Acceptance and Commitment Therapy (ACT): A Powerful Tool for Chronic Pain Management
Chronic pain is one of the most complex challenges faced in healthcare. Despite advances in pharmacological and interventional treatments, many patients continue to experience significant distress, disability, and loss of quality of life. For these individuals, the goal of treatment is often no longer cure, but recovery of function and re-engagement with meaningful living.
Acceptance and Commitment Therapy (ACT), described as a “third-wave” behavioural therapy, offers a robust, evidence-based framework to help achieve this.
What Is ACT?
ACT (pronounced as the word “act”) is grounded in behavioural science and mindfulness. Rather than focusing on symptom reduction, it targets psychological flexibility — the capacity to stay open, present, and engaged with life even in the presence of pain or distress.
The six core processes of ACT are:
Acceptance – making room for uncomfortable sensations, thoughts, and emotions rather than struggling to suppress or control them.
Cognitive defusion – noticing thoughts for what they are (mental events), rather than as literal truths.
Contact with the present moment – cultivating mindful awareness and shifting from automatic, reactive patterns.
Self-as-context – recognising the observing self that can hold experiences with perspective.
Values clarification – identifying what truly matters to the individual.
Committed action – taking steps guided by those values, even in the presence of pain.
Through these processes, ACT teaches you how to change your relationship with pain rather than the pain itself — moving from avoidance and control to engagement and purpose.
The Evidence Base
ACT has been extensively studied in chronic pain populations, with multiple meta-analyses showing improvements in function, mood, and quality of life, even when pain intensity remains unchanged.
A 2020 systematic review (Veehof et al., PAIN) found ACT significantly improved pain interference, depression, and anxiety compared to treatment-as-usual or education-only controls. Gains were maintained at follow-up, reflecting sustained behavioural change rather than transient relief.
Group-based and online ACT programmes have proven equally effective, demonstrating strong cost-effectiveness and accessibility — critical advantages in resource-constrained systems.
ACT’s success lies partly in its transdiagnostic approach: it targets the same processes that maintain suffering across conditions — avoidance, cognitive fusion, and experiential rigidity — making it useful if you are living with pain and comorbid depression, anxiety, or trauma histories.
Why ACT Resonates in Pain Medicine
The traditional biomedical model often reinforces the idea that pain must be eradicated before life can resume. ACT invites a different narrative — that people can live meaningful, vital lives even while pain is present.
For clinicians, this shift can be profoundly liberating. Rather than being limited by the need to “fix” pain, we help people build the skills to respond differently to it. This aligns with the biopsychosocial model and complements medical and allied health interventions.
ACT also integrates well within interdisciplinary pain management, bridging psychology, psychiatry, physiotherapy, and occupational therapy. It offers a shared language for goal setting (“What matters most to you?”) and promotes behavioural activation, pacing, and re-engagement with valued activities.
Why It Works
ACT works because it meets people where they are. It validates the experience of pain while helping to notice how avoidance — of movement, emotion, or uncertainty — may inadvertently increase suffering. By shifting the focus from eliminating pain to living well with pain, patients rediscover autonomy and hope.
Mindfulness-based exercises cultivate awareness and self-compassion; cognitive defusion reduces the dominance of catastrophic thoughts (“I can’t cope”); and values-driven action reconnects individuals with identity, purpose, and social connection — key determinants of resilience and wellbeing.
In Practice
ACT interventions can be delivered individually or in groups, in person or online. Sessions often combine experiential exercises, metaphors, mindfulness practices, and guided reflection. In my own work with chronic pain groups, participants consistently report that ACT helps them “get unstuck” — shifting from constant struggle to gentle acceptance and movement toward what matters most.
Conclusion
Acceptance and Commitment Therapy represents a paradigm shift in chronic pain management — from control to flexibility, from symptom elimination to values-based living.
As healthcare professionals, integrating ACT principles into our conversations with patients — even briefly — can transform how they understand and relate to pain. The outcome is not necessarily less pain, but more life, and that is often the most powerful medicine we can offer.
If you are interested in joining the next group, enroll now.
By Dr Michelle Beukes-King
