ACT Versus CBT Therapy: Which is best for chronic pain?

Did you know that there are variations of talk therapy such as ACT and CBT that can result in dramatic improvements to your pain? Let’s explore these.

For those who suffer from chronic pain, you’ll likely be aware that there are many different ways to help manage it, from medication and lifestyle changes to therapy and physiotherapy. With all the various options, it can be confusing to know which will suit you best – and there’s often one that is forgotten: talk therapy.

Talk therapy can be effective for chronic pain improvement as it deals with the mental and emotional aspects of pain. These aspects can often be neglected in favour of dealing directly with the physical sensations, but that can be largely detrimental to a patients’ health as we fail to deal with the root cause of pain.

The importance of this has become so profound that there is now a speciality of psychology dedicated to pain; workers in this field are aptly known as pain psychologists and they can make all the difference to the pain you experience.

Pain psychologists work with patients to help them better understand their pain, and learn effective coping mechanisms to change the thoughts, feelings and behaviours that can come with an experience of chronic pain. This is a hugely important area of psychology because often, it’s forgotten – or not even known – that pain is directly impacted by how a person thinks and feels.

If you’re looking at undertaking some sort of therapy for your chronic pain management, there are two in particular that can be highly effective. These are: Acceptance and Commitment Therapy (ACT) and Cognitive Behaviour Therapy (CBT). They both have positives and negatives, but is there one that is best suited to chronic pain?

Acceptance and Commitment Therapy

ACT was designed as a combination of cognitive and behavioural therapies, back in the 1980s. Its purpose is to enable patients to focus and behave more in line with individual values, by way of mindfulness and acceptance. The theory behind ACT is that patients are able to learn how to control their emotional responses to external, uncontrollable circumstances.

ACT is known for treating things like mild/moderate depression, obsessive-compulsive disorders, smoking, psychosis, epilepsy, and disordered eating. Further, it’s widely lauded as being a highly effective treatment for chronic pain. 

ACT works to encourage patients to observe and accept their thoughts and feelings, rather than trying to change how they feel. Further, it encourages patients to decide on personal values, goals and a desired life direction, and apply behaviours that are consistent only in those values and goals.

There are six main principles for ACT. They are:

  • Cognitive defusion (which means separating from your thoughts, and looking at them rather than from them) 
  • Expansion and acceptance (the practice of making room for all the unpleasant emotions/sensations we feel, rather than trying to ignore them)
  • Contact and connection with the present moment (in order to feel our emotions/sensations, we must first be connected to ourselves and the present)
  • The Observing Self (an all-encompassing awareness of yourself, from a non-judgemental mindset)
  • Clarification of values (getting clear on the most important things to us, such as loyalty, love, happiness, morality and compassion)
  • Committed action (setting goals and taking active steps towards achieving them through commitment)

ACT is an amazing model of psychotherapy for chronic pain as it encourages belief that pain hurts, but it’s the way we feel about it that causes such stress and struggle. Given that the feeling of pain is, at its very base, a somatic, neurological reflex without emotional tie-ins, it makes sense that the emotions that stem from it come from the mind. Therefore, mindfulness therapy, such as that of ACT, is a great way to combat feelings of suffering. 

Cognitive Behaviour Therapy

CBT is a model of psychotherapy with an emphasis on talking. The premise is that our cognition (the way we think), our behaviour (the things we do) and our emotions (how we feel) all exist together, and by giving this focus and changing our thoughts, we’re able to change the ensuing behaviour and feelings.

With this theory in mind, CBT aims to teach patients how to change their thoughts and behaviours, specifically those which cause the patient great harm and/or distress.

CBT can assist in treating things like:

  • Anxiety and anxiety-related disorders
  • Depression
  • Irrational fears
  • Substance abuse
  • Addictions such as gambling
  • Insomnia
  • Disordered eating

And it works to change what’s known as ‘basic irrational assumptions’. That is, the thoughts that a large majority of people have, yet aren’t aware that they’re not correct in thinking that way. Irrational assumptions can include things like:

  • Believing that you should be thoroughly competent at any task you try
  • Believing that things are catastrophic and doomed if they’re not how you’d like them to be
  • Believing that you have no control over your own happiness
  • Believing that you need someone ‘better’ than you to depend on
  • Believing that anything done in your past is greatly influencing your present

For someone with chronic pain, an irrational assumption might be something like “I’ll never get well again”, or “I’m a burden because of the pain that I feel”. So CBT is a fantastic way to challenge those thoughts directly, proving them to be false, and then replacing them with more positive thoughts. CBT teaches you skills which allow you to do this often, and the more you do it, the easier it becomes. 

Anyone who suffers from chronic pain might be thinking that it isn’t as simple as “changing your thoughts and behaviours”, because this won’t take away the cause of the pain. However, CBT works very well at ensuring patients are well-equipped with better coping skills and a changed awareness and perception of pain. And when you change your perception of pain, you change your experience of it.

There’s no ‘one-size-fits-all’ solution when choosing which therapy model is best for you. And while no one is implying that pain is all in the mind, you can work to change your perception of that pain by removing or dulling the thoughts and behaviours that only serve to fuel it. So whether you decide to participate in ACT or CBT for your chronic pain management, it’s always beneficial to include it alongside other pain management methods, such as medication, massage and/or physical therapy. 


Please note: This article is made available for educational purposes only, not to provide personal medical advice.

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