This piece is adapted from part of the book ‘The Liberated Mind’ by Steven Hayes.

I’d like to share with you a study on how Acceptance and Commitment Therapy (ACT) can help people cope with chronic pain, one of the most challenging conditions to treat.

Back in 2004, 14% of the entire working age Swedish population was on long-term sick leave or early retirement due to disability. That’s a huge amount. People who worked in the public health sector, like nurses, carers, daycare workers were the worst off. The average health care worker missed over two months of work every year. And half of all healthcare workers had been on disability at some point in their career.

The main reasons for the sick leave was physical chronic pain and stress, or burnout.

So they decided to conduct a study on a mindfulness-based therapy called Acceptance and Commitment Therapy (ACT), focusing on public health care workers identified as most at risk of long-term disability.

Note, in Sweden, everyone has free access to doctors, specialists and physical therapy visits.

In this experiment on at-risk healthcare works, half of the group were given the usual treatment. The usual treatment for such cases would be based on reducing stress. So they would get tips on avoiding stress, relaxation exercises to use throughout the day and ways to improve diet, sleep and physical exercise.

The other half were given just 4 x 1 hour group sessions in ACT training. The results were unbelievable. 

Over the next 6 months, let’s look at the results:

1. The group with the usual treatment of relaxation techniques, and tips on diet, exercise and sleep had, each, on average:

• Missed 56 days of work (half of all their work days)

• Had 15 medical visits

• Pain and stress went down (whilst only being at work half the time)

According to previous experience, half of these individuals will go onto a lifetime of disability, never to work again.

2. The group with 4 x 1 hour sessions of ACT had each, on average:

• Missed on average only half a day of work!

• Had only 2 medical visits

• Pain and stress went down (whilst being almost always at work)

So amazingly, with these 4 sessions of ACT training, the second group were 99% more likely to show up to work and 87% less medical visits and much less likely to spend a lifetime at home on disability allowance.

So what was covered in these seemingly magical 4 sessions of ACT? I’ll share an outline with you here.

Session 1

The therapist asked them what they really wanted in each of these 10 areas of their life and were asked to write them down.

They also asked them what barriers were keeping them for living according to their values in each area. For example, it may be fear that’s holding them back from speaking to their team or a negative self-image from preventing them asking someone out on a date.

Once they clarified what they really wanted in each of these domains, they found out what the inner barriers were from them achieving these goals. The looked at those barriers and explored what their current coping strategies were and if they worked. They also examined if the strategies were avoidant. They were then given ACT strategies to let go of the struggle with the unhelpful thoughts and feelings.

They were given a few defusion (ways to step back from thoughts) strategies and acceptance strategies to work with their thoughts and emotions and were encouraged to pick one or two goals based on their values. They could be as simple as calling a friend.

Session 2

In this session, the therapist taught more defusion and acceptance skills and also shared some presence (similar to mindfulness) exercises. The client was encouraged to deliberately bring up some difficult thoughts or emotions and practice using the skills. They then checked in with their goals and made a new commitment.

Session 3

In this session, they explored their values more deeply. They wrote down what they’d like to be heard on their deathbed. This clarified the difference between the way they’re living their life and what they’d prefer their life to be about. 

They then wrote down their mental barriers on cards, and the therapist threw them at them, one at a time, and they were told to fight them away. They found this tiring! Then they were told instead to just put the cards in their pocket to show them it’s easier to just accept them.

They also did some more exercises on defusion and exploring self.

Session 4

They reviewed the barriers they needed to work on using a defusion exercise. The exercise involved listen to their mind like they may listen to a storyteller, rather than someone telling them exactly what to do. They finished by telling the group their values in each of the domains and how they were going to take action on them.

Conclusion

From these descriptions, hopefully you can tell some of the fundamental and radical differences between the approach ACT takes and many other approaches, which you could try applying in your own life.

ACT emphasises:

• Clarifying what your values are

• Encouraging you to set goals inline with your values

• Exploring barriers to attaining your goals, especially limiting thoughts and unhelpful emotions 

• Using short, fun exercises to help you see that thoughts are just sounds or images in your head

• Use ways to encourage you to accept and make peace with your emotions, but not be ruled by them. Teaching you to carry your difficulties rather than fight with them.

• See your thoughts and emotions as just a story - and not who you truly are

• Taking a kind and compassionate approach to this whole process

All this helps to increase your psychological flexibility - and the more flexible you are in this way, the greater your resilience, wellbeing and to lead a fulfilling life.

If you’d like to learn more about my approach of combining mindfulness with kindness, consider my free 7 day course.