New research zooms in on a specific form of cognitive behavioral therapy and examines its benefits for people living with chronic pain. Share on Pinterest A new study finds that acceptance and commitment therapy significantly improves functioning for people with chronic pain. According to the latest data from the National Institutes of Health (NIH), over 25 million Americans are currently living with chronic pain. More and more studies have shown that cognitive behavioral therapy (CBT) helps people cope with the condition. But, as some have pointed out, it is not entirely clear which aspects of the therapy are helpful for people with chronic pain, or how the treatment could be improved in order to achieve better results. This is why a team of researchers from King’s College London (KCL) in the United Kingdom set out to examine the benefits of a particular form of CBT – called “acceptance and commitment therapy” (ACT) – on the functioning and well-being of patients with chronic pain. The first author of the new study is Lin Yu, of the Institute of Psychiatry, Psychology, and Neuroscience at KCL, and the findings were published in the Journal of Pain. ACT is a new form of CBT, which is currently used to treat a variety of psychological problems ranging from addiction to helping people cope with disabilities. As Lance M. McCracken, professor of Behavioral Medicine at KCL and corresponding author on the new study explains, “[f]or pain management, ACT […] focuses on building effective patterns of behavior change rather than symptom reduction.”

ACT and the contextual self As Yu and colleagues point out, ACT relies on the psychological flexibility model. In a previous paper – co-authored by McCracken – psychological flexibility is defined as “the capacity to persist or to change behavior in a way that 1) includes conscious and open contact with thoughts and feelings, 2) appreciates what the situation affords, and 3) serves one’s goals and values.” As McCracken puts it, in reference to the new study, “[p]sychological flexibility is the ability to be more aware, more focused on goals, and more engaged. Another aspect of psychological flexibility pertinent to chronic pain […] is called committed action, which involves goal-directed, flexible persistence.” Yu and colleagues note that a key aspect of the flexibility model is a therapeutic process called “self-as-context” (SAC) or “contextual self.” As the authors explain, “self-as-context” (SAC) – sometimes also called “self-as-observer” – refers to a theory of self that is not grounded in self-evaluations. In this understanding of the self, we are able to “experience a perspective where we are neither defined by nor harmed by our own thoughts and feelings.” For the new research, Yu and colleagues wanted to see if ACT has an effect on the SAC and if SAC measurements correlate with chronic pain outcomes for patients who underwent the treatment.