Acceptance & commitment therapy
What is ACT?
ACT is an evidence-based talk therapy that addresses problems associated with chronic pain by helping individuals think and act differently with respect to pain. ACT focuses on helping patients to reduce pain-related distress through increasing engagement in valued behavior. ACT provides skills that help patients learn to accept pain and focus upon improving quality of life despite pain. ACT can be performed both individually and in groups. Treatment is often short term (8–12 sessions) with follow-up as needed. ACT has strong evidence for reducing pain-related distress.
How does ACT work?
ACT focuses on the development of a rich and meaningful life despite pain. ACT interventions address universal sources of human suffering. Sometimes pain cannot be "fixed", thus ACT attempts to manage distress instead of trying to get rid of it. ACT theory is based on the notion that distress is an unavoidable component of humanity; often, attempts to avoid distress can lead to increased suffering.
The goal of ACT is working to increase acceptance of things outside of one's control and increasing movement towards things that are valued. While the goal of ACT is not specifically to reduce chronic pain, evidence supports its efficacy for several outcomes, including increasing quality of life, decreasing distress, and decreasing mood symptoms, among other benefits. Reductions in these sources of distress often lead to patients reporting decreased pain and decreased distress related to pain. ACT may also include training in techniques which have been shown to be effective for treatment of chronic pain in other contexts, including mindfulness, relaxation, cognitive defusion, and education.
ACT involves a patient and a therapist who each have a specific role. The patient (a) identifies problems, (b) defines goals, © learns skills, and (d) implements solutions focusing on reducing control and increasing behavior in line with their values. The therapist (a) listens, (b) helps refine goals and clarify patient values, © teaches skills, frequently using metaphors and stories, (d) encourages use of new skills, and (e) provides treatment focusing on long-term use.
By accepting things that cannot be controlled (e.g. pain), the therapy focus can shift towards increasing valued behavior and quality of life. When patients have a high quality of life, pain is less influential, consequential, and patients report less pain-related distress.
What other names might this go by?
ACT (pronounced like the word) is a form of psychotherapy that is typically practiced by a trained mental health professional. ACT based skills have however been implemented into a number of platforms including self-help books, websites, and support groups. ACT was developed though Relational Frame Theory, which is a term that is sometimes used in describing treatment. Training in mindfulness is a component of ACT based treatment. Multiple additional interventions utilize mindfulness but may not be related to ACT.
ACT and other forms of therapy including Cognitive Behavioral Therapy (CBT) and Emotional Awareness and Expression Therapy (EAET) may share some techniques or processes – see the CBT and EAET sections for more details.
Who can be an ACT provider?
ACT should be provided by a licensed mental health provider, which may include a Licensed Psychologist, Social Worker, or Professional Counselor. Typically, ACT is provided by an individual who has advanced training in ACT.
The principles of ACT may also be incorporated into other forms of care, including Interdisciplinary Treatment, Physical Therapy, Occupational Therapy, Medial Treatment, and Health Coaching. These skills are often provided informally while participating in other forms of treatment.
Like other forms of mental health treatment, having a strong rapport with your ACT provider is extremely important for effective treatment. While there may be fewer ACT trained clinicians to choose from, individuals with pain are encouraged to seek a provider with whom they feel they can have a good relationship.
What to expect
ACT treatment typically starts with a formal assessment in which the patient is asked questions related to the presenting problem, reason for seeking treatment, history, and any additional relevant information. This allows the patient to provide information about why they are seeking treatment. In the first several sessions the therapist and patient will get to know one another. Specific time will likely be spent processing the impact of pain upon the patient's life.
Early on in treatment it is likely that the topic of values will be explored, including a discussion of the impact of pain upon valued behavior. The patient and therapist will work to develop collaborative goals for treatment, typically focused on increasing function and improving quality of life. Time will also be spent working to identify what would be considered signs of progress. ACT based treatment typically focuses on improving function and increasing valued behavior versus focusing primarily on symptom reduction as measures of improvement.
In many sessions the therapist may provide education on ACT based skills. These skills will likely be presented to address a pain-related concern. ACT-based treatment is likely to focus on exploring current patterns of thinking and behavior related to pain. A fundamental goal of ACT-based treatment will be to identify and accept sources of distress that are outside of a patient's control. Patients are likely to have education in the use of mindfulness and relaxation skills. Treatment will also work to increase action toward valued behavior. Patients will be asked to attempt to implement skills discussed in treatment and are likely to receive homework from their therapist. This homework is often reviewed in session, with time spent discussing use of skills, and adapting skills as needed. In addition to specific ACT-based skills, patients are likely to receive skills for addressing other important aspects of pain such as sleep, mood, and stress management. Success in treatment is associated with improvements in function, increased confidence in the patient's ability to manage pain, increasing valued behavior, and decreased pain-related distress. ACT treatment is typically performed once a week in outpatient settings, with sessions lasting 45–55 minutes.
Potential risks
ACT is a safe form of talk therapy for which there is minimal risk. Sometimes talking about physical or emotional pain can be difficult and make pain or distress more intense for a short period of time.
Resources
Association for Contextual Behavioral Science:
https://contextualscience.org/civicrm/profile?gid=17&reset=1&force=1
Association for Behavioral and Cognitive Therapies (Find a Therapist)
Website: http://www.findcbt.org/FAT/
Psychology Today (Find a Therapist)
Website: https://www.psychologytoday.com/us/therapists
