Lila: Hi, I'm Leela and welcome to Pain Perspective. Here we're going to be talking about various psychotherapies and how they can be used as a chronic pain treatment. This episode is going to be centered around acceptance and commitment therapy. Often ways that people treat pain is by going to their doctors, they try to get a prescription. But recently, especially in light of the opiate epidemic, there have been a lot of people that just haven't felt as comfortable using painkillers. There's also people that feel like pain is this symptom. Like if I get rid of my pain, I might be making it worse without realizing it. So because of that, psychotherapies offer a pretty good alternative. Acceptance and commitment therapy approaches pain from the perspective that the struggles and side effects of pain are what cause the most suffering, not necessarily the pain itself. It basically reduces negative pain patterns by helping patients understand that they do not need to associate their lives with just this pain and then putting everything else on hold because of it. So it's broken into six parts. There is acceptance, cognitive diffusion, present moment awareness, self as context, values, committed action. And overall goal again is to live a peaceful life just without letting pain dictate your actions. When talking about acceptance, it's really important to note that before progress can be made, the patient needs to demonstrate that rather than trying to escape this pain or the constant unpleasantness that comes with it, they need to just see it as normal, as a part of them now. They're basically accepting all the unwanted feelings that they associate with this pain. So for cognitive diffusion, patients learn to just notice thoughts as they occur without really attaching a significance to them. They can sort of differentiate between having a thought and then just obsessing over it and becoming like a part of it. And in developing this skill, patients are better at differentiating between what's considered the thought and reality of their situation. Now, the third part, present moment awareness. Pretty self-explanatory. It can be really hard to live in the present moment when you're dealing with chronic pain. Like imagine you're just trying to read a book, but you just feel this constant ache in your neck that's not going away. How can you enjoy it when you're suffering at the same time? Part of present moment awareness is when the patient actively begins focusing on the experiences that they're actually trying to enjoy in the moment. It's a shift in focus. And while it does seem a little bit hard to just Stop focusing on it. There's exercises that can help with it. one exercises is using your senses to connect with the environment. This looks a lot like mindfulness. so what you do is you steady yourself, you take a deep breath. And try to focus on your breathing. Maybe just try to look in front of you and identify what are just three objects in your line of sight? What are three sounds you hear? Is someone in your house cooking? Does something smell nice? you're just sort of trying to train your brain to be able to focus on the sensory aspects that you want to focus on, Not whatever pain or ache you're dealing with. You're just trying to deviate your focus towards what is actually beneficial. for the fourth part, self as context. In addition to becoming more self-aware in the moment, patients need to learn how to just sort of separate themselves from their thoughts and emotions. During this part of acceptance and commitment therapy, patients learn to just realize all the labels and self-judgments that they've been creating for themselves aren't helpful. You just focus on your body, if you work on just observing your thoughts passively, You start building that mental muscle that's used in HCT to help alleviate chronic pain. Values are also incredibly important. one of the main goals of ACT is to help patients pursue their desired activities and actions. And this often is a lot harder when the fear of pain is associated with a positive action. Like valued exercises, like just going on a walk and enjoying yourself. That can sometimes be associated with pain, and then that just sort of It becomes a lot harder to find yourself enjoying things that you used to. when patients just lose those valued actions just to limit their pain, it can sometimes lead to depression, and honestly, it just worsens their experience. Committed action is the last step. This is where patients begin to commit to changing their values and behaviors in spite of pain. To speak more about this subject, I invited Manisha Chulani to help talk about it. She is a therapist familiar with ACT and does use it on her patients. Let's go and hear what she has to say.
speaker-0: thank you so much for agreeing to meet for the podcast. for me personally, this is a very interesting topic. So being able to hear from an expert or someone who's worked in this field makes it way more interesting.
speaker-1: I'm pretty impressed that you're a student and I read your articles. So was very well researched. I had a lot of annotations.
speaker-0: Yeah, So from the article, it sounds like you're familiar with acceptance and commitment therapy, right?
speaker-1: Yes, I'm you know, I have worked with clients with acceptance and commitment therapy. And it's also something, it you know, from what with acceptance and commitment therapy, I part of why I gravitated towards it is because it does have a little bit of like a similar philosophy as some of what my faith is. You know, I'm Hindu. So I think that's why it kind of resonated with it as well, you know, with the acceptance part of it and the mindfulness part of it as well. So I think it has like a lot of similarities as well. So I could kind of tie both of them together.
speaker-0: Yeah, I think what is really interesting about psychotherapies is that a lot of people can be timid to approach different techniques just because it isn't the most conventional treatment method. from your experience though, how effective has it been or would you recommend it?
speaker-1: Recommended, you know, because people like you know, when people come to me, they don't always come to me generally just saying that they're coming for pain. You know, they might come in saying they might have relationship issues, or they might come in because there's a job issue or something like that, and pain is one part of it, you know, because I don't advertise myself as a pain specialist. you know, I, you know, might say I might be working with anxiety. Or I might say that I'm working with someone who has had issues with relationships. And then the more we dig deeper, I realize that some of those manifest as pain, you know, because they've suppressed their feelings, they've suppressed what's going on with them. And then you realize that, it's a deeper issue than what's going on. And then at that work then it works as a catalyst for talking about acceptance and commitment therapy because it's the pain is another aspect of what's going on with them.
