Chronic pain: third wave case conceptualizations

The three “waves” of behavioral therapy have each considered chronic pain as a relevant and treatable clinical problem. These treatments have a longstanding and well-established evidence base. As the prime example of a third wave behavioral treatment, acceptance and commitment therapy (ACT) for chronic pain seeks to enhance willingness to have chronic pain in the service of engaging in personally meaningful activity. Several studies have examined willingness to have pain (e.g., pain acceptance) in the service of engagement in meaningful activity (e.g., values-based action) and there is strong support for their relevance in those who are living with chronic pain. Treatments using the ACT model have been successful at improving pain acceptance, values-based action, emotional distress, physical ability, healthcare utilization, and engagement in role functioning up through follow-ups of as long as 3 years. As with the other behavioral treatments from preceding waves, ACT for chronic pain seeks to reduce the deleterious effects of pain on functioning. That being said, ACT is distinctive from the previous two behavioral waves with regard to its view of cognition as an important and relevant, but not uniquely causal, aspect of human behavior and in its specification that increasing engagement in valued activities is the principal goal of intervention.