. https://doi.org/10.1111/papt.12275
5. Asl, N. R. H., Dölek, K., & İl, S. (2021). Sosyal hizmet ve bilinçli farkındalık uygulamaları. Toplum ve Sosyal Hizmet, 32(2), 643-659. https://doi.org/10.33417/tsh.807494
6. Assaz, D. A., Tyndall, I., Oshiro, C. K., & Roche, B. (2023). A process-based analysis of cognitive defusion in acceptance and commitment therapy. Behavior therapy, 54(6), 1020-1035. https://doi.org/10.1016/j.beth.2022.06.003
7. Au, T. M., Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-based therapy for trauma-related shame and posttraumatic stress: Initial evaluation using a multiple baseline design. Behavior therapy, 48(2), 207-221. https://doi.org/10.1016/j.beth.2016.11.012
8. Ayre, K., & Krishnamoorthy, G. (2020). Trauma informed behaviour support: A practical guide to developing resilient learners. University of Southern Queensland. https://open.umn.edu/opentextbooks/textbooks/936

9. Badola, A., Yu, W., & King, A. (2025). Mindfulness-Based Interventions for Psychological Trauma and Posttraumatic Stress Disorder (PTSD). Current Treatment Options in Psychiatry, 12(1), 1-11. https://doi.org/10.1007/s40501-025-00364-x
10. Bean, R. C., Ong, C. W., Lee, J., & Twohig, M. P. (2017). Acceptance and commitment therapy for PTSD and trauma: An empirical review. The Behavior Therapist, 40(4), 145-150.
11. Beaumont EA, Galpin AJ, Jenkins PE (2012). ‘Being kinder to myself’: a prospective comparative study, exploring posttrauma therapy outcome measures, for two groups of clients, receiving either cognitive behaviour therapy or cognitive behaviour therapy and compassionate mind training. Counselling Psychology Review, 27, 31–43.
12. Beaumont, E., Durkin, M., McAndrew, S., & Martin, C. R. (2016). Using compassion focused therapy as an adjunct to trauma-focused CBT for fire service personnel suffering with trauma-related symptoms. The Cognitive Behaviour Therapist, 9, e34. https://doi:10.1017/S1754470X16000209
13. Bethay, J. S., Weinstein, B. J. H., & Stubbs, W. (2022). Acceptance and Commitment Therapy Strategies Guide. https://www.mirecc.va.gov/visn16/docs/act-strategies-guide.pdf
14. Blanning, S. (2024). Treating emotional neglect: polyvagal and trauma-informed compassion focused therapy. Counselling Psychology Quarterly, 1-19. https://doi.org/10.1080/09515070.2024.2413093
15. Boone, M. S., Mundy, B., Morrissey Stahl, K., & Genrich, B. E. (2015). Acceptance and commitment therapy, functional contextualism, and clinical social work. Journal of Human Behavior in the Social Environment, 25(6), 643-656. https://doi.org/10.1080/10911359.2015.1011255
16. Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. Journal of Psychiatry and Neuroscience, 43(1), 7-25. https://doi.org/10.1503/jpn.170021
17. Brinckman, B., Alfaro, E., Wooten, W., & Herringa, R. (2023). The promise of compassion-based therapy as a novel intervention for adolescent PTSD. Journal of affective disorders reports, 100694. https://doi.org/10.1016/j.jadr.2023.100694
18. Corrado, M. (2024). Storiez with urban youth: The evolution of a trauma narrative intervention. Clinical Social Work Journal, 52(1), 37-47. https://doi.org/10.1007/s10615-023-00906-x
19. Daneshvar, S., Shafiei, M., & Basharpoor, S. (2022). Group-based compassion-focused therapy on experiential avoidance, meaning-in-life, and sense of coherence in female survivors of intimate partner violence with PTSD: A randomized controlled trial. Journal of interpersonal violence, 37(7-8), NP4187-NP4211. https://doi.org/10.1177/0886260520958660
20. Diebold, J., Sperlich, M., Heagle, E., Marris, W., & Green, S. (2020). Trauma talks: exploring personal narratives of trauma-informed care through podcasting. Journal of technology in human services, 39(1), 1-23. https://doi.org/10.1080/15228835.2020.1820425
21. Gilbert, P. (2009). Introducing compassion-focused therapy. Advances in psychiatric treatment, 15(3), 199-208. https://doi:10.1192/apt.bp.107.005264
22. Gilbert, P. (2010). An introduction to compassion focused therapy in cognitive behavior therapy. International journal of cognitive therapy, 3(2), 97-112. https://doi.org/10.1521/ijct.2010.3.2.97
23. Gilbert, P. (2014). The origins and nature of compassion focused therapy. British journal of clinical psychology, 53(1), 6-41. https://doi.org/10.1111/bjc.12043
24. Haddock, L. R. (2022). Third-wave cognitive behavioral theories with mindfulness-based interventions. İçinde D. Capuzzi & M. D. Stauffer (Eds.), Counseling and Psychotherapy: Theories and Interventions (7th ed., ss. 217–236).
