Both cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) can be helpful for chronic pain, but what if you live in an area with little access to mental health professionals who can teach you one of these practices? Or what if your insurance doesn’t cover it? Here’s some good news: you can learn some aspects of CBT or ACT without a therapist and put them into play within your own environment. If you live with chronic pain, taking time to understand and use CBT and ACT in your day-to-day life may be very well worth your effort.
“Both ACT and CBT are effective at increasing people’s ability to manage chronic pain,” says Beverly E. Thorn, PhD, ABPP, professor emerita of psychology at The University of Alabama in Tuscaloosa, Alabama. “They can reduce the perception of pain intensity as well as the worry and rumination regarding the pain.”
Adds Lindsay G. Miarmi, PhD, a clinical neuropsychologist who also serves as assistant director of neuropsychological services in New York’s Healthcare Associates in Medicine, PC, “Individuals living with chronic pain have higher levels of emotional distress than others, and psychological treatments like ACT and CBT can help address the mental and emotional components of pain conditions. Both ACT and CBT have been empirically demonstrated to produce improvements in functional ability and to decrease pain.”
Specifically, these behavioral therapies can impact three aspects of pain management: pain intensity, the manner in which pain interferes with one’s life, and disability due to pain, according to Lori Ryland, PhD, LP, CAADC, BCBA-D, chief clinical officer at Pinnacle Treatment Centers.
Below are a few ways to get started with CBT or ACT (if you are not sure which therapy may be right for you, check out our overviews).
There are numerous reliable self-help books on CBT and ACT, says Dr. Thorn, and using a self-help book or an Internet-based program can be an excellent way to learn either therapeutic approach. Here are a few recommended by Dr. Ryalnd, Dr. Thorn, and Dr. Miarmi:
Online resources include psychwire.com/harris -- which can help you learn CBT and ACT; the courses cost money-- and online-therapy.com/CBT-- which can help with CBT). With psychwire.com/harris, you can chat online with a therapist, complete helpful worksheets, and get daily tips and tools from the therapist as you learn the strategies.
Learning CBT and ACT on your own means you may need to change some of your daily habits and practice the techniques regularly, says Noelle Lefforge, PhD, MHA, CGP, an associate professor-in-residence of psychology and the assistant director of Clinical Services and Research, at The PRACTICE: A UNLV Community Mental Health Clinic at the University of Nevada, Las Vegas. “It’s entirely possible to learn techniques like progressive muscle relaxation, visual imagery, and deep breathing on your own,” she says.
If you would like to teach yourself to practice CBT or ACT, it’s important to approach your treatment as you would any regularly scheduled therapy appointment – by setting aside specific times of the day to work on it, recommends Dr. Miarmi. “Then stick to the schedule you have set for yourself. Set a timer to help keep yourself on track and motivated. Plan a small reward for yourself after each session, like watching a favorite TV show, reading a magazine, or taking a bath.”
Dr. Lefforge urges those trying behavioral therapies at home to enlistthe support of those around you. It can be helpful to have a family member learn the techniques with you, for instance. You should also loop in your primary care provider as they may have recommendations about how to best approach the self-care therapy.
According to Dr. Thorn, “The more patients ask about resources for psychotherapy, the more mainstream psychotherapy for chronic medical illnesses will become. Getting involved in helping you find resources to learn CBT and ACT will help to educate your primary care doctor that chronic illnesses are not either physical or psychological but are always both and must be treated using both resources.”
You might even consider learning CBT or ACT with others. “It can be useful to gather a small group of like-minded people, about five, to work through a guidebook together, reading and discussing the sequential chapters on a week-by-week basis,” says Dr. Thorn.
If you can, try to see a therapist at least once, advises Dr. Lefforge. “The therapist can help you get the validation and the empathetic connection that allow you to stay motivated,” she says. “If you can work with a therapist even remotely for just one session when learning CBT or ACT, it can be helpful.”
If you would like to find a therapist to help you with one or two visits, Dr. Ryland recommends that you use the member search function provided by the Academy of Cognitive Therapy to find a certified CBT therapist.
Ideally, with both ACT and CBT you will be engaging in regular practice. Just like an exercise program or learning an instrument, it will take time and effort to see changing effects. “Although the skills may seem difficult at first, with practice they become much easier and eventually become second nature,” Dr. Miarmi says. “Ideally, you should practice the techniques most days of the week.”
If you also suffer from insomnia or sleep distractions, CBT can be helpful to retrain your sleep habits.