Acceptance and Commitment Therapy (ACT) for Chronic Pain

Basically, by accepting and learning to live with pain and the limits of what a person can and cannot do then the person who is suffering can limit the control it has over their life is called Acceptance and Commitment Therapy (ACT) for Chronic Pain. Chronic pain can typically come in many different forms of conditions such as fibromyalgia, chronic pain syndrome, and other types of issues that include intense physical work in the present or past that has left the body with chronic pain.

A few examples could be people who were athletes, people who had to do heavy lifting, and people who had injuries on their job site that never fully healed.

Acceptance and Commitment Therapy highlights the feelings and thoughts without changing the thoughts all together. It is more like accepting that the pain is still there but taking away the power the pain has on a person. The pain is still there, but not as debilitating as it had been.

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However, the person would still need to be aware of the limitations that will still come with being is chronic pain. Usually 8 sessions are estimated to be the amount of time needed for this type of therapy to be successful. This can be adjusted as needed because each person is different, so it might need to be tweaked a little.

Pain is a part of life. We all experience at one point or another in our lives. This approach to help with chronic pain is not to take away the pain.

It is that living with the pain everyday can be a struggle and make living your life harder. Chronic pain, while it can be helped with medication and therapy, it does not change the fact that the person is constantly being affected by it every day. and Pain is not always an easy thing to spot. Sometimes it is like if a person has a broken arm, but if they have a dislocated disc then no one would be able to tell just by looking at them. The hope is not to control pain, but how people tend to react to it.

Cognitive behavioral therapy or CBT is a big part of ACT approach. The main use of CBT in this case is the use of life script and schema theory in which the client and therapist can process and evaluate the thoughts and beliefs that can control a person’s life. The main difference between CBT treatment that is commonly used for other presenting issues is that with chronic pain and ACT with chronic pain is that the main goal is on reducing pain behaviors and increasing healthy habits, with the focus being on pain management. ACT, in contrast, is aimed toward on accepting that the pain is a part of who they are now rather than trying to manage or reduce it.

Another theory that is commonly used with ACT is mindfulness. Mindfulness means keeping a consciousness of our thoughts, feelings, bodily sensations, and surroundings, through a calm method. Mindfulness can also involve acceptance, meaning that we pay attention to our thoughts and feelings without judging them or without believing, for instance, that there’s a right or wrong way to think or feel in a given moment. When we practice this, our thoughts focus into what we’re sensing in the present moment rather than repeating the past or conjuring up the future. However, as it pertains to ACT, it is the acknowledgement of pain related thoughts that tells the person in pain to avoid events or situations and assess the thought for what they are, instead of truth or fact.

Techniques

The model of treatment here is built on Acceptance and Commitment Therapy (ACT) and can include mindfulness-based methods and other skills training, depending on the needs of the person looking for treatment. The prime treatment methods from ACT include acceptance, cognitive diffusion, committed action, contact with the present moment, and values. The aim in treatment is not that the patient will understand or believe these as psychological process, and it is that they will engage in behavior patterns that include these processes.

• The treatment ideas talked about here are designed to guarantee the specific procedures are taken into focus. They are designed to be delivered according to ongoing study of behavior problems patients present.
• The primary processes here are specified in a roughly chronological manner, and that sequence may work well for many patients, however, it is also possible to stray from this arrangement if that achieves a better result.
• One goal here is to be sure that each process that is applicable to the individual is delivered as needed. Most of the processes will be brought into sessions repeatedly even if following claims are short-term.
• Sessions will usually progress by checking in with patients, seeing what has happened since the last meeting, often picking up a thread from the previous session, and watching what important psychological content or processes emerges to address.
• Clinical skills around reflective listening, empathy, pace, and building a relationship are important; and it is probably useful to keep a focus on these without getting too focused or exclusively focused on all the interesting ACT methods.

Measures

• Chronic Pain Acceptance Questionnaire-revised

1. Measures acceptance of pain since acceptance is thought to decrease failed attempts to evade or control pain
2. Two key aspects are active engagement and pain willingness

• Chronic Pain Values Inventory https://www.div12.org/wp-content/uploads/2015/06/Chronic-Pain-Values-Inventory.pdf

1. 12 item inventory to show values and assess the degree of accomplishment that the client is having in following values.

• Psychological Inflexibility in Pain scale https://www.div12.org/wp-content/uploads/2015/06/Psychological-Inflexibility-in-Pain-Scale.pdf

1. Assess avoidance, acceptance, fusion and values orientation of clients in chronic pain

• Committed Action Questionnaire -8 https://www.div12.org/wp-content/uploads/2015/06/CAQ-8.pdf

1. Brief inventory to see where client is in terms of hope of quality of future life and current level of hope in general

• Valued Living Questionnaire https://www.div12.org/wp-content/uploads/2015/06/Valued-Living-Questionnaire.pdf

1. Rate 10 domains of life indicating their level of importance and how much the client shows the value of that importance within that week.

Additional Training

• • Life with Chronic Pain: An Acceptance-based Approach Therapist Guide and Patient Workbook ACT for Chronic Pain
• https://www.div12.org/wp-content/uploads/2015/06/Life-with-Chronic-Pain-Therapist-Guide-Patient-Workbook.pdf
• • Acceptance and commitment therapy in the treatment of chronic pain by JoAnne Dahl and Tobias Lundgren University of Uppsala, Sweden
• https://www.div12.org/wp-content/uploads/2015/06/ACT-in-the-treatment-of-chronic-pain.pdf

Additional Tools

• This one is an app for a smart phone, which could be a quick and easy resource: ACT Companion: The Happiness Trap App with Dr. Russ Harris (Berrick Psychology)
• Self Help book: Living Beyond your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain by JoAnne Dahl