25. Hall, J. C. (2022). Narrative Therapy. İçinde Theoretical perspectives for direct social work practice: a generalist-eclectic approach. (Eds. Bolton, K. W., Hall, J. C., & Lehmann, P.) Springer Publishing Company.
26. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press.
27. Hepworth, D. H., Larsen, J. A., & Rooney, R. H. (2023). Direct social work practice: Theory and skills. Belmont, CA: Wadsworth.
28. Hosseinzadeh Asl, N. R. (2022). A randomized controlled trial of a mindfulness-based intervention in social workers working during the COVID-19 crisis. Current Psychology, 41(11), 8192-8199. https://doi.org/10.1007/s12144-021-02150-3
29. Hutchison, M., Russell, B. S., & Wink, M. N. (2020). Social‐emotional competence trajectories from a school‐based child trauma symptom intervention in a disadvantaged community. Psychology in the Schools, 57(8), 1257-1272. https://doi.org/10.1002/pits.22388
30. Jirek, S. L. (2017). Narrative reconstruction and post-traumatic growth among trauma survivors: The importance of narrative in social work research and practice. Qualitative Social Work, 16(2), 166-188. https://doi.org/10.1177/1473325016656046
31. Kelly, M. M., Reilly, E. D., Ameral, V., Richter, S., & Fukuda, S. (2022). A randomized pilot study of acceptance and commitment therapy to improve social support for veterans with PTSD. Journal of Clinical Medicine, 11(12), 3482. https://doi.org/10.3390/jcm11123482
32. Kinman, G., Grant, L., & Kelly, S. (2020). ‘It’s my secret space’: The benefits of mindfulness for social workers. The British Journal of Social Work, 50(3), 758-777. https://doi.org/10.1093/bjsw/bcz073
33. Kirby, J. N. (2017). Compassion interventions: The programmes, the evidence, and implications for research and practice. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 432-455. https://doi.org/10.1111/papt.12104
34. Knight, C. (2015). Trauma-informed social work practice: Practice considerations and challenges. Clinical Social Work Journal, 43, 25-37. https://doi.org/10.1007/s10615-014-0481-6
35. Kul, A., & Türk, F. (2020). Kabul ve adanmışlık terapisi (ACT) üzerine bir derleme çalışması. OPUS International Journal of Society Researches, 16(29 Ekim Özel Sayısı), 3773-3805. https://doi.org/10.26466/opus.741907
36. Lander, A. (2019). Developing self compassion as a resource for coping with hardship: exploring the potential of compassion focused therapy. Child and Adolescent Social Work Journal, 36(6), 655-668. https://doi.org/10.1007/s10560-019-00611-0
37. Lely, J. C., Smid, G. E., Jongedijk, R. A., W. Knipscheer, J., & Kleber, R. J. (2019). The effectiveness of narrative exposure therapy: a review, meta-analysis and meta-regression analysis. European Journal of Psychotraumatology, 10(1), 1550344. https://doi.org/10.1080/20008198.2018.1550344
38. Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113. https://doi.org/10.1093/sw/swx001
39. Levenson, J. (2020). Translating trauma-informed principles into social work practice. Social Work, 65(3), 288-298. https://doi.org/10.1093/sw/swaa020
40. Lewis, N. V., Gregory, A., Feder, G. S., Angill-Williams, A., Bates, S., Glynn, J., ... & Malpass, A. (2023). Trauma-specific mindfulness-based cognitive therapy for women with post-traumatic stress disorder and a history of domestic abuse: intervention refinement and a randomised feasibility trial (coMforT study). Pilot and Feasibility Studies, 9(1), 112. https://doi.org/10.1186/s40814-023-01335-w
41. Lucre, K., & Clapton, N. (2021). The Compassionate Kitbag: A creative and integrative approach to compassion‐focused therapy. Psychology and Psychotherapy: Theory, Research and Practice, 94, 497-516. https://doi.org/10.1111/papt.12291
42. Lucre, K., Ashworth, F., Copello, A., Jones, C., & Gilbert, P. (2024). Compassion Focused Group Psychotherapy for attachment and relational trauma: Engaging people with a diagnosis of personality disorder. Psychology and Psychotherapy: Theory, Research and Practice, 97(2), 318-338. https://doi.org/10.1111/papt.12518
43. Mersky, J. P., Topitzes, J., & Britz, L. (2019). Promoting evidence-based, trauma-informed social work practice. Journal of Social Work Education, 55(4), 645-657. https://doi.org/10.1080/10437797.2019.1627261
44. Miller, J. J., Lee, J., Shalash, N., & Poklembova, Z. (2020). Self-compassion among social workers. Journal of Social Work, 20(4), 448-462. https://doi.org/10.1177/1468017319829404
45. Nash, J. (2022). 14+ ACT Interventions & Helpful Therapy Techniques. https://positivepsychology.com/act-techniques/
46. Neff, K. (2025). What is Self-Compassion? https://self-compassion.org/what-is-self-compassion/#the-elements-of-self-compassion
47. Özcan, Ö., & Çelik, G. G. (2017). Bilişsel davranışçı terapi. Türkiye Klinikleri, 3(2), 115-120.
