Chronic Pain Essay

Adapted from
1. Dahl, Wilson, Luciano, and Hayes (2005) Acceptance and Commitment Therapy for Chronic Pain
2. Dahl and Lundgren (2006) Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain
3. Vowles & Sorrell (2007) Life with Chronic Pain: An Acceptance-based Approach: Therapist Guide and Patient Workbook

Session 1

1. Validation of suffering and consequential loss of life quality (due to pain from injury or chronic pain)
A. Understand back story and get to know the client’s current situation
B. If they are suffering from chronic pain, gain an understanding of the impact it has had on their life from all perspectives (work, school, family, leisure, etc…)
2. Values
A. What are values?
B. Create life compass
C. Next, write what solutions they have tried for these problems (the barriers that hold them back from living according to their values)
3. Creative Hopelessness and Change
A. Work through with the patient the discrepancy between what they have tried in the past to reduce pain and how that has not worked
B. Exercise on Willingness and Pain
C. Take time to explain exposure: need to have a willingness to feel discomfort in order to move in a valued direction
4. What do you want to work on:
A. Have the patient choose two or three life dimensions that have the largest discrepancies and those that they want to focus on in therapy
B. Ask: “what do you intend to do that night, the next day, and the next week to put your intensions into action”
C. Remember to move in a valued direction, you must be willing to feel the discomfort of the symptoms you have been working to avoid
D. Can you make this commitment to move in a valued direction? What would that look like for physical therapy?

Session 2

1. Review the life compass from the previous sessions: Did you find yourself doing anything that shows you were living in a valued direction?
2. Cognitive Defusion
A. Goal of Session: The goal of today is to gain distance from our thoughts.
• Repeated phrase exercise: Repeat a difficult thought that you have over and over again.
B. Screen Metaphor
C. Avoiding Thoughts: We can’t just avoid or control our thoughts either, so now what?
• Chocolate Milk Exercise
• Bus Driver Metaphor
D. The Thought Observer: So how do cognitive defusion?
• Car Driving By Metaphor
E. Labeling Thoughts: Another way to find distance from our thoughts is by labeling the thoughts as simply thoughts.
F. Power of Words – But/And
G. What is your secret exercise (optional)
3. Exposure/Conclusion/Homework:
A. Cognitive defusion is difficult, so it is important to practice observing our thoughts and labeling our thoughts often. Remember that screen, we will talk next week about the importance of being willing to experience discomfort in order to move in a valued direction, or else we are simple avoiding what is important in our lives.
B. End with asking the client to make a commitment to where they are going and how they are going to get there, and how they will confront these unpleasant barriers. Relate to physical therapy.

Session 3

1.
Mega visualization: Funeral exercise
2. Exercises in cognitive defusion:
A. Leaf on a Stream Metaphor
3. Willingness to feel discomfort (relate to values)
A. Revisit Willingness Question from Beginning
B. What is Willingness?
C. Joe the Bum Metaphor?
D. The Bubble in the Road Metaphor:
4. Exposure exercises: Mindfulness
A. Goal of Mindfulness: Operating in your life from the observer self.
B. When to Practice
C. Where to Practice
D. How to Practice
E. Mindfulness Exercises: (important to present multiple options to patients and let them know to choose what works best for them)
• Handout on Being in the Moment
• Handout on Mindfulness Body Scan
• Mindful Walking
• Mindful Journaling
5. Homework:
A. Complete the exercise: Observer-self exercise (optional)
B. Practice Mindfulness and Cognitive Defusion Throughout the Week
C. Continue to Do Something throughout the week that is consistent with you values – physical therapy home exercises!

Session 4
1. Values:
A. Begin with asking what they did this week to live consistently with their values (also review homework)
B. Reintroduce Willingness and Values
C. Complete the Willingness and Commitment Worksheet: Try to use the value of physical self care in relation to physical
therapy.
2. Acceptance:
A. What Does Acceptance Mean
B. Broad field of vision.
C. Acceptance is an ongoing process
3. Commitment:
A. Throughout treatment, I have asked you to make commitments to valued action. Know that with all of these commitments there will be setbacks. Setbacks are to be expected. What do we do when they occur?
B. At the end of the session the client is asked to state and write down commitments in the form of steps that he or she is now willing to take in valued directions along with what activities which will be required for taking those steps.
C. Review what has transpired in therapy, and thank the patient for their time and effort. Present them with some resources if they would like to continue their journey in ACT.
Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain by Joanne Dahl and Tobias Lundgren
Or
Get Out of Your Mind & Into Your Life: The New Acceptance and Commitment Therapy by Steven Hayes with Spencer Smith