Robinson, P., Wicksell, R., & Olsson, G. L. (2005). Act with chronic pain patients. In S. Hayes & K. Strosahl (Eds.), A practical guide to acceptance and commitment therapy, 315-345. New York: Springer Science + Business Media, Inc.
Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl & Wilson, 1999) offers a novel approach that may help behavioral health and medical providers prevent and treat chronic pain. There is a growing body of evidence that acceptance as the term is defined and measured in ACT (using a pain specific measure modified from the Acceptance and Action Questionnaire, Hayes et al., in press) is a key issue in the development and maintenance of chronic pain (McCracken, 1998; McCracken, Vowles, & Eccleston, 2004). Acceptance accounts for more of the variance in outcome on pain, depression, anxiety, disability, vocational functioning, and physical functioning than existing measures of coping with pain (McCracken & Eccleston, 2003). ACT interventions improve the tolerance of pain in normal populations more so than CBT interventions (e.g., Gutierrez, Luciano, Rodriguez, & Fink, in press; Hayes, Bissett, Korn, Zettle, Rosenfarb, Cooper, & Grundt, 1999), while attempt to suppress pain tends to increase it (Cioffi & Holloway, 1993). There are supportive case studies on the outcome of ACT on pain with adults (Luciano, Visdomine, Gutierrez, & Montesinos, 2001; Montesinos, Hernandez, & Luciano, 2001) and children (Wicksell, Dahl, Magnusson, & Olsson, under review). Uncontrolled studies of ACTbased pain programs are also supportive (Robinson & Brockey, 1996). Finally, controlled clinical trials are beginning to appear. For example, in a small randomized trial (Dahl, Wilson, & Nilsson, in press) comparing four sessions of ACT to treatment as usual with workers who were taking excessive sick leave due to pain, large differences were found in the number of work days missed by the end of a six month follow-up. In this chapter, the authors consider gaps in current services as groundwork for consideration of ACT as a model that will enhance prevention and treatment efforts. In separate sections for adults and children, the authors suggest specific interventions and offer methods for anticipating and addressing common obstacles to successful ACT treatment.