speaker-0: Yeah. No, I love that you brought that up because I think a lot of people don't realize like the overlap between like their physical health and how they're feeling and their sort of emotional states. I think the most people really experience on the daily level is like that weird feeling in their stomach if they're anxious. But usually that can also manifest into other health problems. So I'm glad you touched on that. I think like just one of the things that is really interesting about this therapy is just sort of like the timeline of it, because I know. One of the reasons that people also don't want to try acceptance and commitment therapy or another psychotherapy is that they're concerned it's gonna have like a a lot more effort and like time behind it, versus medication is very short term and it reacts well. but between those short term changes you see in medicine and the long term changes you see in therapy, like what do you weigh those benefits as?
speaker-1: So like I said, you know, if you someone's coming specifically for pain, you know, of course, maybe taking the medicine or, you know, chiropractor or whatever might work. And then they start to realize like that doesn't really solve some of the root issues, right? Like they are still having those issues with communication, and then those pains still kind of keep on coming because they're not even recognizing those root issues of what's happening. And then I the therapy might start to uncover some of that. You know, and then You know, kind of acceptance talks about values, you know. So why are they you know, if they're, you know, maybe not talking about their partner about certain issue, or, you know, or if they are in a certain relationship or a certain job and you know, they have to work, you know, have a client, you know, like for certain reasons they have to stay in this job, then how do they kind of make the best you effort to stay in this job? You know, then how do they align their values to stay in this job so they feel more focused?
speaker-0: Yeah. just when it comes to acceptance and commitment therapy in general, I find it's really interesting because I when I was doing my own research, it wasn't one of the first things that really came up with a whole lot of background studies. Like I was able to find way more sources on biofeedback, hypnosis, even like MBSR. Like I think acceptance commitment therapy, mainly because it isn't like the go to psychotherapy for pain just isn't as well known. do you think that's a result of it being less effective or is that just a sign it needs to be further researched?
speaker-1: you know, I think it probably needs to be further research. you know, it does have the mindfulness commitment, you know, component to it, but it has other aspects to it. it has the aspect of, you know, the values, it has the aspect of acceptance and it's not only addressing the pain, it it addresses the whole person. Yeah. And, you know, what's going on. Whereas if you took a you know, someone who's just talking about the pain, you know, then it might be very symptomatic. You know, like okay, if you have a symptom of pain, then you can do something like mindfulness or something. But here we are trying to talk about root issues.
speaker-0: Yeah. No, I touched on it earlier in the podcast, but sort of like its application for pain based therapies is typically a little bit more on just sort of like teaching someone like, you may be dealing with this pain, but you have to sort of like figure out how can you still enjoy your life with it, like not letting it define you, realizing that, hey, you know what? this is just a part of me that I've been struggling with and I don't wanna let this limit myself from exploring other possibilities or stop me from doing things I enjoy.
speaker-1: Yes.
speaker-0: Which I think is like one of the things that is a little bit harder to do than medication 'cause then you can become very dependent on sort of thinking, Well, I need my advil right now or else I'm just not gonna have a good day. Versus I think I mean, and you can correct me if I'm wrong, from what I understood about ACT is a little bit more like she teaching you to build those own habits to sort of feel like, Hey, you know what, I am in like some level of control over this situation and like sort of personally not being bothered as much by it.
speaker-1: Exactly. Again, I read your article, you know, like for example, some cultures, you know, they're maybe a little bit averse to medication, maybe they have a feeling of side effects, or some people might feel, you know, that they're unable to, you know, leave a certain situation. Or so I think acceptance commitment therapy tries to help you kind of coexist in the situation and still have a meaningful life. You know, how do you despite the pain continue to still go to work with accommodations, you know. And I think that's has also helps me personally as well, you know. And I know for me an example has been when I had an ankle issue and I had a right ankle issue, for example. And I went to the physical therapist and then suddenly for whatever reason I sprained my left ankle by mistake and I totally forgot about my right ankle issue. So I feel like if you somehow focus on something else, you kind of it minimizes the pain that you have. Which is why it's nice to have a value system. Like if you think that, yeah, I need the pain is still there. But if you focus like, I need to, for example, have those jobs, you know, because it brings meaning to me or it helps me feel fulfilled, you know. You know, you still would have this pain, but you'll have an anchor for it.
speaker-0: Yeah, and I think that's a really good point. And it's also important to note though that usually people do have to have like training and mindfulness and practicing those mental skills because in practice it's easy to say, just don't focus on it. But I also know from experience too that sometimes that can just draw even more attention to it, especially if it's already being such an inconvenience. which is I think also one of the reasons why people really depend on therapists for those sort of things, why it can be a little bit hard to replicate at home, but for experience though, have patients usually been able to like pick up on those skills pretty fast or does do they still kind of require like a couple months worth of meetings?
speaker-1: You know, they do require some lots of meanings, but sometimes just having someone to talk to, for example, with some clients, you know, they might say that they have migraines and then you do some digging through and you realize that they have migraines on the days that they're, having unstructured time, but the days that they go to work is the times they don't have migraines. Like, that's interesting. So, you know, for you, it's actually more beneficial to have days that are structured, you know. So it kind of you know, alludes to that fact of values, right? For you, being busy, you know, being productive is an important value for you, whether you know it consciously or unconsciously.
speaker-0: Yeah, no, especially because like it can vary so much person to person. Sometimes it's just hard for someone to catch those patterns by themselves.
speaker-1: Mm-hmm.
