Acceptance & Commitment Therapy (ACT) is a modern day psychotherapeutic approach to working with patients who live with/experience persistent pain. I personally don’t like the term “Chronic Pain” and for the purpose of this blog will be referring to chronic pain as, persistent pain. ACT has been used in treatment for anxiety, stress, depression, OCD, addiction, relationship issues, weight loss management programs and pretty much any other area’s of our lives that we may find distress. There have been thousands of peer-reviewed journal articles published on its effectiveness in teaching individuals how to live a valued-meaningful life and recovering from the above mentioned “human states”. 

In brief, ACT consists of 6 priniciples which include cognitive defusion, acceptance, mindfulness, values, transcendant self and committed action. I bet you’re thinking  “what in the world has any of this got to do with persistent pain and how can this help me”? Let me show you with a case presentation. 

Mary, a mother of 3 young kids had given birth 18 months ago. Following a long labour and high stress due to being recently separated from her partner, developed multi-joint pain which included her elbows, knees, lower back and jaw. On exploring Mary’s history it was obvious she had tried several opiates/pain killers with little relief, acupuncture and dry needling, stress relief education, SSRIs and was tired of physiotherapists telling her to exercise as she believed she “had no time” being a single parent of 3 young kids. In utilising ACT principles, we had established that Mary had some real ingrained beliefs about herself and her situation, some of which went like this “I can’t look after my children as well as I would like”, “I cant exercise as I have no time to myself”, “even if I could I would hurt myself and my pain would become unbearable”, “Pain killers couldn’t even help me” and so on so forth!!! And lets face it, Mary isn’t the only one of us who think like this! 

So what did we do with Mary? 

Our priority was to rule out anything systemic, like a systemic inflammatory disorder following her pregnancy (which can happen!) and once that was ruled out and no other sinister indicators raised their heads, we started to explore Mary’s life in more detail. On examination, Mary had no real social interactions due to her “pain limiting” her, something she really valued was going for coffee and meeting her sister for walks along the beach. Mary also enjoyed reading but felt if she lay or sat for long periods of time her pain would get worse and felt like it was doing “harm” to her. She felt that being a mother was her calling in life and felt depressed that her pain couldn’t allow her fully commit to her role as a mother. When we broke these beliefs down, we began to see that these were self-limiting beliefs! She hadn’t sat or lay for long periods as an avoidance strategy, she hadn’t recently contacted her social circles to meet up and she hadn’t tried going for a long walk along the beach. So really the evidence wasn’t there for her to believe her thoughts. In identifying Mary’s values, we then devised a treatment plan which included graded exposure to exercise (mainly walking), building this up along the beach front, advised her the benefits of community and social interaction and encouraged her to have contacted her sister and arrange a phone call to start with and soon to progress to coffee dates and advised her limit her time holding/lifting/carrying/pushing the kids around to give her some time to herself without aggravating her symptoms. Throughout the weeks, Mary was introduced to body scan meditations which focused on allowing her symptoms rather than pushing away and resisting them, she had received BPS and ACT education along with videos, and she continued to expose herself to tasks she found herself “unable” to do previous e.g. reading her book sitting and lying down for long periods (this was built up over time). 

Alongside this physiotherapy treatment, we worked closely with GP around medication and she gradually was able to wean off pain killers, educated her around sleep hygiene and regular exercising benefits, all of which she was open to trying. 

So what was the purpose of my story? ACT allows patients to suffer/resist less of their symptoms and become more allowing, accepting and compassionate to whatever their experience is, in that moment. It combines exposure work with cognitive restructuring of beliefs through valued, committed action. That is the key, COMMITTED ACTION! Some days will be easier than others, and some days will feel like you are going backwards but as along as there is committed action, in line with patient values, I would expect an improvement in patients symptoms over time, perhaps a full recovery too! 

Contact me if you have any questions or would like to know more about how physiotherapists can utilised ACT in their physio tool box!