Chronic pain and psychotherapy: the ACT model is most effective
Chronic pain, the ACT model excels: the National Institute for Clinical Excellence (NICE) “rewards” the psychotherapy model applied by the Clinical Psychology Service for the management of chronic pain caused by cancer, migraine or endometriosis
The ACT model – Acceptance and Commitment Therapy – is the most effective psychotherapy for the management of chronic pain
This is according to the National Institute for Clinical Excellence (NICE), the independent British agency whose mandate is to provide evidence-based guidelines for healthcare professionals to achieve the highest possible standards of patient care.
The NICE guidelines are based on clinical trials, which have shown that the ACT model has a positive effect not so much on ‘pure’ pain, caused by the disease, as on ‘dirty’ pain.
The latter is a term used to indicate the psychological suffering that occurs when physical suffering affects quality of life.
ACT acts on chronic pain-related pathologies
Patients suffering from chronic pain generally suffer from depression, anxiety, sleep disorders and anger, which inevitably amplify the physical pain, lowering the threshold of tolerance.
ACT acts on these aspects, leading the patient to abandon those avoidance strategies that human beings instinctively implement when faced with something they do not know how to control, but which are themselves sources of suffering.
An example? Avoiding people because because of the pain I am a burden.
This only increases the sense of loneliness, of not being loved, and also exacerbates the physical suffering.
But often it is our own thoughts that give us the role of ‘burden’ not the reality of the situation.
As the acronym ACT indicates, the therapy aims to bring about acceptance, a difficult word to say in front of a person who is suffering
Acceptance does not mean resignation or fatalism, but awareness of the present that includes pain but does not have to be seen through it.
Helping the patient to move towards what is important, towards what has value for the person himself despite the pain, is what this model of psychotherapy aims at.
A model which, according to the NICE guidelines, also helps the patient to have greater therapeutic adherence and increases the effectiveness of the medication.
Depression or anger also trigger a sense of mistrust towards the therapy being followed: ‘The pain remains so what is the point?’.
Psychotherapy acts on the dirty pain, affects the perception of the primary pain and increases awareness of the need to adhere correctly to therapy.
If medication is taken correctly, it increases its effectiveness.
Illness, like pain, can represent moments in which we experience unwanted emotions, disturbing thoughts, experiences of impotence and loss of autonomy, so that it is not always easy to live and move coherently with one’s own values.
The therapeutic path proposes to remain in a position of listening and accepting the suffering, in order to then search for a new repertoire of actions, psychological and physical, consistent with the identified values.
Thus, the therapy unfolds through a pathway that develops through the six processes of the ACT model (acceptance of experience, defusion, contact with the present moment, sense of continuity with the self, contact with one’s values and committed action), applied in the context of chronic pain.