speaker-0: Yeah. So I think like you mentioned ACTS, like applications beyond pain. what sort of like scenarios or patients do you think it's just a good audience for, or who do you think it can really benefit?
speaker-1: It can benefit a lot of people, people with anxiety, people who are struggling with their job, for example, and for different reasons, you know, like for example, right now, you know, there are people who have immigration issues and they might have to be in this job and they have no flexibility to leave the job, you know. So for them, having this idea of how do they still feel motivation to keep this job, you know, is helpful. Like how do you Find acceptance and motivation in certain situations, you know, anxiety. So I think it helps in a load load of variety of things. How do you learn to accept like this relationship? You know, instead of feeling like, you know, this person hasn't contacted me or being, you know, kind of having that diffusion, like, I have a thought that this person hasn't contacted me, versus thinking this person hasn't contacted me, they don't like me. So not personalizing certain activities.
speaker-0: Yeah, so then would you say that like during like one of these sessions it's mainly just sort of like talking through the process or just a lot of like back and forth communication or more of like some sort of guided meditation sort of scenario? It's
speaker-1: votes in the beginning there would be some of this talking through but then maybe towards the end you want to do the mindfulness and kind of having them ground themselves as well in the process of you know so that they feel anchored.
speaker-0: and then do you also find that sometimes just like acceptance commitment therapy, although someone may have like a primary reason they decided to go with that therapy, has it shown benefits in other areas of their life? Like if someone came in I think like you said, like they come in with migraine pain, is it common that usually they might also realize some other issues or figure out how to address other problems in their life?
speaker-1: They probably do. And for me, I would actually describe myself as a more generalist. I do work with a lot of different modalities. I'm more person centered. so you know, but I feel like just having that skill where they can find value in some of the other areas, whether it's learning how to work with a partner working in their job, you know, whether it's going to college and you know, someone could find like they've been not able to complete college and suddenly finding motivation to. go to college and finishing college, you know, so I think it does help in that way, just finding the motivation to complete a task.
speaker-0: Mm-hmm. Yeah. And what do you think about like the accessibility parts of this therapy? Like beyond just like acceptance of commitment therapy, hypnosis and other therapies, I mean, you do have to pay f to have a therapist and then keep going to those sessions and making the time for it. And I do know a lot of people that are in like high pressure tense situations either don't have the time or financial resources or something like that. So do you think it may just not be as accessible for certain demographics?
speaker-1: I you know, I'm not too sure about how that is. You know, I feel like every therapist has a different skill set and I think every client has a different kind of, you know, someone who they gravitate to, you know. So I feel like, you know, it's kind of like a puzzle piece, you know, it's what fits best for someone. But I do feel, like a lot of acceptance and commitment therapy, I feel has for me has been like spiritual. It connects to my faith. So that's why kind of why I kind of like it. Yeah. And I feel like some of the clients, you know, they might have some sort of like idea of acceptance or appreciate acceptance. So I think they might grab it gravitate to that. So I feel like it's more about the right client and the right therapist coming together and being aligned.
speaker-0: Yeah. Do you gravitate to this therapy most in particular or are there other ones that you also recommend for patients?
speaker-1: Yeah, I would say I'm a person-centered therapist. So, you know, you know, acceptance and carement therapy is one part of it, but I've also, you know, gotten into, you know, internal family systems or part works and some clients work towards that and they like that. I'm also very spiritual. So then sometimes with some of the other clients, you know, I might have them, you know, talk about their dreams, see what dreams they've had, maybe try and talk about it, draw it and see what emotions come up for them. And for some of them, it's just like reflective listening. And I sometimes even talk to the clients and ask them what it is that they want from me, you know, and kind of just touch base with them and see what it is that they need.
speaker-0: Yeah. Are there any like drawbacks to acceptance to commitment therapy or just like scenarios where you might gear a patient away from it?
speaker-1: Well, I wouldn't say drawbacks, but I had a client, and I was a little stumped. They were like asking me what is the purpose of the values, you know, and then I have to think about it. And then the next session I kind of explained, the values kind of helps guide you. And actually they themselves thought about it, you know, during the week. And then throughout the week they were able to find some meaning in their work, you know. So I feel like, you know, it just kind of helps them, you know, I think you just have to be a little bit more thoughtful compared to reflective listening. Okay.
speaker-0: I feel like that gives a pretty good overview of acceptance of commitment therapy, or at least earlier in the podcast, I also have my own huge feel about it. but I think even though like there is like a bunch of information online about it, I've haven't been too aware of people using it in practice as much. I feel like I only really learned about acceptance of commitment therapy when I started doing research on it versus I mean nearly everybody hears about hypnosis just from like the media and similar resources. so do you think that it's just being properly like advertised as a treatment well enough or that it is like being like properly taught in the psychological community?
speaker-1: you know, acceptance and coming with therapy, it can actually I mean I have done some basic training on PESI, but I know some people have gone really deep and there's different levels to it as well. So Russ Harris is one of supposed to be one of like gurus of acceptance and coming with therapy. And you can go really deep into it and get like for example, the mindfulness really get into how to train that. a client into it. so I feel like a lot of these modalities you can really become an expert into it if you want.
speaker-0: Yeah. Got it. is there anything that you think is super important for patients to know before they really consider going into like the acceptance commitment therapy route or any other psychotherapy?
speaker-1: feel like you know acceptance and government therapy would really help someone, you know, and it helped most people, but especially if you have like some kind of spiritual inkling that would probably help you the most. But I feel like, you know, you shouldn't really go into therapy. I know sometimes a lot of when you do consultations, a lot of therapists or a lot of you know, clients they talk about what mentality you have. But I feel like the best therapy is the one that you feel like is a good fit. It's just like the one you have the good, you know, the best bedside manner. So if you feel like you have a good, you know, connection with the therapist and the c therapist feels like they have a good connection with you, it's probably the best fit for you. It's kind of like the right puzzle piece. Okay.
speaker-0: Great. And thank you so much for your insights. This was super helpful and I'm sure our audience appreciates it.
speaker-1: bye.
