ACT now on pain
Charles Ruddock, Principal Psychologist, Clinical Psychologist, Director
Is pain a case of mind over matter? Being better equipped to manage your pain mentally may move you towards a more meaningful existence and a better quality of life. The Acceptance and Commitment Therapy (ACT) approach can arm you with the skills required to manage persistent pain and allocate your mental energy towards more meaningful experiences. It’s a set of skills that – when practiced – are designed to help increase psychological flexibility. The aim of this is to redirect focus, attention and behaviour away from pain and towards a more flexible, positive outlook. Ultimately, this means being present and acting in the moment, even if it’s uncomfortable!
ACT is based around 6 “processors”, which all work in synergy. Any single one of them can help someone with persistent pain, however practicing all of them will result in the largest improvements. These processors allow us to evaluate ourselves and accumulate a total score, which is a way to monitor how we’re doing with increasing our psychological flexibility.
The six double-headed arrows in the hexaflex on the right offer a contrasting statement at either end of a sliding scale. Choose where you sit, between 1-10, depending on how closely you feel the statement applies to you. If both statements apply equally, or neither apply at all, choose 5. Enter them in the box to generate your total score from 6 to 60. Check back in every so often to see how you are doing!
Explaining The 6 Processors
Defusion
In ACT, fusion means a person gets stuck with their thoughts, while defusion means the person develops some space from their thoughts. Many people are not aware of the power of their thoughts in grabbing their focus and attention, and how it influences their behaviours. For someone with persistent pain, it can feel like there is a Pain Dictator demanding all focus and attention! The defusion skill aims to create some space from the “pain” thoughts and allow the person to redirect their focus, attention and behaviours elsewhere.
Acceptance
Experiential avoidance is when someone attempts to avoid or control their sensations, thoughts and feelings associated with pain (which is most people’s normal response to pain!) The acceptance of pain is when a person becomes more open and curious about their full pain in an empowered and informed way, even when it is difficult. The aim is to fully recognise their pain as part of them, but most importantly not all of them. Acceptance of pain doesn’t mean giving in to it, it is more a realisation that in this moment a person doesn’t have a button to turn off the pain, or a dial that lets them choose the level of pain. Too much of a person’s focus, attention and behaviour can be lost on pain without there being a reward for expending this energy into it – it does not achieve a significant reduction or a stop to pain.
Self-as-Observer
ACT uses the term self-as-observer to refer to the self, sometimes known as the ego. All individuals develop stories (thoughts) about themselves, those around them and the world in relation to them. When someone has persistent pain, they may develop stories about the pain, its impact on them, on those around them and on their life. The skill is to become aware of how tightly these stories seem to be determining focus, attention and behaviour. It is not whether the stories are true or false, good or bad, but how strongly attached the person has become to the story and whether this is helpful in the current moment. Loosening the attachment may free you to move towards a more meaningful life.
Contact with the Present Moment
A person with persistent pain can find their attention dominated by it, which means they are not focussed on being connected to the present moment. The skill seeks to instil the choice of where attention goes in the present moment and consciously allocate energy away from pain and towards other experiences. Mindfulness exercises may include focusing on something very narrow or specific (such as your breath), or something very broad (your connection everything around you).
Values
Values are qualities that align to the way you want to act or behave. They provide direction and purpose, but when someone has persistent pain it can dominate their focus, attention and behaviour and cause them to lose sight these qualities. The skill is to uncover or rediscover these qualities or values and align and model their focus, attention and behaviour around these pillars.
Committed Action
Focus on acting in the present rather than allowing focus, attention and behaviour to be stuck on pain. Committed action with pain means taking small steps in the present, which lead to larger behavioural patterns or habits that ultimately establish a better quality of life (even when there is pain).
Remember, ACT is not a “one size fits all” approach. Draw on the actions that suit your experiences and learn through trial and error which are most helpful to you!
Ready to take action on ACT?
Contact your nearest Advance Healthcare clinic or book online at: https://www.advancehealthcare.com.au/contact-us
Charles Ruddock is a director, principal psychologist and clinical psychologist at Advance Healthcare in Bundoora, Geelong and Hoppers Crossing. Charles has strong clinical skills in a range of mental health areas with an interest in chronic pain, stress, workplace injuries and returning to work after a workplace injury.