Living with chronic pain or illness is on the rise, which far reaching impacts for the individual and their quality of life. Traditional medical treatments, physical therapy and disease and pain education can be complimented by psychological treatments in order to reduce these impacts and improve overall satisfaction with life. Acceptance and commitment therapy (ACT) is one way to help people cope with chronic pain and illness and improve their lives.
Acceptance and commitment therapy (ACT) is an empirically based, third wave cognitive behavioural therapy that uses acceptance, self-compassion, mindfulness, commitment and behaviour change strategies to increase psychological flexibility to move us towards life enhancing goals and actions. The ultimate goal in ACT for chronic pain and illness is to clarify your values so that they can return to a rich, full and meaningful life.
ACT believes that while pain hurts, it is the “struggle” with pain that causes suffering. The ACT approach to living with chronic pain and illness is altogether different and refreshing. It helps people to accept that while pain may be unpleasant, their lives don’t need to be put on hold in order to manage it. In many ways, ACT works to reverse the negative patterns that many pain patients have endured for years. Attempts to avoid pain can sometimes cause more harm than good, both to the body and peace of mind.
Aims of Treatment
The aim is to teach and encourage clients in a group situation to put in to practice ACT principles and exercises, which can aid people in achieving greater psychological flexibility. These skills in turn can be used help people achieve their health and life goals to improve their quality of life. Research has also shown greater change can occur by using experiential learning, metaphors and discussion, rather than lecturing and rationalising.
Unlike some treatments for chronic pain problems, ACT does not seek to cure or control pain or other symptoms as a primary aim. The focus is on helping patients to acquire effective behaviours patterns guided by what they hold as important, their goals, and values. The primary aim is to change behaviour by changing the way people relate to and experience their thoughts, feelings, and sensations, not to change the thoughts, feelings, and sensations themselves. This is to disconnect people from struggling with pain and other symptoms and to connect them with their values and the means to reach their goals.
About the group therapy program
The group is suitable for most adults who experience chronic pain or have a chronic physical health condition that causes significant impairment or disability, and who may also have a mental health issue as result of their pain or illness. The group is aimed at teaching participants the skills needed to achieve their goals and manage barriers, such as thoughts and emotions. It is useful for people either at the beginning of their rehabilitation and for people who feel ‘stuck’, overwhelmed and/or who are not progressing on their goals.
The intervention consists of eight, 90-minute fortnightly group sessions. The intervention is based principally around the “Cat on the Tin Roof” metaphor which is used to provide a consistent narrative thread throughout the groups. We use the metaphor to explore issues of workability, fusion, mindfulness, values and committed action in each of the sessions. We emphasise choice around participation, saying from the outset that, we would like people to participate as much as possible, but it is an equally valid option to sit out of exercises. However, we generally find participants enjoy the interactive aspects of the group and often comment afterwards that the roleplaying is often one of the more memorable aspects of the group.
Program Schedule
The groups are designed to for approximately 6-12 participants. A waitlist will be compiled for each 16-week program cycle, with the group running 3 times per year. An outline of the session is detailed below:
| Session |
Focus |
Summary |
| Session 1 Week 1 |
Solutions that help with chronic pain, illness and life, and solutions that do not help. |
This first week introduces patients to each other, the facilitator/s, some of the concepts they will be addressing, and sets up what is needed for change. In particular, we look at short-term verses long-term solutions. A brief outline of the 8 weeks will be in patients’ workbooks. This week also importantly asks participants to complete the pre-group outcome questionnaires. Introduction to metaphor and understanding triggers, emotions and sensations, DOTs (experiential avoidance), fusion with content/context, values and choices. |
| Session 2 Week 3 |
The six core skills of mental coping (psychological flexibility) and more ‘solutions’ and goals work. |
This week covers a revision of the triggers, thoughts, feelings, and solutions home task. Then the skills of mental coping (psychological flexibility) are demonstrated with a mindfulness exercise, and defusion skills are explained, demonstrated and discussed. Review of DOTs and introducing values and committed action. |
| Session 3 Week 5 |
Skills, values, and health goals. |
This week briefly covers the task from last week about rating the six skills of mental coping (psychological flexibility). Then we work on the idea of finding personal values in order to help motivate, give direction and create some meaningful goals. A visualisation exercise is used to help with this. In Act terms, this is about ‘clarifying values’ and ‘committed action’. Introducing SMART goals. |
| Session 4 Week 7 |
Mindfulness, life goals and barriers. |
This week revises health values, goals and steps. It also introduces two mindfulness exercises that can begin to help you cope when your mind is scattered, or not fully present, or throwing up barriers for your goals. The home task is about life values and goals. |
| Session 5 Week 9 |
Overcoming barriers part 1: What to do with unhelpful thoughts - defusing and distancing. |
This week looks at the life goal setting exercise from last week. Then we begin to identify and do something about some common barriers to achieving goals. Unhelpful thoughts can be one of these barriers, so the idea of thought distancing and defusing is introduced. |
| Session 6 Week 11 |
Overcoming barriers part 2: Acceptance of what cannot be changed. |
This week follows up on thought distancing and defusing, and looks at how else to deal with barriers to our goals. This second main way is learning to accept those things which cannot be changed (e.g., usually our emotions, thoughts, chronic pain and illness, age, past, and other people etc.). demonstrating acceptance as an alternative to control. |
| Session 7 Week 13 |
Revision and the six core skills again. |
This week looks at the acceptance home-tasks from last week. It also revises goals and barriers. In addition, the six core skills of ACT are outlined again, these lead to being mentally fit and flexible – a very useful state for achieving a better life. |
| Session 8 Week 15 |
Putting it all together into your ACT on Goals Plan. |
This week covers having a ‘where to from here’ plan for the future. The plan includes the concepts and skills learnt in all the previous weeks. |
My name is Liam Reilly. I hold general registration as a psychologist, and I am approved to practice by AHPRA through the Psychology Board of Australia.
I am competent working with a range presentation of clients from ages 12 up. I have a diverse skill set learnt through a variety of work setting in community mental health, rural health services, Drug and Alcohol Rehabilitation, and as a FIFO psychologist to rural and remote locations across Western Australia.
I seek to be a warm, non-judgemental, and compassionate clinician to better understand a person’s own unique experience, context, and how it impacts on behaviour. My treatment approach is guided by the philosophy that every person strives for and has the capacity to fulfil their own potential for a rich, full, and meaningful life that promotes positive mental wellbeing and relationships. Being trained in trauma informed care, I can provide a supportive and safe environment for people to heal and grow beyond trauma.
