Written by Karen Tang, General Member
Disclaimer: The insights shared in this blog are not medical advice and thus, should not be taken as such. Please consult a licensed medical professional if you are unsure.
Don’t forget to check out the first blog in this series, which examined Cognitive Behavioral Therapy (CBT) skills!
Given that September is Pain Awareness Month, I thought it would be useful to highlight evidence-based clinical skills I’ve learned as a current Clinical Psychology PhD student. I have used these skills with therapy clients and even in my own life, given my own lived experience with a variety of pain conditions, including chronic pain.
Evidence-Based Skills from Acceptance and Commitment Therapy (ACT)
In this blog, I will draw from Acceptance and Commitment Therapy (ACT) for pain management. ACT is an evidence-based therapy that can help individuals accept and learn to live with pain, which can help minimize the control pain has on one’s life. ACT helps guide individuals to change their expectations of living pain-free as well as learn to cope with pain.
Research has well-supported ACT’s effectiveness in chronic pain management. For example, in a 2011 randomized control trial study, ACT was deemed to be an effective intervention for chronic pain patients by improving pain interference and pain-related anxiety and depressive symptoms. A more recent study published in 2021 found that greater pain acceptance is related to lower pain intensity, catastrophizing of thoughts, and anxiety and depression.
Mindfulness
ACT incorporates mindfulness techniques to help individuals stay grounded in the present moment. This can be particularly useful as it reduces worrying about the future or ruminations about the past, both of which can exacerbate chronic pain.
One of the grounding techniques used in ACT is called “Dropping Anchor.” This skill can particularly useful when you are experiencing heightened pain or overwhelming emotions and can be an excellent first step in coping with chronic pain.
To drop anchor, follow three simple steps.
Firstly, you want to acknowledge what is “showing up” inside you, such as thoughts, feelings, memories, sensations, etc. Aim to be curious while you observe your inner world.
Secondly, while still acknowledging your thoughts and feelings…you also want to come back into and connect with your physical body. There are many different ways you can do this, from pushing your feet into the floor, to straightening your posture, stretching parts of your body, or simply breathing. Do what feels comfortable to you!
Thirdly, while you are still acknowledging your inner world as well as connecting with your body…you want to get a sense of your physical location and refocus your attention on the activity you are doing. Again, there are many ways to engage in what you’re doing, including looking around the room and noticing five things you can see, noticing 3-4 things you can hear, or what you can smell or taste in your nose and mouth.
Feel free to repeat this skill 2-3 times. To conclude this activity, you can give your full attention to the activity at hand.
A guided Dropping Anchor practice can be found here or feel free to search on YouTube for one that suits you!
Cognitive Defusion
One of the critical concepts in ACT is to learn how to “defuse” from one’s thoughts (e.g., loosening the grip of one’s thoughts). In other words, this helps take thoughts as mental events, not straight-up facts. This is a key takeaway for those with chronic pain as it helps people separate their pain from the emotional suffering it creates. Catastrophizing thoughts (or fixating on the worst possible outcome and treating it as likely, even when it is not) can be very common in individuals with chronic pain.
Here are some exercises you can use to cognitively “defuse” from your thoughts:
Notice It: When you notice that you have been stuck on a thought (such as, “I will be in this excruciating pain forever”), you can take a step back from the thought by saying or thinking to yourself, “I’m noticing I’m having another thought that what I said was a catastrophizing thought”.
Sing It: It can be helpful to sing it to the tune of Happy Birthday or any other goofier song. Singing the thought won’t get rid of that thought but it will change the way you think about the thought.
Thank Your Mind: Whenever an unhelpful thought pops up, rather than getting stuck on that thought, you can thank your mind for having that thought. Negative thoughts are there to help protect you, but sometimes, they just aren’t super effective about it! So, “Thank you, mind, for trying to protect me!”
Hopefully, you learned a thing or two from this short series of evidence-based skills! And to my fellow readers with chronic pain, remember to be compassionate and kind to yourself—you are not alone in this journey.
Resources and further reading:
More on Dropping Anchor including a guided audio by the Integrative Pain Science Institute: https://integrativepainscienceinstitute.com/latest_podcast/dropping-an-anchor-a-simple-and-powerful-technique-for-pain-catastrophizing-mindfulness-and-cognitive-defusion
More on Cognitive Defusion: https://cogbtherapy.com/cbt-blog/cognitive-defusion-techniques-and-exercises
Thanking Your Mind (video): https://youtu.be/206WtwEyqzg?si=2cFksSR9PoU3Kg-O