Managing chronic pain (using tools from acceptance and commitment therapy) - contacting the present moment

In the previous post, I gave an overview of the six core processes of acceptance and commitment therapy. Now it is time to delve more deeply into the first one: Contact with the present moment.

What does contact with the present moment mean?

Essentially, this is all about your ability to notice your here-and-now experience and actively choose where you are putting your attention. This can be hard at first but is absolutely a skill that we can train and develop.

How will that help if the present moment is full of pain?

This is a common question. When living with chronic pain or chronic illness, there are two responses that seem very natural: to either turn away from the pain through distraction or avoidance, or to over focus on the pain, forgetting the broader elements of our here-and-now experience.
Both of these responses reinforce the messaging to our brains that pain is a monster to be defeated, which adds a second level of suffering: not only are we in physical pain, but we are hurting psychologically too as we put all our energy into judging and avoiding sensations.
By getting curious about our present experience, we can begin to relax around the pain, and decide where our focus goes.

The how

The biggest tool to cultivate when working on this is mindfulness. The attitude to employ with mindfulness is curiosity. Pretend you are a curious scientist, observing your present experience and sensations with an eager interest. This adds a layer of separation between you and your pain.

Mindfulness is a skill you can be practising all the time. Of course, formal meditation exercises will help very much. But remember, we are always training our brains, and we have many opportunities in the day to practise mindfulness rather than distraction. For example, practise doing an activity that you are able to do and really bring your full attention to doing that activity, rather than multitasking.

Once you start to train in mindfulness, you will be able to direct your attention more easily. If chronic pain is the main issue, it will be most useful to be able to broaden your attention.

Broadening your attention

When we are in pain, it is very natural to focus solely on that pain, tensing up around it. The antidote to this is to get in touch with the broader elements of your experience, for example your other senses and the environment around you. By doing this, pain becomes one sensation in a sea of sounds, thoughts, smells, tastes, sights, etc. In this way, the pain monster loses its power.

 The steps to do this (choose any or all that seem accessible to you):

1)     Take three deep breaths into your belly and allow yourself to relax on the exhale. Notice the support of the chair/bed.

2)     Start to become aware of any sounds around you, and see if you can label three of them. Notice your body relax a bit more.

3)     Gently look around the room and label three things that you see. Notice your body relax a bit more.

4)     Become curious about your sense of smell. Can you smell anything? If so, label the smells. Gently come back to your body and notice any areas where it has relaxed.

5)     Become curious about your sense of taste. Can you taste anything? If so, label the tastes. Gently come back to your body and notice any areas where it has relaxed.

6)     See if you can stay with this broader sense of awareness for another thirty seconds and reflect on what impact the exercise had.

Do this as many times and as often as you need. Remember it is a skill to practice.

Have fun experimenting with this, and remember to be curious!