Managing chronic pain (using tools from acceptance and commitment therapy) - defusion

Let’s have a look at how we can apply the concept of defusion to chronic pain management.

What is defusion?

According to Russ Harris (2019) defusion means learning to step back and separate or detach from our thoughts, images and memories.

What has that got to do with chronic pain?

It is common for people who live with chronic pain or illness to also suffer psychologically as a result. For example, there can be a lot of fear around when the pain or illness may worsen and our ability to cope with it. There can be a sense of grief or sadness about the life we are no longer able to live, or anger that this has happened to us.

A helpful way to look at this is through the concept of ‘the second arrow’ which comes from Buddhist psychology. The first arrow that we can be struck by is physical pain or illness, which of course hurts. The second arrow which often strikes (understandably), is our reaction to that first arrow – our thoughts and judgments about what has happened. It is the impact of second arrow that we are looking to change through defusion. We cannot change the amount of pain we are in, but we can certainly change our reactions to it.

This doesn’t mean that our thoughts are not true, it just means that we learn to relate to them in a way that allows us to engage more fully with the life we have now.

How?

There are many ways to practice defusion. Here is an introduction to some ways you can start getting curious with defusion:

-        Start to experiment with seeing your mind as separate to you, like a nonstop radio that is constantly throwing out thoughts.

-        To do this, try to cultivate a real sense of curiosity about what thoughts are present in your mind at the moment. Stop and ask yourself “what thoughts am I experiencing right now?”

-        Once you have begun to notice the thoughts, start to name them, for example “I am having the thought that I cannot cope with this pain”, and then “I am noticing that I am having the thought that I cannot cope with this pain”.

-        Once you have noticed your thoughts in this way, you can begin to separate from them more effectively. There are many ways to do this. For example, try imagining that your thoughts are balloons in your hand and watch them float away into the sky, or imagine that you are a bus driver and the thoughts are the passengers on the bus (you control the direction of the bus, not the thoughts).

Compassion

Remember that the point here is not to scrub our minds clean by pushing thoughts away or to beat yourself up for having thoughts. Your mind has evolved to react in this way in the face of pain, and having difficult thoughts and feelings is totally natural. Become curious about whether or not your mind’s solutions and thoughts are helping to enrich your life, or if it would be more beneficial to take a step back.

For more examples of how to defuse, I recommend you check out the work of Russ Harris (he has plenty of brilliant YouTube videos that you can access for free).