Lila: So I think something that concerns a lot of people with psychotherapies is when they hear therapy, they're like, no, it's gonna take so much time. I have to go in person. If I just could pop a pill, that'd be so much more convenient. Well, I'm not saying that the therapy sessions might take a little bit more time. they do have some pretty good effects. And it's also important to note that with ACT, telehealth and like virtual conferences, those kind of meetings can work. just as effectively as going in person. You do not have to worry about commuting to a therapist. a study published in 2017 by the Journal of Pain found that telehealth in regards to like in-person acceptance and commitment therapy, was not in any way inferior to the in person delivery of this treatment. And I think that's really important because it's just way more convenient that way for people. Like a lot of people that are just seeing, my God, I don't know if I want to go through all these barriers and have to deal with acceptance to commitment therapy. A lot of therapists these days are willing to work online and help work to make this the most convenient treatment for you as possible without having to deal with all the concerns about Becoming too used to pain medications, becoming dependent on it. Something that's really good about acceptance and commitment therapy is the mindfulness and mental health tools you use. They carry into you for the rest of your life beyond whatever chronic pain you have. Just learning how to just get control over your thoughts. Take this situation and direct that energy into sort of, you know what? Yeah, I am in pain. But let me like reevaluate. What is this actually stopping me from doing? Like, does this actually affect my life as much as I thought it was? Where can I still find joy despite having this issue? focusing a little bit more on the where can I still succeed? I understand this is an issue, but I'm not letting that issue define me. That's a really cool skill that you can put into so many other areas. let's look at an actual case study on someone who used online ACT to overcome their chronic pain. So this study was done in April of 2025 and basically it evaluates online acceptance and commitment therapy on a 78-year-old woman with chronic pain. it was completed in an eight session ACT program and it found that there was actually Pretty good improvements in her overall pain and functioning, but let's break down the sessions and just see what was this person's experience. What sort of did each session look like? So maybe you can visualize: is this the sort of experience I would want for myself? Is this the sort of treatment I think might work for me or for someone you know? So, in her first session, that was the initial assessment. The first session involved moving into sort of like a clinical interview, trying to collect her demographic information, her patient history, where is her pain affecting her. it just sort of really helps the therapist understand: okay, what is all the background stuff here that I need to be aware of going into this treatment? Session two. We've talked about values. This set that session focused on value clarification. It showed that. Her pain condition, along with some of her caregiving responsibilities as a wife and family member, overshadowed some her personal values. She realized that she does value social connection and friendships, but she hasn't been allowing herself that opportunity and recognizing that is the first step to taking action and living a more fulfilled life. Session three, cognitive This one focused on addressing her belief that her condition would just inevitably worsen. She learned though not to like suppress or avoid these thoughts, but more to just sort of like observe them non-reactively. Sounding a little familiar to what we've talked about with ACT. So just really sort of understanding that these thoughts can all coexist together. I can have these thoughts and then also just recognize them passively. And just sort of letting them come and then letting them go. That way, they do not like hold on to you as much. They do not dictate you as much. You don't focus on them as much. You're saying, you know what? I am concerned about this. Now let me just sort of observe what that thought is and then process it. And then it's a lot easier to just release it. Session four, acceptance. This session worked on using analogies to realize that acceptance doesn't count as passively giving in or just putting up with like whatever this issue is. Instead of being a form of surrender, acceptance is sort of framed as a way to accommodate pain. You can still engage in meaningful activities. You're just figuring out how to live and manage it without letting it dictate your thoughts or your life. Session five focused on present moment awareness. So this session mainly focused on connecting with the present moment, and that mindfulness tool is actually so helpful when applying to other areas of life. And just sort of focusing on having breakfast or what sounds you hear. That's like one instance, or just sort of like pausing what you're doing and just sort of sitting in and That just makes it so much easier to appreciate your natural surroundings. And then also just reconnect to the present moment. Actively decreasing anxiety, which makes it so good to manage distress. One of the biggest side effects of chronic pain is that you just do have a lot of emotional baggage in distress. And looking into that moment is really beneficial into just sort of reevaluating, hey, where are my feet right now? Where am I right now? What is going on? And how can I appreciate this moment? That actively reduces stress and helps make you feel better with yourself. And that's one of the things that's a little bit harder to get with medication Session six focused on committed action. This is where she focused on seeing where in her life can she take the steps that she needs that align with her values. Where can she further engage and find social opportunities and make friends? and almost sounds a little bit like, I can just do that myself. But I feel like a lot of people what they don't realize is sometimes You just need to sit down with someone and start talking and being like, wait a second. I haven't spoken to my friend in over a week. I actually don't know that many people. There's some stuff I wanted to try, but it's just I never had that activation energy to start it. Like that's what this therapy helps you do is realizing, okay, I didn't see this as an opportunity I could take before. Why don't I take it now? Session seven, second to last, focused on the concept of self as context. This is the ability to view oneself beyond their current circumstances. This also means acknowledging pain without identifying yourself as a victim, For the patient in this study, she said that this concept actually really resonated