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.
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