ACT: Strategies for Acceptance in ‘Curing’ Chronic Pain

When seeking medical attention for an ailment or chronic pain, we as modern humans are conditioned to focus on a single, specific resolution: a cure.

And yet, when it comes to conditions like chronic pain, the cure – like the specific musculoskeletal cause and generator of long-term pain – is often elusive. Over time, this can lead to a higher level of discomfort, fear, anxiety and even depression in the patient.

chronic pain

For physical therapists, it can be frustrating, as well. Addressing pain head-on when its causes remain a question mark and patient compliance dwindles simply isn’t what you had planned.

That’s why some PTs are now looking to expand their treatment repertoire and their knowledge about the psychological (mental and emotional) effects of chronic pain.

This has led to a strong interest in a form of psychotherapy, counseling, and behaviour change method called Acceptance and Commitment Therapy (ACT). 

Addressing pain head-on when its causes remain a question mark and patient compliance dwindles simply isn’t what you had planned. Click To Tweet

Acceptance & Commitment Therapy (ACT)

ACT is an orientation to psychotherapy that is based on functional contextualism.

ACT is a type of counseling that stresses mindfulness and the acceptance of life’s difficulties, ACT is used to help chronic pain sufferers move more confidently toward behavioral changes and solutions.

chronic pain

Unlike traditional cognitive behavioral therapy, which teaches people ways to better control or eliminate unpleasant or painful  thoughts, emotions, feelings, memories, and physical sensations, ACT encourages people to open to all that life is offering – to be mindful and aware to these challenges in order to bring about change and action.

ACT encourages people to open to all that life is offering – to be mindful and aware to these challenges in order to bring about change and action. Click To Tweet

The goal of ACT is to develop what’s called “psychological flexibility,” or the ability to be more aware, focused and engaged when it comes to challenges like chronic pain. Such flexibility opens up a greater willingness to set and commit to specific goals that can improve the condition.

These goals work to replace avoidance with acceptance, finding direction by establishing a set of values, and taking small steps through committed actions that can improve quality of life.

My experiences with hundreds of chronic pain patients over the last decade have clearly taught me that these concepts about the very nature of chronic pain are the most important first steps in recovery.

However, changing how one understands the pain and finding hope in the belief that the pain can be cured is not always sufficient. Many people do need more.

Through ACT, they get more by developing a level of one’s acceptance, which allows them to find a higher level of control in their condition. Over time, this allows them to move toward change, action and rebuilding their lives.

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Enter Physical Therapy with ACT

Armed with the principles of ACT, a physical therapist can further enhance his or her treatment of chronic pain in a way that’s both innovative and evidence-based. Weaving ACT in with traditional physical therapy creates a type of psychologically informed physical therapy. 

chronic pain

Combined with other enhancements such as functional nutrition and relevant physical therapy interventions, ACT can allow a private practice PT to develop a more comprehensive, holistic and effective chronic pain program for his/her clinic that, over time, sets them apart within their markets.

Of course, such efforts will also prove more successful in improving the outcomes of your most important allies: your chronic pain patients.

To learn more about Acceptance and Commitment Therapy and how to incorporate such approaches within your PT clinic, visit our website. There, you can also learn more about the ACT courses we offer physical therapists, as well as join a waiting list for our next course, “Exposure-Based Treatment of Chronic Pain.”

REFERENCES:

1- Buchbinder, R., van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., … & Maher, C. G. (2018). Low back pain: a call for action. The Lancet, 391(10137), 2384-2388.

2- Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., … & Turner, J. A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet, 391(10137), 2368-2383.

3- McCracken, L. M., & Morley, S. (2014). The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain, 15(3), 221-234.

4- Godfrey, E. L., Wileman, V. A., Galea Holmes, M., McCracken, L., Norton, S., Moss-Morris, R., … Critchley, D. J. (2019). Physical therapy informed by Acceptance and Commitment Therapy (PACT) versus usual care physical therapy for adults with chronic low back pain: a randomised controlled trial. The Journal of Pain.DOI: https://doi.org/10.1016/j.jpain.2019.05.012

5- Godfrey, E., Holmes, M. G., Wileman, V., McCracken, L., Norton, S., Moss-Morris, R., … & Critchley, D. (2016). Physiotherapy informed by Acceptance and Commitment Therapy (PACT): protocol for a randomised controlled trial of PACT versus usual physiotherapy care for adults with chronic low back pain. BMJ open, 6(6), e011548.

6- Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., … & Carr, D. B. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 113(1), 9-19.

7- Bombardier, C. (2000). Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine, 25(24), 3100-3103.

8- Hudak, P. L., & Wright, J. G. (2000). The characteristics of patient satisfaction measures. Spine, 25(24), 3167-3177.

9- Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017). Acceptance and Commitment Therapy (ACT) for Chronic Pain: A Systematic Review and Meta-Analyses.

10- Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2011). Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behaviour research and therapy, 49(11), 748-755.

11- Richmond, H., Hall, A. M., Copsey, B., Hansen, Z., Williamson, E., Hoxey-Thomas, N., … & Lamb, S. E. (2015). The effectiveness of cognitive behavioural treatment for non-specific low back pain: a systematic review and meta-analysis. PloS one, 10(8), e0134192.

12- Pincus, T., Anwar, S., McCracken, L. M., McGregor, A., Graham, L., Collinson, M., … & Farrin, A. J. (2015). Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk; results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy. BMC musculoskeletal disorders, 16(1), 147.

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