Acceptance and Commitment Therapy for Chronic Pain

Status: Strong Research Support


Acceptance and Commitment Therapy (pronounced "ACT" as one word) is a type of cognitive-behavioral therapy that stems from research and theory on experiential avoidance-the idea that private experiences (emotions, thoughts, and symptoms including pain) that are routinely avoided lead to various disorders. ACT also is based on Relational Frame Theory, a theory of how human language influences experience and behavior. ACT aims to change the relationship individuals have with their own feared or avoided thoughts, feelings, memories, and physical sensations. Acceptance and mindfulness strategies are most commonly used to teach patients to decrease avoidance, to disconnect their thoughts from their actions, and to behave according to their broader life values. Acceptance of one's experience, rather than change or control of symptoms, is emphasized. Patients learn to clarify their goals and values and to commit to behave accordingly. ACT is a model of therapy, not a specific protocol, and there are variations in how ACT is conducted, particularly its format but sometimes the specific techniques. Most protocols include mindfulness, for example, but some do not; however, the overarching approach of specific techniques is to help people to be intensely present-focused. With respect to chronic pain, the expressed goal of ACT is not to reduce symptoms or pain, but to improve functioning by increasing psychological flexibility, or the ability to act effectively according to personal values, even in the presence of negative experiences such as pain.

There is substantial basic research supporting ACT's fundamental processes, and preliminary evidence regarding their mediational role in ACT outcomes. As of late 2011, there are at least 11 clinical trials, including several that are randomized and controlled, demonstrating that ACT improves some outcomes in heterogeneous chronic pain samples, particularly functioning and mood, although pain severity may be less affected. ACT is superior to wait-list or no treatment, and thus far demonstrates outcomes for chronic pain that are comparable to cognitive behavioral therapy.

Key References (in reverse chronological order)

Clinical Resources

Training Opportunities

The Association for Contextual Behavioral Science website provides a full listing of resources and training opportunities, including books and clinical resources.