because she remembered feeling like she was succumbing to her condition or she just felt excessive time just staying on a chair and watching TV and disengaging from meaningful activities because she just identified herself as dysfunctional. Taking this selfless context step to realize, hey, I may have foot pain, that doesn't mean that's who I am. Now I'm not the person with foot pain. Like, no, there's more to you than that. There's more to anyone than what their pain or their feelings are. And this therapy helps you recognize that and helps you figure out who do I wanna be? What can I be? That's why this is so much helpful, more beyond chronic pain, is it helps you build the skills that you can carry. To live a more satisfactory life. The last session, session eight, was just mainly the review and final assessment. It clarified remaining questions, and then overall was just kind of a wrap-up. Overall, I mean, from this study, and remember this is also the online version, totally convenient for everybody. eight sessions, she felt some significant improvements. I mean on a scale from zero to fifteen on the rapid assessment of physical activity exam, she went from first session one out of fifteen to eighth session. She scored a ten. That's some significant improvement on just her physical activity. And guess what? She still had pain. Both throughout all that session, she just figured out, hey, wait a second. This isn't inhibiting me as much as I thought it was. Chronic pain isn't the best to deal with, but what's important is understanding how to best manage it. Using acceptance and commitment therapy allows you to treat your pain without having to deal with all the nasty side effects with medication. Do I recommend it? Yes, I know it's really effective. I hope this podcast has been insightful in helping you understand what the therapy is, how it works, and how it can benefit patients. And if you're interested, I hope you're able to connect with a nearby practitioner. Thank you.
speaker-0: thank you so much for agreeing to meet for the podcast. for me personally, this is a very interesting topic. So being able to hear from an expert or someone who's worked in this field makes it way more interesting.
speaker-1: I'm pretty impressed that you're a student and I read your articles. So was very well researched. I had a lot of annotations.
speaker-0: Yeah, So from the article, it sounds like you're familiar with acceptance and commitment therapy, right?
speaker-1: Yes, I'm you know, I have worked with clients with acceptance and commitment therapy. And it's also something, it you know, from what with acceptance and commitment therapy, I part of why I gravitated towards it is because it does have a little bit of like a similar philosophy as some of what my faith is. You know, I'm Hindu. So I think that's why it kind of resonated with it as well, you know, with the acceptance part of it and the mindfulness part of it as well. So I think it has like a lot of similarities as well. So I could kind of tie both of them together.
speaker-0: Yeah, I think what is really interesting about psychotherapies is that a lot of people can be timid to approach different techniques just because it isn't the most conventional treatment method. from your experience though, how effective has it been or would you recommend it?
speaker-1: Recommended, you know, because people like you know, when people come to me, they don't always come to me generally just saying that they're coming for pain. You know, they might come in saying they might have relationship issues, or they might come in because there's a job issue or something like that, and pain is one part of it, you know, because I don't advertise myself as a pain specialist. you know, I, you know, might say I might be working with anxiety. Or I might say that I'm working with someone who has had issues with relationships. And then the more we dig deeper, I realize that some of those manifest as pain, you know, because they've suppressed their feelings, they've suppressed what's going on with them. And then you realize that, it's a deeper issue than what's going on. And then at that work then it works as a catalyst for talking about acceptance and commitment therapy because it's the pain is another aspect of what's going on with them.
speaker-0: Yeah. No, I love that you brought that up because I think a lot of people don't realize like the overlap between like their physical health and how they're feeling and their sort of emotional states. I think the most people really experience on the daily level is like that weird feeling in their stomach if they're anxious. But usually that can also manifest into other health problems. So I'm glad you touched on that. I think like just one of the things that is really interesting about this therapy is just sort of like the timeline of it, because I know. One of the reasons that people also don't want to try acceptance and commitment therapy or another psychotherapy is that they're concerned it's gonna have like a a lot more effort and like time behind it, versus medication is very short term and it reacts well. but between those short term changes you see in medicine and the long term changes you see in therapy, like what do you weigh those benefits as?
speaker-1: So like I said, you know, if you someone's coming specifically for pain, you know, of course, maybe taking the medicine or, you know, chiropractor or whatever might work. And then they start to realize like that doesn't really solve some of the root issues, right? Like they are still having those issues with communication, and then those pains still kind of keep on coming because they're not even recognizing those root issues of what's happening. And then I the therapy might start to uncover some of that. You know, and then You know, kind of acceptance talks about values, you know. So why are they you know, if they're, you know, maybe not talking about their partner about certain issue, or, you know, or if they are in a certain relationship or a certain job and you know, they have to work, you know, have a client, you know, like for certain reasons they have to stay in this job, then how do they kind of make the best you effort to stay in this job? You know, then how do they align their values to stay in this job so they feel more focused?
speaker-0: Yeah. just when it comes to acceptance and commitment therapy in general, I find it's really interesting because I when I was doing my own research, it wasn't one of the first things that really came up with a whole lot of background studies. Like I was able to find way more sources on biofeedback, hypnosis, even like MBSR. Like I think acceptance commitment therapy, mainly because it isn't like the go to psychotherapy for pain just isn't as well known. do you think that's a result of it being less effective or is that just a sign it needs to be further researched?
