ACT (Acceptance and Commitment Therapy) stems from some of the same concepts as CBT; it helps you to understand your pain, to come to a state of acceptance, and to commit to taking action to live with your chronic condition more effectively. As with CBT, it helps you to empower yourself and improve your life while living with your illness.
ACT focuses on accepting what is happening in the present and not trying to avoid situations that may cause a flare up in symptoms, instead facing things head on. It focuses on setting goals and doing what you want with your life rather than limiting yourself. ACT is fundamentally about being committed to the actions you have chosen to take and not allowing fear of your pain to stop you from moving forward and going after what you really want in your life.
How is ACT different to CBT?
ACT is different than CBT, although comes from the same school of thought, because while CBT focuses on changing the thoughts you are having, challenging them with the goal of making them more positive, ACT is about accepting those thoughts and understanding that it’s ok to have a negative thought rather than trying to change it. ACT helps you to understand a negative is just that, it’s just a thought, and it doesn’t have to dictate your actions. ACT helps you to accept those negative thoughts, to accept your pain, and not trying to shy away from it; this can empower you to realise that even if you are in pain, you can still function and that you do not have to be afraid of your pain.
How ACT can help you with your chronic pain
When you live with chronic pain it’s natural to use the behaviour of avoiding things that you feel could increase your symptoms as a coping strategy, because simply, we do not want to make our pain worse when we are already struggling. That’s a valid response, but it can also be a detreminal one. By avoiding certain situations we perpetuate fear, and we condition ourselves to avoid certain situations and train our minds to think that we ‘can’t’ do certain things. This leads to us limiting our life and missing out on experiences. Not only that, but it makes us so much more aware of our pain, bringing it to the forefront of our minds and therefore increasing stress and worry, contributing to the cycle of pain.
Learning how to accept what you are going through and not to fear it, frees you from these boundaries that you may have put in place in your mind; you are free to live the life you choose and to take action to shape that life in the way that you desire. This study showed that,
Participants showed significant improvements in physical disability, psychosocial disability, and depression
6 core ACT processes
There are six core processes that ACT is developed around:
Acceptance: this stage revolves around learning to accept the fact that you are in pain, to accept the reality of your situation without trying to run away from those difficult thoughts. Facing up to things can be really tough, but it can also be highly beneficial in a therapy of this sort.
Cognitive defusion: this stage is about learning to acknowledge thoughts without putting too much stock in them. For example thinking “I’m in a lot of pain today and it’s really hard to deal with”, recognising that thought without attaching a negative or positive connotation to it: it’s not bad or good to have that thought, it just is what you are thinking.
Present moment awareness: when you live with pain in your life, without even realising it, it becomes a habit to start worrying about how that pain is going to affect the rest of the day, the rest of the week, your long term future. This stage of ACT is about learning not to overthink, not to get ahead of yourself, essentially to deal with things one moment at a time and be grounded in the present.
Self as context: this stage allows you to connect more with who you are as a person, meaning understanding more so that you are not your pain, that your pain is something you are going through but your own sense of self is separate from your symptoms. It can be easy to think you already know this, and practically you may, but when you’re living with pain every day, it’s so easy for that pain and your own sense of self to become deeply entwined unconsciously.
Values: often what is most difficult about living with a chronic pain condition is not just the pain itself but the life you feel you have lost, the things you feel you are no longer able to do. This stage is about understanding what your values in life are, what will make you happy, what you want to achieve and experience, and realising that you can still have those things. It’s all about resetting your priorities in life and setting goals for your future without limitations from your chronic illness.
Committed action: the final step is about following through on the lessons you have learned, setting practical goals that align with the values you have realised, and really being determined to follow through. It’s about taking action and forging on towards those goals you’ve set, even if you come across bumps in the road or find it worrisome.
Living the life you deserve
ACT can help us to break out of that box that we have created for ourselves. To understand that the key to living with our condition is not to limit our lives and miss out on experiences, but instead to face things head on and be dedicated to working with our pain and doing things that bring us joy. ACT’s goal is not necessarily to reduce the pain but to help you to live your life with it, to feel more confident in engaging in activities that you might have otherwise swayed away from. It’s about understanding that while chronic pain is valid and very difficult to live with, that the pain isn’t going to cause damage to you, and that you can still function while you’re in pain. This study showed that those in a group being treated with ACT, “demonstrated lower disability, less depression, and significantly higher pain acceptance”
The similarities in both ACT and CBT are that both empower you to live with your chronic pain and live at a higher level of functioning; the goal is to have a more fulfilled life. The type of therapy that is going to work for you is individual to each person, to your mindset and your situation; for some the approach of CBT may be more beneficial, while for others ACT could really help you to live the life you deserve.
Please note: This article is made available for educational purposes only, not to provide personal medical advice.
- Lance McCracken, Ph.D., (2012), “ACT for Chronic Pain”
- Lance McCracken, Ph.D., Rosie Jones BSc, (2012), “Treatment for Chronic Pain for Adults in the Seventh and Eighth Decades of Life: A Preliminary Study of Acceptance and Commitment Therapy (ACT)”
- JoAnne Dahl and Tobias Lundgren, “Acceptance and commitment therapy in the treatment of chronic pain”
- Lance M. McCracken, Ayana Sato, Gordon J. Taylor, (2013), “A Trial of a Brief Group-Based Form of Acceptance and Commitment Therapy (ACT) for Chronic Pain in General Practice: Pilot Outcome and Process Results”
- Psychology Today, Deborah Serani Psy.D.,(2011), “An Introduction to Acceptance and Commitment Therapy”
- Integrative Pain Science Institute, “Acceptance and commitment therapy for chronic pain”
- Good Therapy, (2007), “Acceptance and Commitment Therapy (ACT)”