What ACT Actually Looks Like in Chronic Pain Therapy
After reading about acceptance, values, catastrophising, and avoidance, many people ask a very reasonable question:
“But what does ACT for chronic pain actually look like in practice?”
For some, therapy feels abstract or intimidating. Others worry that psychological treatment means their pain won’t be taken seriously. ACT approaches chronic pain differently — not by dismissing pain, but by working with the whole person living with it.
ACT Starts With Validation, Not Fixing
ACT does not begin by trying to change pain, thoughts, or emotions.
It begins with validation.
Chronic pain is real. It is exhausting. It affects identity, relationships, work, and hope for the future. ACT recognises that anyone living with ongoing pain is doing the best they can with a nervous system under constant strain.
Rather than asking, “How do we get rid of pain?”, ACT asks:
“How do we reduce suffering and help you live well, even if pain remains?”
Understanding the Pain–Mind–Nervous System Loop
A central part of ACT for chronic pain is helping people understand how pain interacts with:
Thoughts (such as catastrophising)
Emotions (fear, frustration, grief)
Behaviour (avoidance, pushing, withdrawal)
The nervous system’s threat response
This understanding is not about blame. It is about choice and flexibility.
When people can see these patterns clearly, they gain more room to respond differently.
Working With Thoughts — Not Against Them
ACT does not aim to eliminate difficult thoughts about pain.
Instead, therapy focuses on:
Noticing thoughts as mental events
Reducing their grip on behaviour
Learning how to step back rather than argue with them
This is particularly helpful for people caught in cycles of worry, fear, or catastrophising, where thoughts quickly escalate pain and distress.
Making Space for Difficult Emotions
Chronic pain often brings grief, anger, sadness, and fear. These emotions are understandable — and often avoided.
ACT helps people learn how to:
Make room for emotions without being overwhelmed
Reduce emotional avoidance
Respond with self-compassion rather than self-criticism
This emotional flexibility is a key part of reducing suffering.
Reconnecting With Values and Meaning
One of the most transformative aspects of ACT is its focus on values.
In therapy, people explore questions such as:
What kind of person do I want to be, even with pain present?
What matters enough to take small steps toward, despite discomfort?
Values guide action — not pain levels or fear. This allows life to expand again, gradually and meaningfully.
From Avoidance to Gentle Engagement
ACT does not encourage pushing through pain.
Instead, it supports:
Graded, values-based re-engagement
Flexible pacing rather than rigid rules
Rebuilding trust in the body over time
Progress is measured not only by pain reduction, but by increased participation in life.
ACT Works Alongside Medical Care
ACT for chronic pain is not an alternative to medical treatment. It is a complementary, evidence-based approach that addresses the psychological and nervous system aspects of pain.
It is particularly helpful for people who:
Feel stuck despite medical treatment
Experience significant fear or avoidance
Notice pain is closely linked to stress or emotions
Want to live more fully, even if pain persists
Therapy Is About Building a Life, Not Winning a Battle
ACT reframes the goal of therapy.
Rather than fighting an endless battle with pain, therapy becomes about building a life that is rich, meaningful, and aligned with what matters — with pain present, but not in charge.
I offer ACT-informed therapy for people living with chronic pain, both individually and in groups. If this approach resonates, you’re welcome to contact me to explore whether it may be helpful for you.
By Dr Michelle Beukes-King
