What is Acceptance and Commitment Therapy (ACT) and its potential role in Pain Management?
Acceptance and Commitment Therapy (ACT) is a form of therapy which can be used to treat many different conditions such as depression, anxiety and pain. It is best described as:
Getting to know unpleasant feelings, then learning not to act upon them (Noam, 2010)
ACT gets its name from its two core messages:
- Accept what is out of your personal control – in this context, pain.
- Commit to action that improves and enriches life
ACT utilises three key mechanisms:
- Values-based action
Acceptance through ACT teaches you how to accept the fact that you have pain. This allows you to recognise the things you cannot do at present because of the pain. This does not mean that you will never be able to do these things or that you will always necessarily be in pain. It just means that you can identify specific things which are unachievable goals at that moment in time. This then allows you to move forwards and create a plan for how you may be able to do these things in the future. It is much easier to plan going forwards, if you have unloaded all the ‘baggage’ of worry about various things you cannot currently do.
Mindfulness has been described as a mental state of awareness, focus and openness (Harris, 2013). This mental state allows you to engage fully in what you are doing at any particular moment. In a state of mindfulness, difficult thoughts and feelings have much less impact and influence over you. As you can imagine, this is extremely useful to allow you to escape your ‘pain-troubled existence’.
3. Values-Based Action
Usually, when you attend a physiotherapist or a therapy session of any kind, the therapist will talk about goals - goals for treatment, goals for sport, functional goals etc. However, ACT works a little differently. Rather than creating goals, ACT facilitates you in becoming aware of the most important things in your life at that point in time by becoming aware of your values. For example, a goal could be: ‘Able to walk a mile’. A value could be: ‘Able to walk around the corner to visit your elderly neighbour’. While the physical distance in the first one is far greater, the importance is not in the size of the achievement of the goal. It is instead about which is of more personal value to you in the present.
So how do all these mechanisms help with pain management?
Anyone who has experienced pain, be it for a few hours or a few years, will know how distracting it can be. One can become consumed by it and be unable to think of anything else. When in a ‘pain distracted state’, the aforementioned 3 mechanisms can help greatly:
- Acceptance can allow you to accept where you are at the present, to allow you to better plan for the future.
- Mindfulness can allow you to live in the moment and help you to avoid constant thoughts of pain.
- Values-based action can allow you to live a more fulfilling life in the present – one according to your own personal values.
Where’s the proof?
A recent body of research by Buhrman et al, 2013; Johnston et al, 2010; McCracken & Gutierrez-Martinez, 2011; McCracken & Jones, 2012; Vowles & McCracken, 2008 and Thorsell et al, 2011 has proven the effectiveness of ACT as a method of treating pain, specifically chronic pain.
I will finish with a quote from a participant of a piece of unpublished research which investigated the effects of ACT for a group of chronic pain sufferers in Ireland...
“Prior to the course I wasn’t sure anyone took my chronic pain seriously. During the course this was never in question and it helped me to accept that I would have to live with the pain but [that I could] make it [the pain] more tolerable by employing various thought processes.”
- Buhrman M, Skoglund A, Husell J, Bergström K, Gordh T, Hursti T, Bendelin N, Furmark T, Andersson G. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behav Res Ther 2013; 51: 307-315.
- Harris, Russ 2013. ACT Mindfully, Excellance and innovation from australia’s leaders in Acceptance and Commitment Therapy. Acceptance and Commitment Therapy Training. URL: http://www.actmindfully.com.au/acceptance_&_commitment_therapy
- Johnston M, Foster M, Shennan J, Starkey NJ, Johnson A. The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. Clin J Pain 2010; 26(5): 393-402.
- McCracken LM, Gutiérrez-Martínez O. Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behav Res Ther 2011; 49: 267-274.
- McCracken LM, Jones R. Treatment for Chronic Pain for Adults in the Seventh and Eight Decades of Life: A Preliminary Study of Acceptance and Commitment Therapy (ACT). Pain Med 2012; 13: 861-867.
- Shpancer, Noam (September 8, 2010). "Emotional Acceptance: Why Feeling Bad is Good". Psychology Today.
- Thorsell J, Finnes A, Dahl J, Lundgren T, Gybrant M, Gordh T, Buhrman M. A comparative study of 2 manual-based self-help interventions, acceptance and commitment therapy and applied relaxation, for persons with chronic pain. Clin J Pain 2011; 27(8): 716-723.
- Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. J Consult Clin Psychol 2008; 76(3): 397-407.