Acceptance and Commitment Therapy (ACT) for Chronic Pain
Learning to live well, even when pain stays.
When you live with chronic pain, it can feel like your entire life shrinks around it. Plans get cancelled, movement becomes cautious, and energy is rationed. Understandably, the goal becomes to get rid of the pain. But what happens when the pain doesn’t go away?
That’s where Acceptance and Commitment Therapy (ACT) comes in.
What is ACT?
ACT (pronounced as the word “act”) is a form of therapy that helps people build a richer, more meaningful life — even when pain, sadness, or fear are present. Instead of fighting against uncomfortable sensations or emotions, ACT teaches you how to change your relationship with them.
The focus shifts from control to choice:
“Even if pain is here, how do I want to live today?”
The Six Core Processes of ACT
ACT uses six core processes to help you develop psychological flexibility — the ability to stay open, present, and engaged in what matters most, no matter what your body or mind throws at you.
Acceptance – Learning to make space for pain rather than resisting it. Resistance often amplifies suffering; acceptance allows us to respond rather than react.
Cognitive Defusion – Gaining distance from unhelpful thoughts (“I can’t handle this,” “I’m broken”) so they lose their power.
Being Present – Focusing on what’s happening right now, instead of reliving the past or fearing the future.
Self-as-Context – Seeing yourself as more than your pain or your thoughts — as an observer who experiences them, but is not defined by them.
Values – Clarifying what truly matters to you: family, creativity, independence, compassion, or contribution.
Committed Action – Taking small, consistent steps toward those values — even if discomfort is along for the ride.
Why ACT Works for Chronic Pain
ACT doesn’t promise to eliminate pain, but research shows it can transform how you live with it. Studies have found that ACT improves quality of life, reduces pain interference, and decreases distress — even when pain intensity remains unchanged.
By focusing on what you can control — your actions, attention, and values — ACT helps break the cycle of avoidance and despair that often accompanies chronic pain.
An Example
Imagine someone who values connection but has withdrawn from friends because socializing feels exhausting. Through ACT, they might begin to reconnect — maybe starting with a short phone call, a coffee date, or joining an online support group. The pain might still be there, but life becomes bigger again.
ACT in Practice
In therapy or group sessions, ACT might include mindfulness exercises, values clarification worksheets, and small behavioural experiments that align with your goals. Over time, this approach builds resilience and flexibility — essential ingredients for living well with pain.
The Heart of ACT
At its core, ACT is about learning to say:
“Pain may be part of my life, but it doesn’t have to be the driver of it.”
By Dr Michelle Beukes-King