speaker-1: you know, I think it probably needs to be further research. you know, it does have the mindfulness commitment, you know, component to it, but it has other aspects to it. it has the aspect of, you know, the values, it has the aspect of acceptance and it's not only addressing the pain, it it addresses the whole person. Yeah. And, you know, what's going on. Whereas if you took a you know, someone who's just talking about the pain, you know, then it might be very symptomatic. You know, like okay, if you have a symptom of pain, then you can do something like mindfulness or something. But here we are trying to talk about root issues.
speaker-0: Yeah. No, I touched on it earlier in the podcast, but sort of like its application for pain based therapies is typically a little bit more on just sort of like teaching someone like, you may be dealing with this pain, but you have to sort of like figure out how can you still enjoy your life with it, like not letting it define you, realizing that, hey, you know what? this is just a part of me that I've been struggling with and I don't wanna let this limit myself from exploring other possibilities or stop me from doing things I enjoy.
speaker-1: Yes.
speaker-0: Which I think is like one of the things that is a little bit harder to do than medication 'cause then you can become very dependent on sort of thinking, Well, I need my advil right now or else I'm just not gonna have a good day. Versus I think I mean, and you can correct me if I'm wrong, from what I understood about ACT is a little bit more like she teaching you to build those own habits to sort of feel like, Hey, you know what, I am in like some level of control over this situation and like sort of personally not being bothered as much by it.
speaker-1: Exactly. Again, I read your article, you know, like for example, some cultures, you know, they're maybe a little bit averse to medication, maybe they have a feeling of side effects, or some people might feel, you know, that they're unable to, you know, leave a certain situation. Or so I think acceptance commitment therapy tries to help you kind of coexist in the situation and still have a meaningful life. You know, how do you despite the pain continue to still go to work with accommodations, you know. And I think that's has also helps me personally as well, you know. And I know for me an example has been when I had an ankle issue and I had a right ankle issue, for example. And I went to the physical therapist and then suddenly for whatever reason I sprained my left ankle by mistake and I totally forgot about my right ankle issue. So I feel like if you somehow focus on something else, you kind of it minimizes the pain that you have. Which is why it's nice to have a value system. Like if you think that, yeah, I need the pain is still there. But if you focus like, I need to, for example, have those jobs, you know, because it brings meaning to me or it helps me feel fulfilled, you know. You know, you still would have this pain, but you'll have an anchor for it.
speaker-0: Yeah, and I think that's a really good point. And it's also important to note though that usually people do have to have like training and mindfulness and practicing those mental skills because in practice it's easy to say, just don't focus on it. But I also know from experience too that sometimes that can just draw even more attention to it, especially if it's already being such an inconvenience. which is I think also one of the reasons why people really depend on therapists for those sort of things, why it can be a little bit hard to replicate at home, but for experience though, have patients usually been able to like pick up on those skills pretty fast or does do they still kind of require like a couple months worth of meetings?
speaker-1: You know, they do require some lots of meanings, but sometimes just having someone to talk to, for example, with some clients, you know, they might say that they have migraines and then you do some digging through and you realize that they have migraines on the days that they're, having unstructured time, but the days that they go to work is the times they don't have migraines. Like, that's interesting. So, you know, for you, it's actually more beneficial to have days that are structured, you know. So it kind of you know, alludes to that fact of values, right? For you, being busy, you know, being productive is an important value for you, whether you know it consciously or unconsciously.
speaker-0: Yeah, no, especially because like it can vary so much person to person. Sometimes it's just hard for someone to catch those patterns by themselves.
speaker-1: Mm-hmm.
speaker-0: Yeah. So I think like you mentioned ACTS, like applications beyond pain. what sort of like scenarios or patients do you think it's just a good audience for, or who do you think it can really benefit?
speaker-1: It can benefit a lot of people, people with anxiety, people who are struggling with their job, for example, and for different reasons, you know, like for example, right now, you know, there are people who have immigration issues and they might have to be in this job and they have no flexibility to leave the job, you know. So for them, having this idea of how do they still feel motivation to keep this job, you know, is helpful. Like how do you Find acceptance and motivation in certain situations, you know, anxiety. So I think it helps in a load load of variety of things. How do you learn to accept like this relationship? You know, instead of feeling like, you know, this person hasn't contacted me or being, you know, kind of having that diffusion, like, I have a thought that this person hasn't contacted me, versus thinking this person hasn't contacted me, they don't like me. So not personalizing certain activities.
speaker-0: Yeah, so then would you say that like during like one of these sessions it's mainly just sort of like talking through the process or just a lot of like back and forth communication or more of like some sort of guided meditation sort of scenario? It's
speaker-1: votes in the beginning there would be some of this talking through but then maybe towards the end you want to do the mindfulness and kind of having them ground themselves as well in the process of you know so that they feel anchored.
speaker-0: and then do you also find that sometimes just like acceptance commitment therapy, although someone may have like a primary reason they decided to go with that therapy, has it shown benefits in other areas of their life? Like if someone came in I think like you said, like they come in with migraine pain, is it common that usually they might also realize some other issues or figure out how to address other problems in their life?
speaker-1: They probably do. And for me, I would actually describe myself as a more generalist. I do work with a lot of different modalities. I'm more person centered. so you know, but I feel like just having that skill where they can find value in some of the other areas, whether it's learning how to work with a partner working in their job, you know, whether it's going to college and you know, someone could find like they've been not able to complete college and suddenly finding motivation to. go to college and finishing college, you know, so I think it does help in that way, just finding the motivation to complete a task.
