Acceptance and Commitment Therapy for Chronic Pain
Status: Strong Research Support
Acceptance and Commitment Therapy (pronounced "ACT" as one word) is a type of cognitive-behavioral therapy that stems from research and theory on experiential avoidance-the idea that private experiences (emotions, thoughts, and symptoms including pain) that are routinely avoided lead to various disorders. ACT also is based on Relational Frame Theory, a theory of how human language influences experience and behavior. ACT aims to change the relationship individuals have with their own feared or avoided thoughts, feelings, memories, and physical sensations. Acceptance and mindfulness strategies are most commonly used to teach patients to decrease avoidance, to disconnect their thoughts from their actions, and to behave according to their broader life values. Acceptance of one's experience, rather than change or control of symptoms, is emphasized. Patients learn to clarify their goals and values and to commit to behave accordingly. ACT is a model of therapy, not a specific protocol, and there are variations in how ACT is conducted, particularly its format but sometimes the specific techniques. Most protocols include mindfulness, for example, but some do not; however, the overarching approach of specific techniques is to help people to be intensely present-focused. With respect to chronic pain, the expressed goal of ACT is not to reduce symptoms or pain, but to improve functioning by increasing psychological flexibility, or the ability to act effectively according to personal values, even in the presence of negative experiences such as pain.
There is substantial basic research supporting ACT's fundamental processes, and preliminary evidence regarding their mediational role in ACT outcomes. As of late 2011, there are at least 11 clinical trials, including several that are randomized and controlled, demonstrating that ACT improves some outcomes in heterogeneous chronic pain samples, particularly functioning and mood, although pain severity may be less affected. ACT is superior to wait-list or no treatment, and thus far demonstrates outcomes for chronic pain that are comparable to cognitive behavioral therapy.
Key References (in reverse chronological order)
- Wetherell, J.L., Afari, N., Rutledge, T., Sorrell, J.T., Stoddard, J.A., Petkus, A.J.,….Atkinson, J.H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152, 2098-2107.
- Vowles, K. E., & Thompson, M. (2011). Acceptance and Commitment Therapy for chronic pain. In L. M. McCracken (Ed.) Mindfulness and acceptance in behavioral medicine: Current theory and practice (pp. 31-60). Oakland: New Harbinger Press.
- Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain - A randomized controlled trial. Pain, 141, 248-257.
- Wicksell, R, K., Ahlqvist, J., Bring, A., Melin, L. & Olsson, G. L. (2008). Can exposure and acceptance strategies improve functioning and quality of life in people with chronic pain and whiplash associated disorders (WAD)? A randomized controlled trial. Cognitive Behaviour Therapy, 37, 1-14.
- Vowles, K. E. & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of effectiveness and treatment process. Journal of Clinical and Consulting Psychology, 76, 397-407.
- McCracken, L. M, Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long-standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.
- Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802.
- Luoma, J. B., Hayes, S. C., & Walser, R. D. (2007). Learning ACT: An Acceptance and Commitment Therapy skills-training manual for therapists. NY: Harbinger Publications.
- Dahl, J. C., & Lundgren, T. L. (2006). Living beyond your pain: Using Acceptance and Commitment Therapy to ease chronic pain. Oakland, CA: New Harbinger.
- Dahl, J., Wilson, K. G., Luciano, C., & Hayes, S. C. (2005). Acceptance and Commitment Therapy for chronic pain. Reno, NV: Context Press.
- McCracken, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Seattle, WA: International Association for the Study of Pain.
- Hayes, S. C. (2005). Get out of your mind and into your life: The new Acceptance and Commitment therapy. NY: New Harbinger Publications.