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

Living with chronic pain can have an undeniable effect on our mental health. A natural response to pain is to treat it like a scary monster, swinging between fighting it and putting lots of time and energy into pretending it is not there (avoiding). It is no wonder then that our lives can begin to shrink, and we can begin to experience difficult thoughts and feelings, as well as difficult physical sensations.

But what if there is another way? What if we can release our grip on the monster, and even invite it in for tea now and again?  Techniques from Acceptance and Commitment Therapy (ACT) offer us the tools to do this. Instead of waiting for the pain to leave before we start living, we can change the way we relate to the pain in order to do more of what we want to do now.

Acceptance and Commitment therapy, created by Steven Hayes in the 1980s, is all about taking action guided by your core values, whilst allowing the pain and difficulty to be there. There are 6 core processes of ACT; let’s have a look at each of them and consider how we can apply them to chronic pain.

1)     Contact with the present moment.

This is all about being here now. When we are in pain, it is very natural to be solely focused on that pain, but it can be useful to practise being flexible with our attention. Can you notice your belly rising and falling? Are there any areas of your body that feel more comfortable at the moment? What sounds can you hear? Have a go at intentionally relaxing around the pain and noticing what else is happening in your present moment, even if just for thirty seconds.

2)     Defusion

Traditionally cognitive defusion is about learning to take a step back from our thoughts, rather than being completely hooked by them. This works well for pain too – we can learn to take a step back and observe the pain, holding it lightly with a sense of curiosity and compassion. Get really curious about the sensations of the pain: is it just one sensation? Do the sensations move? How far is it radiating? This curiosity puts distance between you and the pain, and can help you defuse from it.

3)     Acceptance

Accept your monsters! This is about making room for the uncomfortable sensations, and accepting the pain and all that comes with it, rather than resisting it and pushing it away. We allow the pain to come and go as it chooses. There is relief in realising it is out of our control.

1)     Self-as-context

As you begin to accept your pain and create some space around it, you will become more familiar with the part of you that notices your experiences. You are not your pain, you are the noticer of your pain.

2)     Values

It is really helpful to actively consider what matters to you in life. What is it, given your context, that you want to do and give in this very brief life? Our values are our compass, guiding us into action. By knowing our values, we can build the life that we want to build, rather than getting swept away by our thoughts and feelings about the pain.

3)     Committed action

Committed action is about taking action guided by our values, and this can be either physical action or action that we do in our heads. When you are in pain it can be difficult to do anything at all – this is not about putting pressure on ourselves or forcing ourselves to do things. Being kind to your body, for example, is a very useful value, and many times resting may be the committed action. What can you do, in this moment whilst allowing the pain to be there, that will contribute to you growing the life that you want to grow?

Summary

Through the core processes of acceptance and commitment therapy we can learn to do what matters to us with the scary pain monster by our side.

In the next post, I will offer some tips on how you can start to be in contact with the present moment whilst in pain.