Top Left Image Top Right Image

CB Login

CB Workflows

CB Online

No Users Online

Syndicate

Home
New data on ACT for chronic pain

Research Update

 

New data on ACT for chronic pain

 

Fresh data on ACT and RFT seem to be surfacing almost continuously these days. In this edition of our newsletter, we are especially intrigued by a forthcoming article on the use of ACT with children experiencing chronic pain.

 

One of the distinctions that we often make as ACT therapists with our clients is that between pain and suffering. While pain is regarded as the direct result of difficulties in our lives, whether it is a physical ailment or natural response to life challenges, suffering is the indirect result of being a verbal human being who compares, evaluates, and struggles with our pain. Much of ACT treatment involves teaching clients to cultivate a different relationship with their suffering. A new study by Rikard Wiksell, working with adolescents with physical ailments, suggests that ACT can be a useful treatment for changing one’s relationship to chronic pain as well. Dr. Wiksell compared ACT treatment with a multidisciplinary treatment approach that included an antidepressant, and found that children receiving ACT had better outcomes not only in their psychological functioning, but their physical functioning as well. In fact, these better outcomes were still significantly better than the multidisciplinary treatment at a 7 month follow-up. Although these children had physical problems, their physical and psychological suffering decreased via the exposure-based processes in ACT. Arguably, acceptance, defusion, and commitment to valued activities increased the quality of these kids’ lives.

 

A growing body of literature suggests that chronic pain is a substantial problem among children, and that these children are at risk for continuing problems into adulthood. Most of the research has addressed means of reducing pain and distress, and CBT is an established treatment for this condition, although the body of supportive data is relatively small. ACT views experiential avoidance as the key measure in human functioning, rather than the presence or absence of pain. This pain can be psychological or physical. More specifically, the ACT model suggests that efforts to control, minimize, and avoid unwanted thoughts, emotions, and sensations leads to excessive time focusing on pain and less time building upon the quality in one’s life. ACT treatment builds competency in accepting one’s experience while engaging in valued activities as the alternative to this control agenda.

 

Wisksell and his colleagues provided ACT treatment to 16 children coping with chronic pain and compared outcomes to 16 children with chronic pain who received a multidimensional treatment package at a children’s hospital. This multidimensional treatment included amitriptyline, an antidepressant. Children were assessed pre-treatment, and the conclusion of treatment, and approximately 3.5 and 7 months after treatment. The assessment package included various measures of daily physical functioning, pain intensity, and beliefs about impairment due to pain, and psychological well-being. Treatment was provided individually on a weekly basis. ACT treatment lasted roughly 4 months while the multidimensional treatment lasted somewhat longer.

 

The results showed improvements in all measures for both treatments, and most revealed large effect sizes. Furthermore, the ACT condition consistently produced significantly better outcomes than the multidimensional treatment. On a more qualitative note, the authors point out that the ACT treatment was of shorter duration and may have cost substantially less than the alternative. Given that this treatment reduced reports of pain and increased reports of quality of life, these data strongly suggest that ACT is a viable and promising treatment for chronic pain among children.

 

Clinical implications

 

Many of us may have clients struggling with health problems on top of the psychological struggles that they present in therapy. Chronic physical pain and health problems can be exacerbated by experiential avoidance and fusion, just as can psychological pain. If you are interested in applying ACT in the realm of chronic pain, there are a number of ACT books and workbooks that cover these topics. Here are three:

 

Citation: Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (in press). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial. Pain.

 

 

 

 

 

 

 

 

 
Contacting Self as Context

Self as context is the concept that we are not the content of our experience -- we are not our thoughts, our feelings, our experienced sensations, the things we see, or the images that pass through our heads. Through exercises and metaphors, we can contact a transcendant sense of self that is more like the context, perspective, or arena where life happens. In ACT, this self as context is contrasted with self as content, or the stories and thoughts that we have about ourselves, our identity, and our history.

In fusion with self as content, we lose the distinction between ourselves as the experiencer of life and the thoughts and stories that we tell about our lives. We would never get ourselves confused with the chair we sitting on or something that we are looking at, but when it comes to noticing that we are distinct from our own thoughts, it becomes much harder to take the observer position and to see the distance between our selves and our thoughts.

In ACT, people are trained to be more aware of this sense of self through a variety of exercises, several of which are relatively lengthy. However, these exercises can be quite brief. This is discussed to some extent in the book Learning ACT .

Today I stumbled upon an idea for an exericse that could create an experience of self as context. It came from an exercise by Eckhardt Tolle (not really a big fan of him, but I liked this exercise) that I modified to be more consistet with an ACT perspective and more focused on self as context specifically.  

Here's the exercise (as I modified from the original):

Stop and silently listen to what you are saying to yourself, to the voice in your head. Once you are listening closely, ask yourself the following two questions: 

  • Am I the thoughts that are going through my head?

  • Or, am I the one who is aware of these thoughts that are going through my head?

 

 

 

In this exercise, our job with these questions is not to answer them, but rather to sit with the question and wait, aware, and see what shows up. This is not about creating more thoughts, but creating a new awareness where we are aware of the distinction between ourselves and our thoughts. The point of the exercise is not to create belief in a new sense of self, but to develop the ability to step back from thoughts, to observe them with less entanglement. 

If I were doing this in session with a client, I would probably debrief the exercise after I did it with them. Or I might give it as something to practice several times over the week between sessions and have them journal a bit about reactions to the exercise after they did it. Or I might record the exercise on my mobile phone using Drop.io and send a copy of the MP3 to a client to use in practice.

Perhaps you might try out the exercise yourself, right now and let me know what you think of it.

 

 

 
The Hexaflex as a Dynamic Therapy Tool

The Hexaflex Dimensional  Approach to Diagnosis and the ACT ADVISOR Psychological Flexibility Measure are both relatively new iterations of the Hexaflex that have exciting applications for ACT clinicians. Let's take a look at them...

Read more...
 
<< Start < Prev 1 2 3 4 5 6 Next > End >>

Results 5 - 8 of 23
Bottom Left Image Bottom Right Image