Why does the news want pain

Live instead of fighting

Mindfulness and acceptance

Unlike acute pain, chronic pain, which by definition lasts longer than three months and is not due to tumor diseases, cannot be treated well with drugs. According to the biopsychosocial model, not only physical findings, but also psychological and social aspects contribute significantly to the disease process. Accordingly, according to current knowledge, patients with chronic pain should receive multimodal therapy. In addition to physiotherapy and education about the disease, the program also includes learning how to cope with stress and various forms of psychotherapy.

One of them is acceptance and commitment therapy. It has its roots in cognitive behavioral therapy, Mehner reported. Avoidance behavior should be reduced. The focus is on mindfulness and acceptance. In order to understand this approach, it is important to define the terms. Acceptance should be understood as an active acceptance of the situation without judging it. "Acceptance is not giving in to pain," said Mehner. "It's about finding your own peaceful way of dealing with pain." Mindfulness, in turn, is a certain form of "attention that is intentional, relates to the present moment, and is not judgmental." Mindfulness exercises as a form of meditation are used to cope with stress. "But they are not to be confused with relaxation," emphasized the psychologist.

Pure and dirty pain

According to the ACT model, a distinction can be made between “clean pain”, the pure feeling of pain, and “dirty pain”, the suffering associated with it. The latter is a kind of secondary pain. It corresponds to what thoughts make of the actual pain perception: How unfair and sad it is that you suffer from constant pain, what you miss and miss and what strain you represent for your loved ones. This dirty pain is caused by unsuccessful strategies to combat the sensation of pain, such as avoiding or numbing pain, which can lead to frustration, resignation and social withdrawal. In contrast to the pure feeling of pain, suffering is more or less self-made and can therefore also be influenced by the patient himself.

This is where the ACT comes in. It should help to give up the unsuccessful control attempts and the fight against the pain and to use the energies released sensibly. Accordingly, the determination of goals and values ​​in life occupies an important place in the ACT. This is what the second part of the term, "commitment", stands for. The patient should do and experience again what is important to him.

"The ACT is not suitable for every pain patient," said Mehner. "The procedure can only be successful if the patient is willing to engage in acceptance and mindfulness-based exercises." A simple introduction is to integrate mindful activities into everyday life. This means that certain everyday activities such as brushing your teeth, showering or drinking coffee are not carried out automatically, but rather with special attention, explained the speaker. How does the water feel on the skin? What does the coffee taste like? What do I smell, what do I feel? Another technique is the body scan. The patient focuses on various organs and body regions and on the tensions that exist there.

To end negative circles of thought, there are also some exercises. Since thoughts cannot be controlled, patients should learn to observe their thoughts neutrally without trying to evaluate or suppress them. A central point in the ACT is the clarification of life goals. Since this is difficult for many patients, there are also various exercises for this. For example, one could ask a patient what he would do if he won the lottery or had only one year left to live.

Subject of research

The ACT has become increasingly popular in recent years. However, the data on their effectiveness are still thin. In 2006, Professor Dr. Steven C. Hayes and colleagues in a review to the result that the data are insufficient to determine that ACT is generally more effective than other forms of therapy. But it is also no less effective and the available data are very promising, write the researchers in the specialist journal “Behavior Research and Therapy” (DOI: 10.1016 / j.brat.2005.06.006). A meta-analysis published in 2014 in the same journal with a total of 60 randomized controlled studies, in which ACT was compared with other forms of behavioral therapy in various diseases, showed a slight, insignificant superiority of ACT (effect size 0.16). Overall, however, the author Lars-Göran Öst, Professor of Psychology at Stockholm University, concludes that the method is not yet well established in any clinical picture, but is "probably effective" for chronic pain and tinnitus (DOI: 10.1016 / j.brat. 2014.07.018).

"Time, patience and practice are important for the success of the therapy," said Mehner. "You don't even learn mindfulness and acceptance and then master them for a lifetime." The methods have to be constantly adapted to suit the situation. It is important to be kind to yourself and to accept that the path in life is not always straightforward. /