Meaningful living with pain: the value of Acceptance and Commitment Therapy in chronic pain

This thesis has been completed to fulfil the academic requirements of the doctorate in clinical psychology. The topic developed from the author’s experience of working therapeutically with individuals with chronic pain in the first year of clinical training. The thesis includes a literature review of studies exploring the process of change with Acceptance and Commitment Therapy (ACT) in chronic pain, an empirical study exploring the value of ACT in chronic pain and a reflective paper of the author’s reflections on this process. The literature review highlighted several factors involved in the process of change, these included the six core processes of ACT; acceptance, values, self as context, present moment, cognitive defusion, and committed action. Increased acceptance and values based activity were associated with improved functioning and quality of life. Social support from peers, normalisation and validation were also found to be helpful. The studies in the review mainly collected data via self-report questionnaires, which are open to respondent biases, confounding variables and overlook the personal value of an intervention. Qualitative approaches, although limited, have captured individual narratives of pain management, which have been helpful in understanding personal experiences. The empirical paper uses Q methodology to understand the value of group based pain management. Ten chronic pain service users completed Q-sorts in which they ranked a range of statements about change processes. Three factors emerged; (1) being believed, accepted and understood (2) the value of self-compassion and empowerment, and (3) a bipolar factor representing the importance of clarity and changing the relationship with pain. The six core processes of ACT were represented in the three factors. Self-as-context, values, and acceptance were found to be particularly relevant to therapeutic change. The reflective paper outlines the author’s reflections on the process, the challenges, limitations, and growth and learning points throughout the journey