speaker-0: Mm-hmm. Yeah. And what do you think about like the accessibility parts of this therapy? Like beyond just like acceptance of commitment therapy, hypnosis and other therapies, I mean, you do have to pay f to have a therapist and then keep going to those sessions and making the time for it. And I do know a lot of people that are in like high pressure tense situations either don't have the time or financial resources or something like that. So do you think it may just not be as accessible for certain demographics?
speaker-1: I you know, I'm not too sure about how that is. You know, I feel like every therapist has a different skill set and I think every client has a different kind of, you know, someone who they gravitate to, you know. So I feel like, you know, it's kind of like a puzzle piece, you know, it's what fits best for someone. But I do feel, like a lot of acceptance and commitment therapy, I feel has for me has been like spiritual. It connects to my faith. So that's why kind of why I kind of like it. Yeah. And I feel like some of the clients, you know, they might have some sort of like idea of acceptance or appreciate acceptance. So I think they might grab it gravitate to that. So I feel like it's more about the right client and the right therapist coming together and being aligned.
speaker-0: Yeah. Do you gravitate to this therapy most in particular or are there other ones that you also recommend for patients?
speaker-1: Yeah, I would say I'm a person-centered therapist. So, you know, you know, acceptance and carement therapy is one part of it, but I've also, you know, gotten into, you know, internal family systems or part works and some clients work towards that and they like that. I'm also very spiritual. So then sometimes with some of the other clients, you know, I might have them, you know, talk about their dreams, see what dreams they've had, maybe try and talk about it, draw it and see what emotions come up for them. And for some of them, it's just like reflective listening. And I sometimes even talk to the clients and ask them what it is that they want from me, you know, and kind of just touch base with them and see what it is that they need.
speaker-0: Yeah. Are there any like drawbacks to acceptance to commitment therapy or just like scenarios where you might gear a patient away from it?
speaker-1: Well, I wouldn't say drawbacks, but I had a client, and I was a little stumped. They were like asking me what is the purpose of the values, you know, and then I have to think about it. And then the next session I kind of explained, the values kind of helps guide you. And actually they themselves thought about it, you know, during the week. And then throughout the week they were able to find some meaning in their work, you know. So I feel like, you know, it just kind of helps them, you know, I think you just have to be a little bit more thoughtful compared to reflective listening. Okay.
speaker-0: I feel like that gives a pretty good overview of acceptance of commitment therapy, or at least earlier in the podcast, I also have my own huge feel about it. but I think even though like there is like a bunch of information online about it, I've haven't been too aware of people using it in practice as much. I feel like I only really learned about acceptance of commitment therapy when I started doing research on it versus I mean nearly everybody hears about hypnosis just from like the media and similar resources. so do you think that it's just being properly like advertised as a treatment well enough or that it is like being like properly taught in the psychological community?
speaker-1: you know, acceptance and coming with therapy, it can actually I mean I have done some basic training on PESI, but I know some people have gone really deep and there's different levels to it as well. So Russ Harris is one of supposed to be one of like gurus of acceptance and coming with therapy. And you can go really deep into it and get like for example, the mindfulness really get into how to train that. a client into it. so I feel like a lot of these modalities you can really become an expert into it if you want.
speaker-0: Yeah. Got it. is there anything that you think is super important for patients to know before they really consider going into like the acceptance commitment therapy route or any other psychotherapy?
speaker-1: feel like you know acceptance and government therapy would really help someone, you know, and it helped most people, but especially if you have like some kind of spiritual inkling that would probably help you the most. But I feel like, you know, you shouldn't really go into therapy. I know sometimes a lot of when you do consultations, a lot of therapists or a lot of you know, clients they talk about what mentality you have. But I feel like the best therapy is the one that you feel like is a good fit. It's just like the one you have the good, you know, the best bedside manner. So if you feel like you have a good, you know, connection with the therapist and the c therapist feels like they have a good connection with you, it's probably the best fit for you. It's kind of like the right puzzle piece. Okay.
speaker-0: Great. And thank you so much for your insights. This was super helpful and I'm sure our audience appreciates it.
speaker-1: bye.
