“Arms at Rest” by Siri Hustvedt is an article that appeared in a recent New York Times issue.  It’s a poignant and inspiring account of a person’s journey of acceptance of her chronic lifelong migraines.

The author’s comments about the way in which our culture has confused accepting adversity in one’s life with being ‘passive’ or a ‘pessimist’ strongly brought to mind the nature of acceptance as it is understood and practiced in ACT.

It also sent me on a hunt to discover what resources are out there on ACT for chronic pain…

First, a few more words on what I liked about the essay “Arms at Rest” by Siri Hustvedt.   I like that she began it by coining a new term for herself, a ‘migraineur’.  That seemed to me a simple but powerful way of truly ‘owning’ a condition as being part of herself, and as something she does rather than is done to her.  Of course, as she talks about in the essay, this is not to put some kind of glib spin on the experience of this painful and physically debilitating condition that she has in no sense chosen for herself.  Putting a glib or glossy spin on something would be a big time avoidance move, and that is the opposite of what acceptance is in ACT.  However, as she talks about, she can see now that there are ways in which she does the headaches in the sense that they play a part in her “emotional economy.”

She also explains that she came to understand that the posture she had taken of fearful rejection of the pain the migraines brought caused her suffering to escalate.  She says, “The migraine then became self-perpetuating. I am convinced that a state of fear, anxiety, and a continual readiness to do combat with the monster headache pushed my central nervous system into a state of continual alarm, which could only be stopped by a deep rest.”

With her mention of her mind casting the headaches as ‘monsters’, you may be seeing the connections I saw with ACT’s Tin Can monster and Tug-of-War with a Monster metaphors.

And speaking of ACT exercises, this article and Ms. Hustvedt’s coining of the term ‘Migraineur’ made me think that perhaps coming up with a new, chosen term to go along with a non-life-threatening painful condition someone has been struggling against could be a acceptance exercise, a late-stage graduation kind of exercise, by which someone is essentially saying “I’m taking these monsters along with me on the bus” by coming up with a term.  I’m an Arthritiseur.  I’m a Back Paineur.  I myself live with a chronic bowel-related condition, so maybe instead of slinking off sheepishly to use the facilities a dozen times a day, I can be a Bathroomeur.  Might strike a chord with some clients.

So now to the ACT for chronic pain stuff I was inspired to dig up.  The most prominent resource for chronic pain treatment from an ACT perspective is Dahl & Lundgren’s 2006 book Living beyond your pain: Using Acceptance and Commitment Therapy to ease chronic pain.  I haven’t yet had a chance to check out this book, but from the abstract, it looks like relenquishing control and “feel good” avoidance strategies and moving into active acceptance plays a big role in the treatment approach, as well as mindfulness exercises and a simultaneous focus on committed action.

A search through the resources on contextualscience.org brings up an impressive multipart 2006 presentation by Lance McCracken, of the University of Bath, U.K., entitled “A Contextual Cogntiive Behavioral Approach to Chronic Pain: Eleven Years of Development & Data on Acceptance, Values, and Mindfulness.”  There’s also an interesting power point presentation by Laura Meyers, PhD, of the Minneapolis VAMC.

If you haven’t gotten into checking out the resources on contextualscience.org (only available to ACBS members–remember to pay those values-based dues!), it’s a really useful central repository for ACT publications, many of which are directly downloadable.

Wow, funny how one article with ACT connections can lead to a whole investigation into what ACT has to offer for the treatment of chronic pain.  But it’s an investigation well worth making!