48. Ramirez, M. W., Woodworth, C. A., Evans, W. R., Grace, G. A., Schobitz, R. P., Villarreal, S. A., ... & Terrell, D. J. (2021). A trauma-focused intensive outpatient program integrating elements of exposure therapy with acceptance and commitment therapy: Program development and initial outcomes. Journal of Contextual Behavioral Science, 21, 66-72. https://doi.org/10.1016/j.jcbs.2021.06.002
49. Reha, N., & Reha, A. R. (2024). A Brief Yoga-and Mindfulness-Based Psychoeducation Program for Women Who Have Experienced Domestic Violence: An RCT Study. Journal of Family Violence, 1-14. https://doi.org/10.1007/s10896-024-00734-8
50. Rodríguez-Riesco, L., Vivas, S., Herrera, A. M., Pérez-Calvo, C., & Ruiz-Duet, A. M. (2022). Behavior therapy: roots, evolution, and reflection on the relevance of behaviorism in the clinical context. Papeles del Psicólogo, 43(3), 209-217.
51. Ross, N., Brown, C., & Johnstone, M. (2023). Beyond medicalized approaches to violence and trauma: Empowering social work practice. Journal of Social Work, 23(3), 567-585. https://doi.org/10.1177/14680173221144557
52. Russell, B. S., Wink, M. N., & Hutchison, M. (2024). Mixed methods illustration of teachers’ trauma-informed attitudes and practice. Journal of Child & Adolescent Trauma, 17(2), 349-362. https://doi.org/10.1007/s40653-023-00583-5
53. SAMHSA (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
54. Schachter, J., Ajayi, A. A., & Delgado, J. E. (2024). Evaluating the core processes of a hybrid trauma-informed acceptance and commitment therapy intervention for college students. Journal of Contextual Behavioral Science, 34, 100852. https://doi.org/10.1016/j.jcbs.2024.100852
55. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). The Guilford Press.
56. Spidel, A., Lecomte, T., Kealy, D., & Daigneault, I. (2018). Acceptance and commitment therapy for psychosis and trauma: Improvement in psychiatric symptoms, emotion regulation, and treatment compliance following a brief group intervention. Psychology and Psychotherapy: Theory, Research and Practice, 91(2), 248-261. https://doi.org/10.1111/papt.12159
57. Steindl, S., Bell, T., Dixon, A., & Kirby, J. N. (2023). Therapist perspectives on working with fears, blocks and resistances to compassion in compassion focused therapy. Counselling and Psychotherapy Research, 23(3), 850-863. https://doi.org/10.1002/capr.12530
58. Tanner, D. (2020). ‘The love that dare not speak its name’: The role of compassion in social work practice. The British Journal of Social Work, 50(6), 1688-1705. https://doi.org/10.1093/bjsw/bcz127
59. Uluslararası Sosyal Hizmet Uzmanları Derneği (2015). Code of ethics of the National Association of Social Workers. Washington, DC: Author.
60. Vatan, S. (2016). Bilişsel davranışçı terapilerde üçüncü kuşak yaklaşımlar. Psikiyatride Güncel Yaklaşımlar, 8(3), 190-203. https://doi.org/10.18863/pgy.238183
61. White (2015). Michael White (1948-2008). https://www.goodtherapy.org/famous-psychologists/michael-white.html
62. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. Norton & Company.
63. Winders, S. J., Murphy, O., Looney, K., & O'Reilly, G. (2020). Self‐compassion, trauma, and posttraumatic stress disorder: A systematic review. Clinical psychology & psychotherapy, 27(3), 300-329. https://doi.org/10.1002/cpp.2429