Acceptance and Commitment Therapy (ACT) for Chronic Pain and Illness
Acceptance and Commitment Therapy, simply called “ACT,” stems from traditional Cognitive Behavioral Therapy (CBT). ACT is an evidence-based, third-wave cognitive behavioral therapy that includes acceptance, mindfulness, and committed action to help increase psychological flexibility. The goal of ACT is not to reduce symptoms per se, which is a tremendous additional side effect- but to clarify a person’s values to live a meaningful life.
Acceptance and Commitment Therapy is not like traditional therapy and other pain management models that focus on “feeling good” and pain reduction as primary sources of help. Many approaches operate under the belief that “pain is bad” and that you need to be pain-free to have an excellent, nourishing existence.
The Core of ACT- Increasing Psychological Flexibility
Psychological flexibility rests on the ability to in the present moment with full awareness and openness to our experiences and to live and take value-based actions. When we can allow ourselves to open up to new experiences, the greater our quality of life can be despite living with chronic pain and illness. When we engage in value-based actions, we can develop a sense of purpose and meaning and experience more self-energy.
The Six Core ACT Processes
Acceptance
Cognitive Defusion
Present Moment Awareness
Self as Context
Values
Committed Action
Acceptance
Within ACT, acceptances mean opening up and making room for painful feelings, urges, sensations, and emotions. Acceptance does not mean liking or wanting pain, and it simply means making room for them. Often the more we fight, resist, and avoid negative feelings and emotions- it doesn’t mean they will go away. Instead, it keeps us in our heads and avoids being in the present moment.
Applying acceptance when working with chronic pain and illness allows the individual to open themselves up to the experience of pain rather than always trying to escape pain or the feelings associated with it- the person begins to see it as a part of their usual way of living.
Cognitive Defusion
Defusion means learning to “step aside or back” and detach or separate from our images, thoughts, and memories. It is easy to become overwhelmed and caught up in our thoughts, which leads us overanalyzing situations. We notice them when using ACT instead of getting caught up in our thoughts or being pushed around. We let our thoughts, images, and memories come and go, such as the clouds in the sky or cars passing by outside. We just watch, nonjudgmentally, and maybe with a bit of curiosity.
Contacting the Present Moment
Contacting the present moment, or maybe you have heard of mindfulness, means being psychologically present: consciously and intentionally engaging and connecting with this very present moment. Practicing mindfulness is not easy. Our minds are always active, providing us with all sorts of sometimes- fun or not chatter. It’s easy to get caught up and lose touch with what’s going on around us. We may spend a lot of time in the past or future, which often leads to us feeling depressed (past) or anxious (future). Contact the present moment encourages us to become more flexible with bringing our awareness to the physical world, our psychological world, or even at the same time. Present moment awareness makes us focus on our “here-and-now” experience instead of being stuck on “auto-pilot.”
Self-As-Context (Pure Awareness)
There is much debate around the concept of “Self.” From an ACT perspective, self-as-context is divided into two elements, the thinking self and observing self. I’ll briefly explain the difference. First, our thinking self is the part of us that many of us know all too well. This part of us is, well, always thinking- creating beliefs, thoughts, judgments, memories, plans, and it continues. The second part, the observing self this - may be more unfamiliar. Our observer self is the side of us that is aware of our feeling, senses, thinking, or doing at any moment. I know that may sound confusing- but just keep following me. For instance, as you move through life, you change- your body changes, feelings change, thoughts change, and roles change- but “you” can still notice and observe all of those changes. Your “Self” is always there, noticing everything around you.
Values
Your values are the things that you believe are important to the way you live your life. Look deep into your life; what do you truly desire? What do you want to be remembered for during this lifetime? What is matters to you in the big picture? Our values help us to describe the way we want to move throughout our lives. ACT works to clarify values as an important factor towards living a meaningful life. While living with chronic pain or illness poses many challenges, you still have values! Ultimately, as long as we are taking steps (big or small) that align with our values, you are already working toward creating your definition of a meaningful life.
Committed Action
Committed action is the last step of ACT, when individuals change their behaviors and take actions that support and move towards their values, despite living with chronic pain or illness. For instance, this stage may look like developing goals that align with their values.
I’ll use a more concrete example. Let’s say Anya values spending more time with friends. Anya makes the goal to spend 2-3 hours a month spending time with friends. However, Anya lives with chronic pain and worries that it will interfere with meeting with friends. When Anya begins to experience anxious thoughts, fears, unease, or psychological barriers- she may implement present moment awareness or cognitive defusion, so she can still have these thoughts and feelings while still living towards her values, in this case, seeing her friends.
How ACT Can Help you With Chronic pain and Illness?
It’s not uncommon for those living with chronic pain to avoid things that further increase their symptoms through various coping strategies. Most people do not want to make their pain worse- I get it. However, by continually avoiding situations, we further continue the cycle of fear, worry, and anxiety- we subconsciously train ourselves to avoid certain situations and tell ourselves that we cannot do certain things, increasing the sense of isolation and making us miss out on life experiences. Not only do we feel bad for missing out on experiences, but it also brings feelings of pain into our minds, increasing stress which contributes to the pain cycle.
ACT is not a cure for pain. Your pain is genuine, and we cannot wish it away for many people living with chronic pain and illness. Learning how to accept your pain and illness and approach it with fear- can make you break free from the chains that your mind can create. Within ACT, you can still have chronic pain and take actions that you desire to create the life you deserve.
You deserve happiness.
Reach Out to an ACT Therapist for Chronic Pain and Illness in Fayetteville, NC
The Virtual Couch specializes in chronic illness and pain counseling, anxiety therapy, trauma counseling, grief and loss therapy, disability counseling, depression therapy, and Brainspotting. These services are available via online counseling in North Carolina from Raleigh, Cary, Greensboro, Winston-Salem, Durham, Chapel Hill, Wilmington, Greenville, Charlotte, or Asheville. If you are ready to begin, just follow these quick steps:
1. Contact The Virtual Couch for a free 15-20 minute meet and greet.
2. Meet Patricia, a chronic pain therapist.
3. Begin effective online counseling from the comfort of your home.