Lila: So I think something that concerns a lot of people with psychotherapies is when they hear therapy, they're like, no, it's gonna take so much time. I have to go in person. If I just could pop a pill, that'd be so much more convenient. Well, I'm not saying that the therapy sessions might take a little bit more time. they do have some pretty good effects. And it's also important to note that with ACT, telehealth and like virtual conferences, those kind of meetings can work. just as effectively as going in person. You do not have to worry about commuting to a therapist. a study published in 2017 by the Journal of Pain found that telehealth in regards to like in-person acceptance and commitment therapy, was not in any way inferior to the in person delivery of this treatment. And I think that's really important because it's just way more convenient that way for people. Like a lot of people that are just seeing, my God, I don't know if I want to go through all these barriers and have to deal with acceptance to commitment therapy. A lot of therapists these days are willing to work online and help work to make this the most convenient treatment for you as possible without having to deal with all the concerns about Becoming too used to pain medications, becoming dependent on it. Something that's really good about acceptance and commitment therapy is the mindfulness and mental health tools you use. They carry into you for the rest of your life beyond whatever chronic pain you have. Just learning how to just get control over your thoughts. Take this situation and direct that energy into sort of, you know what? Yeah, I am in pain. But let me like reevaluate. What is this actually stopping me from doing? Like, does this actually affect my life as much as I thought it was? Where can I still find joy despite having this issue? focusing a little bit more on the where can I still succeed? I understand this is an issue, but I'm not letting that issue define me. That's a really cool skill that you can put into so many other areas. let's look at an actual case study on someone who used online ACT to overcome their chronic pain. So this study was done in April of 2025 and basically it evaluates online acceptance and commitment therapy on a 78-year-old woman with chronic pain. it was completed in an eight session ACT program and it found that there was actually Pretty good improvements in her overall pain and functioning, but let's break down the sessions and just see what was this person's experience. What sort of did each session look like? So maybe you can visualize: is this the sort of experience I would want for myself? Is this the sort of treatment I think might work for me or for someone you know? So, in her first session, that was the initial assessment. The first session involved moving into sort of like a clinical interview, trying to collect her demographic information, her patient history, where is her pain affecting her. it just sort of really helps the therapist understand: okay, what is all the background stuff here that I need to be aware of going into this treatment? Session two. We've talked about values. This set that session focused on value clarification. It showed that. Her pain condition, along with some of her caregiving responsibilities as a wife and family member, overshadowed some her personal values. She realized that she does value social connection and friendships, but she hasn't been allowing herself that opportunity and recognizing that is the first step to taking action and living a more fulfilled life. Session three, cognitive This one focused on addressing her belief that her condition would just inevitably worsen. She learned though not to like suppress or avoid these thoughts, but more to just sort of like observe them non-reactively. Sounding a little familiar to what we've talked about with ACT. So just really sort of understanding that these thoughts can all coexist together. I can have these thoughts and then also just recognize them passively. And just sort of letting them come and then letting them go. That way, they do not like hold on to you as much. They do not dictate you as much. You don't focus on them as much. You're saying, you know what? I am concerned about this. Now let me just sort of observe what that thought is and then process it. And then it's a lot easier to just release it. Session four, acceptance. This session worked on using analogies to realize that acceptance doesn't count as passively giving in or just putting up with like whatever this issue is. Instead of being a form of surrender, acceptance is sort of framed as a way to accommodate pain. You can still engage in meaningful activities. You're just figuring out how to live and manage it without letting it dictate your thoughts or your life. Session five focused on present moment awareness. So this session mainly focused on connecting with the present moment, and that mindfulness tool is actually so helpful when applying to other areas of life. And just sort of focusing on having breakfast or what sounds you hear. That's like one instance, or just sort of like pausing what you're doing and just sort of sitting in and That just makes it so much easier to appreciate your natural surroundings. And then also just reconnect to the present moment. Actively decreasing anxiety, which makes it so good to manage distress. One of the biggest side effects of chronic pain is that you just do have a lot of emotional baggage in distress. And looking into that moment is really beneficial into just sort of reevaluating, hey, where are my feet right now? Where am I right now? What is going on? And how can I appreciate this moment? That actively reduces stress and helps make you feel better with yourself. And that's one of the things that's a little bit harder to get with medication Session six focused on committed action. This is where she focused on seeing where in her life can she take the steps that she needs that align with her values. Where can she further engage and find social opportunities and make friends? and almost sounds a little bit like, I can just do that myself. But I feel like a lot of people what they don't realize is sometimes You just need to sit down with someone and start talking and being like, wait a second. I haven't spoken to my friend in over a week. I actually don't know that many people. There's some stuff I wanted to try, but it's just I never had that activation energy to start it. Like that's what this therapy helps you do is realizing, okay, I didn't see this as an opportunity I could take before. Why don't I take it now? Session seven, second to last, focused on the concept of self as context. This is the ability to view oneself beyond their current circumstances. This also means acknowledging pain without identifying yourself as a victim, For the patient in this study, she said that this concept actually really resonated because she remembered feeling like she was succumbing to her condition or she just felt excessive time just staying on a chair and watching TV and disengaging from meaningful activities because she just identified herself as dysfunctional. Taking this selfless context step to realize, hey, I may have foot pain, that doesn't mean that's who I am. Now I'm not the person with foot pain. Like, no, there's more to you than that. There's more to anyone than what their pain or their feelings are. And this therapy helps you recognize that and helps you figure out who do I wanna be? What can I be? That's why this is so much helpful, more beyond chronic pain, is it helps you build the skills that you can carry. To live a more satisfactory life. The last session, session eight, was just mainly the review and final assessment. It clarified remaining questions, and then overall was just kind of a wrap-up. Overall, I mean, from this study, and remember this is also the online version, totally convenient for everybody. eight sessions, she felt some significant improvements. I mean on a scale from zero to fifteen on the rapid assessment of physical activity exam, she went from first session one out of fifteen to eighth session. She scored a ten. That's some significant improvement on just her physical activity. And guess what? She still had pain. Both throughout all that session, she just figured out, hey, wait a second. This isn't inhibiting me as much as I thought it was. Chronic pain isn't the best to deal with, but what's important is understanding how to best manage it. Using acceptance and commitment therapy allows you to treat your pain without having to deal with all the nasty side effects with medication. Do I recommend it? Yes, I know it's really effective. I hope this podcast has been insightful in helping you understand what the therapy is, how it works, and how it can benefit patients. And if you're interested, I hope you're able to connect with a nearby practitioner. Thank you.
