Acceptance and Commitment Therapy (ACT) is a psychological approach to helping people deal with various issues from mental health (depression, anxiety) conditions to chronic pain. It includes elements of mindfulness practice. Today we want to discuss what ACT is and how it might apply to your lower back pain.

Six Core Elements of ACT

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The six elements of ACT are cognitive defusion, expansion and acceptance, contact and connection, the observing self, values clarification, and committed action.

It’s difficult to explain how ACT works in clinical practice but perhaps knowing the six principles behind ACT would help. They are

1. Cognitive defusion

Cognitive defusion is about the end goal of being able to see events as they are at face value rather than the emotions or the experiences that they are associated to. For example, looking at a slouched over posture as a slouched over posture without the negative perceptions that it’s bad for you, back pain/neck pain, etc.

2. Expansion and acceptance

Expansion and acceptance is interesting because the principle is about embracing the unpleasant sensation or experience rather than challenging them.

Quite often in clinical practice, we ask our clients to challenge their pain. If a specific benign movement was to recreate a pain experience, we sometimes get patients to repeat the movement to see if the pain experience diminishes. In essence we challenge the pain with the intention to dispel it.

With the expansion and acceptance principle, we are looking to include the experience as part of who you are. For example if you were to get pain with a benign movement, we might ask you to continue doing the same movement while observing it from a third person. You want to know where the pain is, the boundaries of where pain ends, the type of sensation, the intensity, etc.

Sounds pretty much like mindfulness practice, no?

Instead of making it go away, the end goal is to make space for your pain experience (i.e. acceptance).

p.s. this is assuming this is a pain problem in the absence of injury or pathology

3. Contact and connection with the present moment

This is very much like mindfulness practice. You are looking to experience your pain in the present moment as it is.

In some aspects, I think, it overlaps with the point #2.

Imagine yourself experiencing eight out of ten neck pain during a client meeting. You are losing control of the direction of the meeting and you start getting frustrated with yourself.

Being at the present at the moment would mean reflecting on the bodily neck pain as you are experiencing it. Instead of being frustrated, you want to focus on these sensations AND the current events as they unfold.

Are you truly losing control of the meeting?

Part of being present also include taking action to engage 100% at the moment. Evaluate the situation (neck pain + current meeting state) as is and focusing on being engaged with the person in front of you.

If you do indeed find yourself losing control of the meeting, this would be the right time to get back into focus and take control.

4. The Observing Self

The observing self is difficult. It’s involves two processes: your thoughts and your observations.

What you want to do is to be able to observe your thoughts without judgement.

For example, I have neck pain. My life is terrible.

This is not your observing self because you have passed a judgement on your life. The observing self withholds from judgement. For example, I have neck pain and my pain is terrible.

The observing self is NOT about rejecting your pain or putting your pain away. It’s about being able to look at your pain experience as what it is on its own while at the same time looking at your capacity to bear it, to enjoy life as separate, independent components.

5. Values clarification

I am not entirely sure if this applies to chronic pain. So, I am going to skip this and come back to it later when I have more clarify.

6. Committed action

Nearly 100% of our clients will go through a goal setting exercise with us.

We will admit that we use this as a patient-specific outcome measure rather than to use it it as a process for our clients.

In committed action, the goals are about reminding clients where they’d want to be and how taking action will help them reach where they desire.

Does Acceptance and Commitment Therapy work for lower back pain?

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Believe it or not, over 40% of Singaporeans experience pain on a weekly basis

Now you get an idea of how ACT works. The big question is, does ACT work for lower back pain?

Well, we got the answer just for you.

It is a yes!

A study that was just published last month in Journal of Pain looked at 248 patients who underwent Acceptance and Commitment Therapy vs. standard physiotherapy care. The ACT group experienced better disability and function outcomes compared to those who received standard physiotherapy at three months follow up.

However, there was no difference between outcomes at one year follow up.

Current perception of lower back pain needs to change

chiropractor, lower back pain, paul foster, jesse cai
Chiropractor Jesse Cai performs a chiropractic adjustment on celebrity host and actor Paul Foster. In light of poor evidence supporting the effectiveness of spinal manipulation as long term pain solution, adjustments are no longer our preferred treatment approach for lower back pain.

We tend to look at lower back pain from a mechanical or structural perspective.

“My muscles are tight.”

“My joints are locked.”

“My spine is out of alignment.”

If these are true reasons why people experience lower back pain, Acceptance and Commitment Therapy shouldn’t work better than standard physiotherapy care.

Perhaps it’s time we give other aspects of pain better consideration. We have blogged about pain before on two occasions – Why your pain hurts? From a bayesian brain approach as well as All you need to know about pain: Elite athlete edition.

We already know that pain is not just about physical tissue damage. There are other components that contribute to your pain experience. They include the contextual factors contributing to your pain and the prior experiences you have.

We invite you to consider the larger picture of why people experience lower back pain. Current evidence supports that lower back pain is a multifactorial disease. We invite you to examine your attitudes and beliefs towards chronic pain and to see if they are align to best evidence practices.

Get result with Singapore’s evidence-based chiropractor

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Since September 2018, chiropractor Jesse Cai has transitioned from a manual therapy clinic to offer evidence-based chiropractic treatments: exercise, advice, and education.

Square One is arguably the only chiropractic clinic in Singapore that works with you on a truly biopsychosocial approach.

We completely breakaway from outdated hypotheses (tight muscles, misaligned pelvis, short leg) as causes of your pain and approach your pain treatment from a genuine holistic, multifactorial approach.

(Of course we do work with your pain from a structural, injury-based approach if there is indeed an injury. Check out our case on Kingsley’s Tay Achilles tendinitis.)

At Square One, we believe in empowering our clients. Our monthly Pain Schooled! workshops are aimed at changing what it means to live with pain the 21st century.

While some chiropractic clinics in Singapore still choose to practise the traditional crack-and-go way, Square One has gone above and beyond. We adopted exercise as our core treatment modality and education plus advice are a big part of what we do. We have also started looking at implementing self-directed mindfulness practice as part an adjunctive therapy.

We deliver results at Square One Active Recovery. Over 80% of our clients will achieve full recovery in four to seven visits. If you are considering therapy for your lower back pain, Square One is likely the best chiropractor for you.

Do you have a question for us? Reach out via our contact form below. We’ll be happy to assist.