Acceptance And Commitment Therapy For Pain

Traditionally, cognitive behavioral therapy (CBT) has been used to help change the thought processes of many who suffer from chronic pain conditions, as well as other mental conditions. It uses empirical research to develop coping strategies that are used in reshaping negative thought patterns in behaviors and emotional regulation. Years of practice has shown this to be an effective treatment for many mental disorders. Its use is prominent in psychiatry circles. However, a new form of therapy, called acceptance and commitment therapy (ACT), has been making waves in the medical community recently. While over the years its viability has been questioned, research is starting to show the overall benefits and effectiveness of this new treatment option for pain and mental disorders.

What is acceptance and commitment therapy?

Acceptance and commitment therapy is an empirically-based psychological intervention that focuses on noticing negative thought and emotions and accepting them, rather than using strategies to prevent them all together. It teaches the user to accept negative thought as a harmless event rather than treating them as a symptom of a disease.

Acceptance and commitment therapy contradicts the belief of most Western psychiatry by avoiding the assumption of healthy normality. ACT does not assume that a human being given a healthy lifestyle and environment will automatically be happy and content. This also means that contending with psychological pain or suffering is not seen as abnormal. It is also not viewed as a syndrome that must be treated.

Instead, acceptance and commitment therapy assumes that the normal psychological process of being a person can often be destructive, which leads to mental pain and suffering. This new belief allows a person to take action to improve and grow without having to first change or eliminate the negative feelings that past experiences have instilled.

At the core of this therapy is the goal to allow the person using ACT to live a meaningful life by accepting the pain that goes with everyday life. This pain comes in many forms such as negative thoughts, feelings, urges, memories, and images. ACT accomplishes this goal largely by teaching mindfulness and psychological flexibility.

Acceptance and commitment therapy basic values

So what exactly it mindfulness? There are many definitions, but at its most basic, mindfulness is about being present in the current moment rather than getting lost in thought. The point is to be objectively aware of and separate from your thoughts, allowing a deeper analysis and understanding of them. ACT suggests that this process leads to a better life.

There are six core processes that assist in developing mindfulness and psychological flexibility in the acceptance and commitment therapy model.

Cognitive defusion

This technique allows the user to change their interaction with thoughts by deconstructing the contexts that make the thought harmful. More simply put, someone practicing cognitive defusion learns to diminish the believability of a thought or event. For instance, having the thought “I am a terrible person” is reframed in a more external way, such as “I am having the thought that I am a terrible person.” In this way, the thought can become an objective idea to be examined, rather than a factual personal belief.


Acceptance is taught to counter experiential avoidance, which is the attempt to avoid negative thoughts and experiences as this can cause harm in the long term. Acceptance includes embracing all thoughts rather than trying to change their frequency, form, or impact.

Contact with the present moment

A main ongoing process in ACT is to be aware of all psychological and environmental events as they occur, in a nonjudgmental way. The idea is to be open and receptive to everything happening in the present moment rather than being bogged down by those thoughts and feelings.

The observing self

This process comes with accessing a transcendent sense of self. It is identifying the conscious part of yourself that is ever present and wholly separate from your thoughts, feelings, memories, and physical body. In essence, the observing self is the part of the mind that can observe the thoughts you are having rather than what is generating a thought.


ACT encourages you to identify what is most important to you, or your values. You may consider what kind of person you want to be and what you truly believe to be meaningful. Specifically, this process is used to determine what you actually value versus what things you believe you should value based on family or social pressure.

Committed action

Finally, the user sets goals that are in tune with their values. The user then proceeds to take action to achieve these goals.

How chronic pain patients can use acceptance and commitment therapy

One of the basic premises of ACT is that while pain hurts, it is the struggle with pain that causes suffering. Pain is considered a useful reflex as it serves to warn us of an injury and is important to our overall health and survival. This is also true for emotional pain as the grieving process allows for healing and acceptance. However, when pain becomes chronic, the attempt to control it can cause negative outcomes such as anxiety, stress, and increased pain.

The usefulness of ACT comes from taking the negative thoughts that are spawned from a chronic pain condition and accepting them as a part of life. The purpose of ACT is to allow the patient to focus on creating a new and improved life rather than concentrating on pain management.

In constructing the Chronic Pain Acceptance Questionnaire, McCracken et al discovered two principal aspects of pain acceptance to be critical: engaging in valued life activities despite pain and the willingness to experience pain. Those who accepted pain based off this criteria displayed lower pain intensity, less depression and anxiety, less pain avoidance, and better work status.

ACT can be a powerful tool for those who suffer from chronic pain. It can help reshape negative thoughts that prevent growth and change, while reframing them to become innocuous events rather than barriers to recovery. In this way, chronic pain can be reduced as the practitioner focuses on living a life more in tune with their personal beliefs, which can greatly reduce emotional stress and conflict.

Do you think the principals of acceptance and commitment therapy could help you lead a better life?