When it comes to psychological therapies, it can seem like there is a lot of choice- with not much clarity – about what works for which condition and for which type of person. Also, all therapies have been shown to be roughly as effective as each other. This makes sense when you think about how different people are in their approaches to life and their problems; so too will different types of therapy will work for individuals and be favoured by different therapists, who are also individuals. The important question is, how do you know if ACT is for you? Hopefully by reading the following article will answer some of your questions about ACT and whether you will want to find out more. Or maybe you have previously tried a therapy that has not worked for you because you found yourself always saying “yes, but…”.

Acceptance and Commitment Therapy (ACT) is called a 3rd wave Behavioural Therapy, meaning that it comes from the same school of therapies as Cognitive Behavioural Therapy (CBT), known as ‘2nd wave’. These therapies developed from the original Behaviour Therapy, and they consider behavioural change to be fundamental in changing thoughts and emotions that are causing someone distress. CBT was developed in its current form in the 1960s, combining behavioural therapy and cognitive therapy, where the interaction between thoughts, feelings, behaviours and physical sensations was seen as being the driver for maintaining psychological distress.

Most of the evidence base supports CBT for chronic pain, as CBT lends itself easily to outcome studies and so most research happens with CBT. CBT recognises that someone’s thoughts (their interpretation) of a situation influences their feelings about that situation and eventually their behaviour within it. Naturally, their physical sensations (meaning primarily their physical sensations of anxiety, depression, craving, pain etc) and emotions affect their thoughts. Psychological difficulties are therefore seen as arising from vicious cycles that arise.

CBT views a person’s thoughts and feelings as contributing to their suffering with their pain, and helping to reduce the negative impact of pain on their lives. The following diagram shows how the thoughts, emotions, sensations and behaviours in response to pain feed into each other to make it all worse. For example, the pain causes a person to have negative thoughts about themselves, their abilities and their future. This leads to feelings of anxiety (e.g. about what the pain means) and sadness and frustration (e.g. at all the things they cannot do as a result of their pain). Worry about damage causes them to reduce activity levels, or frustration at reduced activity levels causes them to overdo activity leading to a crash. A flareup of pain causes a sense of hopelessness, and reinforces beliefs that the pain is in control and that whatever they try, the person cannot continue their life as they want with their pain. You can see how each part of a person’s thoughts, feelings, sensation and behaviour interlink and feed into one another: