Int. j. econ. manag. soc. sci., Vol(3), No (9), September, 2014. pp.

512-515

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International Journal of Economy, Management and Social Sciences

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ISSN:
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In terms of acceptance and commitment therapy for chronic pain based

on ACT
Hojatolah Tahmasebian
Kermanshah university of medical sciences, Kermanshah, Iran.

Bahman Roshani *
Kermanshah university of medical sciences, Kermanshah, Iran.

Mokhtar Arefi
Department of psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.

Mahshid Saeidi Pour

School of dentistry, Kermanshah university of medical sciences, Kermanshah, Iran.

Seyed Ali Hoseini

Kermanshah university of medical sciences, Kermanshah, Iran.

Masoud Nosrati
Young Researchers and Elite Club, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
*Corresponding author: Hojat_t47@yahoo.com

Keywords

Abstract

Chronic pain
Acceptance-based treatment
Adhering acceptance

Acceptance and Adhesion-based Treatment (ACT), is one of the Third Wave cognitive-behavioral approaches
in which give emphasis on control of controllable aspects and acceptance of uncontrollable aspects, although
chronic pain often is mention as a pain which cause disability and affects on all aspects of patients life.
However, from the Acceptance and Adhesion-based Treatment view point, many of problems which are due
to suffering from pain don't have result from their pain directly, but these problems occur as a result of a
psychological flexibility. According to this view, there are six main factors that are related to each other and
root in a verbal process involving forming mental flexibility in patients with chronic pain problems. These
factors are as follow, experiential avoidance, cognitive fusion, lack of clear values, past or future instead of
present time, and dependence to perceived self.

Introduction
Chronic pain is a common problem that has various effects on quality of life in person who suffers from it. Also, chronic pain has a significant
cost to individuals and society. Uncontrollability of Chronic pain in despite of using medical treatments and emotional distress caused by it, is
among the reasons that directed researchers and practitioners to understanding of psychological processes associated with chronic pain [1].
Control of Chronic pain is impossible significantly, but sometimes patients who suffer from chronic pain, go on to having control over their pain
with obstinacy and in this way, trying to avoid from pain may be dominant on the life of individual, and by awing one from his responsibilities
cause to other problems for him and his family. These people by insist on giving up from pain deny and also prove uncontrollable nature of pain.
Inconsistency in such a situation has been caused to trend toward a more balanced approach, which is known as Third Wave Approaches [2].
Third Wave Approaches or acceptance and mindfulness-based approaches can be considered as a modified and expanded form of two previous
approaches: The factor approach and Cognitive - behavioral approach. Third generation approaches, consider chronic pain as an inevitable part
of life which can be accepted it. From this point of view, the struggle to avoid the inevitable pain will cause to take more pains. These
approaches, instead of eliminating of unwanted symptoms, focus on acquiring healthy behaviors. They have applied a combination of methods
for control of pain and approaches based on acceptance to reduce pains of patients and to improve their performance. Examples of Third wave
cognitive - behavioral treatments include Approaches based on Acceptance and Adhesion (ACT-Oct), Dialectical behavior therapy (DBT) and
mindfulness -based cognitive therapy (MBCT). In the following lines, we examine chronic pain from Acceptance and Adhesion viewpoint [3].

Acceptance and Adhesion-Based Approach (ACT)

The Third Wave approach, from among Acceptance and Adhesion -based treatment, has been studied more actively. This approach also has been
distinct from other approaches in terms of the particular formation path which has follow; especially by considering effort to establish behavioral
laboratories for create basic clinical principles [4]. Second-generation approach (cognitive-behavioral treatment), boast more than the first
generation approach (behavior therapy) because don't know classic operant learning principles alone as a sufficient way to make clear human
cognition. Acceptance and Adhesion-based treatment is representatives for application range of twenty years effort to create a new form of
behavior analysis which can overcome on problem of making clear human cognition by adding required principles for explain human cognition.
In fact, the main idea of this effort is that behavior therapy has need to more effective interaction with cognition and this is more likely that a
textural theory about cognition lead to advancing its practical goals while maintaining the basic and scientific commitments to behavior therapy

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International Journal of Economy, Management and Social Sciences Vol(3), No (9), September, 2014.

tradition. In general, the Acceptance and Adhesion-based treatment include textural philosophy about science, the basic theory of language and
cognition, and functional theory of psychopathology and psychological changes [5].

Acceptance and Adhesion -Based Approach view about forming avoidance from Pain
According to this view, this matter which patients are allowed to bring different problems under their control is reasonable and at the same time
harmful. Public culture has accepted this belief that positive excitements, cognitions and physical states cause to good behavior, and negative
excitements, cognitions and physical states cause to bad behavior. We made great efforts in our schools to teach people to have higher valuing
feeling, being more optimistic and smiling and avoid from pain. From earlier age, it is told to us that we can and even should control the negative
aspects of experiences. It is said that we should precede life without pain and stress, and in fact, we should avoid these feelings [6].
From accepting and adhering based treatment viewpoint, this is perfectly a normal procedure and actually forms part of human cognition. As
mentioned, Oct, based on a comprehensive language and cognition theory terms as relational frame theory (RFT). Already this theory has been
affirmed in more than 70 studies and means that human language based on learned ability to make connections between events [7]. The simplest
situation for solving verbal problem, need to establish relation between the words and Events (This is the problem which we must solve it);
present and the future (If I do this, this thing will happen) and a comparison relation (If this happens, the situation will be better than my current
situation) [8].
What happens if these capabilities being encounter with negative feelings and thoughts? They are undesirable. Good feeling is better than bad
feeling. Present times can be associated with a better future (I feel better before. Again in the future, I should have a better feel) and act
accordingly (If I have more rest, I feel better). According relational frame theory (RFT) it is impossible that individuals have a capability for
solving verbal problem without the ability to concentrate this capability on feelings and thoughts. When a person brings this capability to
feelings and thoughts field, it is produce empirical avoidance. Empirical avoidance, means to an attempt to change the form, frequency, or
situational sensitivity of private events (E.g. thoughts, emotions, memories and body feelings) [9].
The verbal problem-solving methods have a good performance regarding external subjects (If I already have the seeds of a plant, I'll have food
later). But these methods act unpleasant, when used for private experiences. Verbal rules which determine avoided private events contain verbal
seeds of these events. In this way, it is most likely unsuccessful, trying to avoid painful thoughts because related rule a) reminds one a lot of
thought and b) memories may be contain concerns or outcomes which are painful themselves. Therefore, avoid from pain cause to increasing
and not decreasing of pains. In addition, works which are done to avoid pain may be creating practical patterns which are limit, inflexible, and
less value [10]. Thus, from Oct perspective, the Empirical avoidance forms by main function (such as problem solving) of the natural forms of
human language and expands by cultural forces expands. When someone tries to avoid from inevitable experiences such as chronic pain, his
behavior pattern is inflexible and therefore is harmful [11].

On Oct model of chronic pain

There is this believe in Oct model that psychological problems related to reciprocal effect of linguistic processes and human behavior. General
utility of linguistic processes result to domination of verbal rules in compare to other control sources - in setting of behavior, even when these
processes are harmful (Such as when cognitive fusion occurs) [12]. Also, domination of verbal rules leads to several other problems.
Lack of connection with present time

Avoiding from pain and other feelings

Lack of clarity in values

Cognitive
inflexibility

Involving with thoughts related to pain

Lack of acting according to values

Domination of self perception

Figure 1. Act model about chronic pain.

Relational frames for co ordination, time / causality and comparison cause to trend towards to classification, evaluation, prediction and trying to
avoid special private events. Empirical avoidance, only increase the functional importance of classified private experiences in verbal terms,
therefore increase sensitivity to these events.
Verbal entanglements lead to lack of contact with the present moment. Also, "Self is a subject for verbal classification, so that person considers
himself as a "Failed", "victim" and "disappointed" one. This person is too busy with internal problems that give up his valuable activities

Hojat Alah Tahmasebian, Bahman Roshani *, Mokhtar Arefi, Mahshid Saeidi Pour, Seyed Ali Hoseini, Masoud Nosrati

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International Journal of Economy, Management and Social Sciences Vol(3), No (9), September, 2014.

gradually [13]. In initial pain period, patients use Empirical avoidance methods as a dominant form for resistance against pain. This process is
reinforced by negative factors such as initial reinforcement (Associated with avoidance of pain) and social / verbal support.
Patients engage to thoughts of pain actively, thoughts such as "Before pursuing any work and prior to accept whatever responsibilities, pain
should be reduced" or believing that based on "being with pain Chronic, is not fair, they not only avoid from pain, but also avoid from actions,
thoughts and emotions associated with it. Their cognitive and behavioral focus on alleviation of pain lead to dont caring to other behavior
approaches. They give up their valuable works for reason to reducing pain and due to their inability to control of pain, they experiences feelings
such as hopelessness, depression, anxiety or anger. This procedure leads to greater inflexibility and lack of liveliness, negative thoughts and
feelings are heightened and frequency of values - based action decreased. In table 1, we present summary from process which involve in chronic
pain [14]. The general objective of acceptance and adhesion - based treatment, is increasing Psychological flexibility. Psychological flexibility is
defined as ability to direct contact and openness towards current experiences which let behavior go on or change according available
opportunities and personal goals and values. Increase of Psychological flexibility, occur through 6 main process of Oct: increased 'acceptance'
toward the distressing content of experiences, enhance the ability of clients to establish "being present", Create a sense regarding to "self as a
context"; using ways of "cognitive diffusion" to interrupt effects of problematic cognitions, "Values clarification" of clients in various fields and
increase of effective and committed act" and work towards these valued goals clients. With regard to Oct view about chronic pain, aim of this
treatment is that patients with can response to pain, distress and associated experience to it by flexibility so that unnecessary and ineffective
struggle with these experiences reduce and behave according their goals and values [15].
Table 1. Summary of processes which involve in chronic pain
The main processes

Experiential avoidance / acceptance

physical sensations,
(Dissatisfaction / satisfaction)
traumatic memories,

Psychological inflexibility

*pain, fatigue and other

Psychological Flexibility

* body feels pain, fatigue and other unpleasant

* unpleasant thoughts about the problem, the problem of memory

Traumatic, disturbing emotions.
*
Along with the inevitable struggle to control them

Are treated.

*, thoughts,

Nagging sensation,
*

yet exist.

And one in the present moment and the future, the following
Dissatisfaction with their experiences or efforts * Its values and goals, they experience satisfaction.
Vain to control, escape or avoid them.* There.
Dominated by the experience of thoughts, images, memories * Forecasts, estimates, because
And other responses that may include: * Laws, mandates, should, and could not
Forecasts
*
"I'm weak," "I Sick
Evaluation
*
"I'm trying," "I'm a perfectionist
Reasons *
"I'm not always successful"
Rules
*
Still occur, but a strong correlation between the
Compulsory, should have and could not.* Specific thoughts and actions, and is impotent
Now there are options and choices.
If your content /stories exert influence, assessments, and
If your texture
Judgments are attributed to
Such as: "I'm weak," "I sick
"I'm trying," "I'm a perfectionist '
"I'm not always successful"
Past or future dominance /Activities by past Choices* Not to divert the minds of the past and the
future, but
Awareness of the present momentOr fear of the future, are determined. *
This person has the ability to
understand these deviations,
Thoughts gently several times to follow
and the awareness of the present moment back.

Lack of value / worth it

It is not clear what the

*
A clear sense of what is most meaningful to
A person is most important. Behavior under
*
Gives life. (Its value) and the
Dominated by the desire to reduce
*
Behaviors that are at the service
or eliminate pain, or experience
of its value, explores

Private events are more painful.

Inactivity and resistance

Hard / act responsibly
re-operation for

Actions or failure to unstable steady states are impulsive Yale

*Action are performed

resistance, selectively, Surface
positive objectives
To change the level, when
a certain level is not
feasible, is likely.

and

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In terms of acceptance and commitment therapy for chronic pain based on ACT
International Journal of Economy, Management and Social Sciences Vol(3), No (9), September, 2014.

Conclusions
Oct (ACT) does not consider the distinction between normal and abnormal behavior. Instead, this view suggests that psychological inflexibility
root in common linguistic processes that all humans have. According to this view, six major components that are related to each other and
overlapping together are involve in creating problems in patients with chronic pain problems: Experiential avoidance, cognitive fusion lack of
clarity in values, repose and lack of liveliness, dominance of past or future rather than the present time, and dependency to perceived ego. The
traumatic processes, in interaction with together will cause to psychological inflexibility. Therefore, while using accepting and adhering - based
treatment for patients with chronic pain, we must reinforce positive psychological processes including acceptance, cognitive diffusion, values
clarification, committed act, considering oneself as context, being present, with the goal of increasing psychological flexibility.

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