If you suffer from chronic pain you’ll know just how debilitating it can be. Pain is not only unpleasant in itself, it can affect our mobility and stop us from doing things we enjoy. It can also lead to increased risk of anxiety and depression. And we can spend all our time and energy trying to manage our pain, instead of getting on with life. Acceptance and Commitment Therapy for chronic pain offers a novel solution.

The central idea from Acceptance and Commitment Therapy (ACT) is that pain doesn’t have to stop you enjoying life. By accepting and learning to live with pain – instead of trying to eliminate it – you can limit the control it has over your life.

What is chronic pain?

Chronic pain is generally defined as pain that lasts for longer than 12 weeks despite medication or treatment. It may come and go, and range from mild to severe on any given day. It may be the result of a chronic condition such as arthritis, endometriosis or fibromyalgia; or due to an injury, illness or disability.

While past injuries or current conditions can cause chronic pain, sometimes there’s no apparent cause. For example, chronic pelvic pain (CPP) in women of reproductive age is a common complaint – often with no obvious underlying pathology.

Chronic pain is something that many people experience. According to the American Academy of Pain Medicine, it affects more than 1.5 billion people worldwide. That’s about one in five of the global population.

While it’s important to stick to any pain management regime recommended by your doctor, chronic pain doesn’t have to take over your life. Managing pain can too easily become a full-time job, and you can end up spending more time trying to fix your pain than you do enjoying life.

What is Acceptance and Commitment Therapy?

ACT stems from the more widely-known Cognitive Behavioural Therapy (CBT). It aims to help you achieve a fulfilled and meaningful life, while accepting the pain that inevitably goes with it. We’re all human, and we all hurt sometimes. That pain may be emotional or physical. Accepting that can result in less suffering than fighting it.

ACT helps you learn to accept what’s outside of your control, and commit to action that improves and enriches your life, in line with your values. The three principles of ACT are:

  1. Accept what’s beyond your personal control and live in the present moment.
  2. Choose valued behaviours mindfully, rather than allowing automatic responses.
  3. Take action, rather than become stuck in painful experiences.

In ACT, a therapist helps you to clarify your values – then encourages you to take action based on them. They’ll also help you with skills and exercises to accomplish this. Find out how you can get started with ACT with My Online Therapy. You can also learn more about this therapeutic approach by listening to the ACT modules in our Self-care courses.

How can Acceptance and Commitment Therapy help with chronic pain?

The goal in Acceptance and Commitment Therapy for chronic pain is to identify your values so that you can live a rich, full life – despite your pain. ACT challenges conventional approaches to pain management that focus on pain reduction. Instead, the focus shifts from eliminating pain completely to living with it as well as you can.

Chronic pain can limit your mobility and reduce flexibility and strength – which may make daily tasks and activities challenging. It can therefore lead to anxiety and avoidance around your pain. You might stop engaging in activities that you associate with pain, or abandon hobbies you once enjoyed. You might, for example, cancel drinks with friends because you’re anxious your back pain might flare up; or stop playing the piano because of your arthritis. This is known as ‘experiential avoidance’ in ACT.

Yet these attempts to reduce pain can actually make things worse, as they make you focus on it even more. It’s important not to avoid things you enjoy – since taking part in these activities can boost your mood and decrease stress. Avoidance and isolation can give you a more negative outlook on your condition – and even increase your sensitivity to pain.

This is consistent with current NHS advice for chronic pain management: that inactivity only makes things worse. This may sound counterintuitive, since the advice for managing chronic pain, such as back pain, used to be bed rest. But we now know this is the worst thing possible.

The NHS also advises that it’s important to try to stay in work even though you’re in pain – since research shows that people become less active and more depressed when they don’t work.

Six steps to apply ACT to living with chronic pain

There are six core ‘processes’ in ACT. Here’s how to apply them to living with chronic pain.

  1. Acceptance. Pain is a part of life. Rather than trying to escape pain and the unpleasantness that comes with it, try to learn to see it as normal. Be willing to experience some pain while still living the life you choose.
  2. Cognitive Defusion. Try to detach from your thoughts by simply observing them. Add the phrase “I’m having the thought that…” in front of them. For example, “I’m having the thought that I have a lot of pain today.”
  3. Present Moment Awareness. It can be hard to live in the moment when you’re experiencing pain. Focusing on your breath and practicing mindfulness meditation can help you connect to the present moment, rather than dwell on the past or worry about the future. Or try the 5-4-3-2-1 grounding technique: become aware of five things you can see, four you can touch, three you can hear, two you can smell and one you can taste.
  4. Self as Context. Mindfulness also helps you establish a sense of self that’s separate to and greater than your thoughts and feelings – and even your body. It can also help reduce any automatic thoughts or ‘mindscripts’ you have around your pain – such as “I can’t socialise because of my pain”.
  5. Values. What activities do you value? These might be anything from socialising with friends, taking part in community events, going to work or playing with the kids. ACT helps you define the values that are most important to you – and to refocus away from pain and towards doing things you enjoy, that align with your values and bring meaning to your life. If you avoid these activities because of your pain it can lead to depression.
  6. Committed Action. This is the final step of ACT, where you commit to taking actions that support your values, despite your pain. Begin to develop goals that align with your values. For example, if ‘friendship’ is an important value for you, you might choose to engage in more social activities.

If you live with chronic pain, it doesn’t have to define you or hold you back from living your life. With ACT the most important thing is to identify your values and then act accordingly. You accept your thoughts and feelings – and your pain. But you leave them in the background and focus on choosing what you want from life – then living it.