What is ACT?
ACT is an evidence-based talk therapy that addresses problems associated with chronic pain by helping individuals think and act differently. Rather than attempting to eliminate or reduce pain entirely, ACT helps people pursue meaningful life activities and goals even when pain is present. The approach emphasizes psychological flexibility – the ability to be present in the moment, to accept difficult thoughts and feelings, and to take action based on one's values.
ACT is a form of Cognitive Behavioral Therapy (CBT) but differs in that it focuses less on changing the content of thoughts (as in traditional CBT) and more on changing the relationship with thoughts. ACT teaches that struggling with pain or trying to control it often makes things worse, whereas accepting pain as part of life can free up energy for valued activities.
How does ACT work?
ACT works through six core processes: Acceptance (opening up to unwanted private experiences), Cognitive Defusion (learning to perceive thoughts as just thoughts), Being Present (attending to the here and now), Self as Context (accessing a transcendent sense of self), Values (discovering what is most important), and Committed Action (setting goals and taking action guided by values).
In the context of chronic pain, ACT helps patients stop the struggle with pain and instead invest energy in living a meaningful life. Research has shown that acceptance of pain is associated with less pain, less disability, less depression and anxiety, and better functioning in work and daily activities.
What other names might this go by?
ACT is sometimes referred to as "third wave" cognitive behavioral therapy. Related approaches include Mindfulness-Based Stress Reduction (MBSR), Dialectical Behavior Therapy (DBT), and Functional Analytic Psychotherapy. Some of the skills taught in ACT, such as mindfulness and values clarification, are also taught in other contexts outside of therapy.
Who can be an ACT provider?
ACT is typically provided by licensed psychologists, social workers, or licensed professional counselors with specialized training in ACT. While many therapists are trained in general CBT approaches, it is recommended that you identify a therapist with specific training in ACT for chronic pain.
Note: As with CBT, finding a therapist with whom you feel comfortable is important. The therapeutic relationship is a key component of successful therapy.
What to expect
ACT sessions typically involve a combination of discussion, experiential exercises, and skill-building activities. Early sessions focus on understanding your relationship with pain and what you have tried in the past to manage it. The therapist will help you identify your core values and what matters most to you in life.
Subsequent sessions teach mindfulness skills, techniques for noticing and accepting difficult thoughts and feelings, and strategies for taking committed action toward valued goals. You may be given exercises to practice between sessions. Treatment typically ranges from 8-12 sessions, though this can vary based on individual needs.
Potential Risks
ACT is generally considered a safe form of therapy with minimal risks. Some people may initially find it challenging to accept pain rather than fight against it. This shift in perspective can be uncomfortable at first but typically becomes easier with practice.
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)