Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

You've Got to Give a Little, Take a Little

Acceptance and Commitment Therapy versus interfering thoughts and emotions

We all remember the lyrics from that old song. Perhaps if more of us would internalize that existential flexibility, the world would be a better place for the individual and those within his or her social orbit.

To be more specific—and more germane to this blog—the chronic patient would do well to accept psychological flexibility as a mediator of improvement in the process of cognitive behavioral therapy (CBT).

It is not unusual for readers of the Psychology Today website to register their doubts about CBT for the treatment of chronic pain with “comments” that might be most politely described as acerbic. However, CBT has made important contributions to the management of chronic pain, although there is an intransigent subset of chronic pain patients who have difficulty changing their behaviors, exhibiting a psychological inflexibility which, alas, contributes to disability.

There do exist acceptance-oriented forms of CBT, such as Acceptance and Commitment Therapy (ACT), which seeks to improve functioning and quality of life by increasing psychological flexibility, defined as the ability to act effectively in the presence of interfering thoughts and emotions.

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Interestingly, ACT is not explicitly attempting to reduce pain and suffering; rather, ACT has the goal of promoting the acceptance of negative experiences in order to increase psychological flexibility. Many studies have indicated the importance of acceptance and willingness, activities engagement, and avoidance in the treatment of chronic pain. A study published two years ago in the European Journal of Pain examined the processes of change in a successful application of ACT involving patients suffering from whiplash.

Researchers found that pain intensity, anxiety, depression, and self-efficacy did not have major mediating effects. In contrast, significant indirect effects were appreciated for psychological inflexibility on pain-related disability and satisfaction scores.

A recent observation in the journal Pain noted the increasing number of studies of acceptance, mindfulness, and values-based action in relation to chronic pain. These processes may be important for reducing suffering and disability associated with chronic pain conditions. Further, these processes taken together yield the overarching process: psychological flexibility.

It is not easy to learn flexibility, but psychological treatment modalities continue to approach how we can all give a little  For the disabled, if not the downtrodden, there might finally be the sense that life is giving something back—free for the taking.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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