A New Form of CBT May Manage Chronic Pain, Research Says

A New Form of CBT May Manage Chronic Pain, Research Says

We all get disturbed by the pain that we experience on everyday basis. Even the prick of a needle makes us jump for a second and we require at least a few seconds to get back to our senses.

Imagine what would happen to those who suffer from this pain, a lot more high in severity as compared to a needle prick, and that too for every minute of every day?

Chronic pain is extremely disturbing and difficult to live with. It can lower down the quality of life to a great extent. Some of the most common diseases that feature chronic pain include osteoarthritis, fibromyalgia, multiple sclerosis, and shingles.


Despite decades of research, scientists have not been able to understand the concept of chronic pain, its mechanism, and treatment. In fact, chronic pain has been notoriously hard to control and manage.

As per the data collected by the National Institutes of Health (NIH), more than 25 million people living in the United States are suffering from chronic pain. To make their lives easier, research has been going on for long.

Most of the studies have indicated that cognitive behavioral therapy or CBT helps such people to cope with their lives. However, a few have also pointed out the confusion in this matter.

Scientists are not clear regarding the exact aspect of CBT that helps these people and addresses their problem. It is also not clear how exactly CBT can be used to get better treatment outcomes in people with severe pain.

For this reason, researchers belonging to King’s College London (KCL) in the UK came together and set out to investigate the benefits of a certain type of CBT known as the acceptance and commitment therapy (ACT) on the well-being and functioning of people living with chronic pain.

The first author of this study was Lin Yu, belonging to the Institute of Psychiatry, Psychology, and Neuroscience at KCL. The study was later published in the Journal of Pain.

ACT refers to a newer form of CBT which is currently being used to address a number of psychological problems such as addiction. It is also being used to help people suffering from certain disabilities.

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The researchers included in this study explained that ACT in pain management aims and focuses on building effective patterns of behavior change and does not only focus on the reduction of symptoms.


ACT and the Contextual Self

The exact role of the ACT has been described by the researchers as a method that uses the psychological flexibility mode.

The psychological flexibility is defined as an individual’s capacity to persist or to bring changes in his behavior in such a way that it fulfils the following three statements:

  • It includes the open contact and conscious with feelings and thoughts
  • It appreciates what a particular situation can afford
  • It serves to fulfil one’s values and goals

The psychological flexibility has also been referred to as the ability of a person to be more focused on his goals, to be more aware of himself and the surroundings, and to be more engaged in whatever task he is accomplishing.

Another important aspect of psychological flexibility related to chronic pain is known as a committed action which includes a flexible persistence which is oriented by life goals.

The researchers noted that the key aspect of this flexibility model is a therapeutic process known as “self-as-context” (SAC) or the contextual self.

The contextual self or SAC is also known as “self-as-observer”. The researchers have explained this as a theory of self that is not limited to self-evaluations. They also pointed out how they were able to experience a perspective in which they are neither harmed or defined by their own feelings and thoughts.

For the new research, Yu and his colleagues were determined to check if ACT has any impact on SAC. It was also to be known if SAC measurements correlate with the management outcomes in patients with chronic pain who had already been through any treatment.

ACT Improved the Functioning

Yu and his colleagues included 412 adult patients in their study. All of these adults were suffering from pain and were recruited from the pain management center in London.

The researchers examined the pain acceptance and SAC in addition to the treatment outcomes like depression, pain-related interference and adjustment in the social and work setup.

These measurements were taken thrice at three different points; once before the treatment begun, once when it was completed, and lastly, nine months after the treatment officially ended.

The researchers then performed paired sample t-tests and several other analyses in order to check the changes in SAC as well as in the patient outcomes.

Overall, the results indicated a significant amount of improvements in the patients after treatment. All the participants had considerably improved and these improvements were further confirmed after a period of nine months.


Specifically, about 67.5 percent of the participants who took part in this study experienced meaningful improvements right after the treatment as well as at the follow-up that took place after additional nine months.

Moreover, the changes in SAC were thought to correlate with the changes in every one of the treatment outcomes i.e. work and social adjustment, pain-related interference, and even depression.

In other words, it can be said that the increase in SAC was found to improve the functioning and quality of life in people suffering from chronic pain.

The findings of this study were summarized by the author saying that the increase in psychological flexibility is related to less anxiety related to pain, less depression, less disability in terms of psychosocial, physical aspects, and the measures of the patient function

As per the studies on CBT that did not include an ACT in it, the acceptance of pain, a component of the psychological flexibility, is a general mechanism through which the CBT treatment acquires improvement in the functioning. Targeting the pain related acceptance more specifically can cause further improvement in this aspect.

Nancy Walker

Nancy holds a Medicine degree and a Masters of Science MS in Infectious Disease and Global Health (MS-IDGH) from Tufts University. She worked as a lecturer for three years before she turned towards medical writing. Her area of interest are infectious diseases; causes, mechanism, diagnosis, treatments and prevention strategies. Most of her writings ensure an easy understanding of uncommon diseases.

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