Maybe it's the opioid crisis, or this generation's general inclination towards living better through psychological counseling, but cognitive behavioral therapy (CBT) has become a frequently used intervention for people with chronic pain. A new study out of Kings College London takes psychological pain management even further.

First, we need to define some terms. Acceptance and Commitment Therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process known as "self-as-context" (SAC). Contextual self refers to a sense of self that is not based on self-evaluations. It is similar to being an observer of one's own psychological experiences. The Kings College team set out to measure whether any changes in SAC would have any effect on how much pain could be treated.

"Psychological flexibility is the ability to be more aware, more focused on goals and more engaged. Another aspect of psychological flexibility pertinent to chronic pain, and supported by SAC, is called committed action, which involves goal-directed, flexible persistence," said co-author Lance M. McCracken. "For pain management, ACT is an approach based on the psychological flexibility model and focuses on building effective patterns of behavior change rather than symptom reduction."

The researchers gathered 412 adults referred to a pain management center in London for the study. They completed measures of treatment processes, such as SAC and committed action, and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon treatment completion and after nine months.

The results were a “win” for pain management through counseling on multiple levels. The data reflected that scores from both the process and outcomes measures significantly improved after treatment and were maintained at nine-month follow-up. The ACT-oriented treatment was associated with improved SAC as well as improved functioning. Changes in SAC were associated with changes in pain-related interference, work and social adjustment and depression.

"Greater psychological flexibility is associated with less pain-related anxiety and avoidance, less depression, less physical and psycho-social disability and other measures of patient function," said McCracken. "Based on studies of forms of CBT that did not include ACT, acceptance of pain, one component of psychological flexibility, may be a general mechanism by which CBT treatments achieve improvements in functioning, and more specific targeting of pain-related acceptance may lead to further improvement is CBT outcomes."

The authors noted that their study results are consistent with an increasing number of longitudinal and mediation studies showing that ACT for chronic pain improves patient functioning, specifically through enhanced psychological flexibility.

The study was published in The Journal of Pain.