ACT for the management of chronic pain

Acceptance and commitment therapy (ACT), is often associated with treatment for anxiety and depression. However, it has a much broader relevance and is particularly useful for those suffering from chronic pain.

ACT is a contextual behavioural therapy, which places psychological flexibility at the core of healthy emotional functioning. It does this by encouraging clients to take values-guided action, grounded in actual experience, to inspire behavioural change.

ACT teaches ways to stop paying attention to troubling thoughts, so that a person can create and live a rich, full and meaningful life guided by values, while also accepting the pain that is inevitably part of life. It recognises that we all experience illness, physical pain, frustrations, loss and failure, no matter how good our life may be. Using ACT principles and tools, enables a person to realise that they can let go of troubling thoughts and emotions, rather than hold on so tightly that they give up.

The basic premise of ACT, as it relates to chronic pain, is that while pain hurts, it is the struggle with pain that causes suffering. ACT encourages a values-based change in perspective and promotes a more flexible approach to life. While a person may not be able to remove the pain, they can think and act differently to enable them to live a richer and more meaningful life, while accepting that pain is part of their life.

An ACT therapist uses a number of techniques when working with a person suffering from chronic pain. These include:

Encouraging the client to accept that while pain is part of their life, it does not define it. This involves the client taking a step back and looking at their life and thoughts from a different perspective. By simply observing their life and the way their mind interprets it, they give themselves the space and opportunity to think about it in a different way. Acceptance of pain also reduces its intensity.

Understanding and changing the underlying rules that the client lives by. Often we impose rules on ourselves which cause us to become stuck in the struggle of constant negative thinking and action. If a client can identify the unhelpful rules which govern their thinking and belief systems, they can find ways to change them. This is particularly helpful for people suffering with chronic pain who may believe for example, that they need to overcome or work through their pain, when instead they could give themselves permission to rest or do less.

Working with the client to identify their values, which provide the direction or compass for daily life. By understanding and living each day according to clear values, the client is able to live a life beyond a narrow focus on symptom management.

Developing present-moment awareness by the practice of mindfulness. This encourages the client to consciously focus on each moment in an expansive way, while gently letting go of judgement and negative thoughts or worries.  For those suffering with pain, present-moment awareness encourages a broadening beyond a narrow focus on pain, to include an awareness of the wider world around them in each current moment.

Encouraging committed action by finding the actions and activities that work for the client and that are in accordance with the client’s values. For example, taking medication or having a day in bed may sometimes be the best thing a client can do.

While chronic pain can be debilitating, ACT based therapy can relieve some of the suffering. This enables a person to live a richer, more meaningful and value-based life. 

References:
1 Dahl & Lundgren. Acceptance and commitment therapy in the treatment of chronic pain. University of Uppsala, Sweden
2 Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc. Stoddard, J.A., & Afari, N. (2014) The big book of ACT metaphors. Oakland, CA: New Harbinger Publications, Inc.

Caroline Hurst
Contextual Behavioural Therapist
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