Acceptance and Commitment Therapy (ACT)

A New Psychological Treatment for Chronic Pain

Newer psychological approaches such as Acceptance and Commitment Therapy (ACT) are guided by the premise that we cannot change the pain we’re left with, so let’s change our response to that pain. ACT was outlined in a 2014 article in the journal American Psychologist.

ACT differs notably from traditional CBT in method. Rather than challenging and changing thoughts, ACT seeks to reduce their influence over our behaviour. This core treatment process is called “psychological flexibility,” which is the ability to contact the present moment fully and consciously, based on what the situation affords.

Acceptance and commitment therapy for pain

What I like about Acceptance and Commitment Therapy (ACT)

I am in accord with the philosophy behind this, even if I do better in CBT because I am very ‘thought’ orientated. If you get me through my thinking process… I am There. But I agree acceptance should affect behaviour.

Like I don’t want to go out and socialize but I do every few months. I don’t want to because of the pain and the vertigo (when they are half-assed treated, which currently they are not). And I say ‘I’ll get worse and won’t be good company‘ But I go because I want to maintain friendships and I know some modest socializing really boosts my mood. I don’t let things stop me from having a modest life when I have medication to somewhat help me. So I agree with this theory.

The catch is that unhelpful thoughts and emotions can dominate without a person even being aware of them. This results in “psychological inflexibility,” which leads to rigid, ineffective behaviour. If I let my thoughts run the show, the result would have been that I isolated myself at home with my pain and likely more suffering. Other positive behaviours and experiences would have been essentially blocked from me. No thank you.

Self-isolating is what I excel at with pain. And I do it well. So I know I have to do things in order to have a semblance of a life. I know my mood drops if I do not. And I know I cannot avoid pain, so doing things that may increase it are still worth doing because… I’d be in pain anyway. And I can always leave if things get too severe.

What I do not like about Acceptance and Commitment Therapy (ACT)

It is extremely close to ‘pushing through the pain’ and exceeding our limits on a daily basis will lead to survival mode and a far lower quality of life. In other words, if you have a bad therapist their expectations of you may far exceed your capabilities. And they may push too much, especially if they have any association with an insurance company.

The second problem I have is that this therapy is considered, often these days, as a substitute for medications. Because of the stigma of certain medications. It will not work alone. It will not work with unmanaged pain. It will not work with unmanaged pain and depression. It will make someone feel hopeless in-itself. But in conjunction with effective treatment and pain management… they yes, it can be beneficial.

CBT was beneficial to me only because I was on pain meds and I was on depression meds. Without Either or those, I am not in the mindset to get one damn bit out of it. I feel like they just want me to suffer and suffer and it seems like torture to me. And why should I live with torture? Isn’t that madness? But with treatment, I can be far more receptive to coping strategies and trying to have a bit of a modest life.

So if this is all that is being offered? It is a very narrow-minded view of pain management and it simply will not work. Not for someone like me with depression as an added bonus. I am just saying. Just a simple fact. People with unmanaged pain do not take too kindly to just go out there and do things and suffer more. Hell, go to work, and suffer more. And more. And more. Until you lose all hope.

So I have a bit of an issue with it when they do not offer effective pain management but nor am I against it either with effective treatment. I wouldn’t discount it as a viable addition to our treatment strategy. Although, I find it a tad offence they don’t think we have acceptance of our pain and illness and are working through that. And that acceptance seems to be defined by behaviours. And behaviours… can be faked. I faked being well through a deep dark depression for a very long time. I fake not being in pain all the time. Behaviours are just behaviours we use to get through the day. Treatment, quality of life, wellbeing… well you have those and you have authentic behaviours. This isn’t about faking it till you make it, because pain pushes back… hard. And it doesn’t work. Acceptance is about accepting your limits and living with them but also exploring treatments that can help you cope. And I believe there is a place for this therapy if done at the right time in our pain and illness management. But not before that. Because pushing people to exceed their limits when they are already exceeding their limits just Being, won’t do a damn thing but make them feel like a failure and guilty. And I am done feeling guilty that sometimes I have severe limitations. Like lately. And I comprehend sometimes we need to rest and get effective treatment before we can nudge our limits.

Other related posts

Fibromyalgia: Catastrophizing and mindfulness in women

Emotional awareness and expression therapy

Acceptance therapy for migraine

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7 comments

    1. Yes, and sometimes it is not which I feel fails to do it justice. I know people who have gone through it as a substitute for medical treatment and didn’t have a great time with that experience.

      Liked by 1 person

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