What are physical health problems?
When we discuss physical health problems we generally refer to chronic health conditions, long-term illnesses, or health issues that significantly impact one’s lifestyle. While these may be categorised as physical health, the overlap with mental health is well-documented. For an individual who has been used to leading an active and busy life, being diagnosed with a chronic health condition, can be devastating. Many chronic health conditions come with fatigue, leaving an individual struggling to manage their life with the reduced energy resources available. Endometriosis is a common chronic health condition, that can result in constant pain and fatigue. A clinical study examining the likelihood of these individuals suffering from depression showed that depression was detected in 86% of the patients with endometriosis and chronic pelvic pain compared with 38% of the patients without chronic pelvic pain (Lorençatto, 2006). As one sufferer shared, “My GP said I needed to accept that I had a finite amount of energy, but it is really hard to come to terms with that.” While chronic health conditions are technically physical health problems, the burden they place on our mental health can be extensive. Traditional treatment approaches typically focus on medication or lifestyle adjustments to alleviate symptoms, but they often overlook the importance of addressing mental health.
What is ACT and how can it help with physical health?
ACT (which stands for acceptance commitment therapy), encourages us to accept what has happened, in this case, our physical health problems, and commit to an action that enriches or improves our life. This is not prescriptive, there is no right action, and it will vary for everyone. ACT is a powerful resource for working with physical health issues as it is transdiagnostic (applies to more than one condition), and it can help to improve a person’s general well-being. Often, we respond to bad circumstances with unhealthy coping mechanisms.
Fatigue is often a big part of a physical health problem. For those living with fatigue, ACT can help to gently adjust their thought process about being busy. Our society places great emphasis on being busy, people even become competitive about how much they can fit in a day. It can be very easy to feel like a failure if you are struggling with managing your energy levels. ACT gives us the framework to accept our limitations, be kind to ourselves, and set achievable actions, rather than judging ourselves against a healthy person. While ACT can’t always improve chronic pain or give us more energy, it can help improve our mindset around our health and teach us to listen to our bodies. This psychological intervention can make an incredible difference in how we manage our conditions. Engaging in a 10-minute mindfulness session instead of relying solely on avoidance based coping can benefit pain management, while taking a moment to rest instead of “pushing through” can help alleviate fatigue. For these reasons, ACT is an excellent resource for working with clients who are struggling with chronic health conditions.
An example of ACT in practice
Take the example of Jeremy, who received ACT therapy for long-standing back pain from an injury. Jeremy was a building site manager and after his injury, was forced to take time off work, and on return, he had to take a different role, which he felt he was less suited to. He dealt with this by using avoidance, withdrawing from his family, and resorting to alcohol as an unhealthy coping mechanism. ACT helped him to accept his altered physical health and turn to healthier coping mechanisms. This created a positive cycle, enabling him to open up to his family, listen to his body, and be kind to himself.
Research shows that ACT can be very beneficial for physical health conditions
Research is being carried out to investigate the efficacy of ACT as a treatment for physical health conditions. Indeed, a recent systematic review by Konstantinou et al. (2023) showed that ACT was superior to comparison groups in terms of both quality of life and symptom improvement. ACT is now considered successful for managing physical health conditions and is recommended by NICE as a specific treatment for tinnitus and as a psychological therapy for chronic primary pain (NICE, 2019; 2021). NICE are renowned for their stringent, no-nonsense guidelines, and this endorsement will help to bring ACT into mainstream treatment protocols. After extensive research, NICE stated that ‘the committee agreed that ACT was likely to offer a good balance of benefits and costs and recommended that it should be considered as a psychological therapy for chronic primary pain.
Published research into the efficacy of ACT on physical pain found that delivering ACT as a 1-day workshop was extremely successful (Dindo et al., 2017). Using the language of the workshop, helped to engage those who may be put off by the idea of therapy. While improving, some people still face stigma around mental health support, and presenting ACT as a workshop navigates around this barrier. It is intriguing that presenting the treatment as a “workshop” instead of “therapy” offers several advantages., This terminology is more suitable for patients who may associate seeking mental health care with stigma. This is extremely important as it makes ACT a viable and practical way to deliver support and help. Because it works with our approach towards our pain, teaching us to accept rather than fight against the pain, ACT is successful in treating clients with physical health issues, “Research has consistently shown that an ACT-based approach to chronic pain leads to improved functioning and quality of life (Dindo et al. 2017).
Develop your skills with an ACT course designed to help those with physical health conditions
Clients may present with a range of issues, both physical and psychological. It can be hard to disentangle the threads to find the root cause of the problem. ACT is a fantastic resource as it can work across the conditions, helping both the physical and psychological aspects of a person. We know that they are intrinsically entwined, and that when we work with people, we need to work with the whole individual. If they present with depression, but the root cause is from their coping mechanisms for their long-term health conditions, then having the resources to work with the whole person is vital.
If you are interested in learning more about ACT for physical health problems, we have a number of upcoming workshops in our schedule:ACT for physical health problems: Intermediate level deep dive into skills development
Dr Ray Owen
4th – 12th Dec 2024: 14 hours (12 CE credits)
ACT for physical health problems: An introductory skills workshop
Dr Ray Owen
4th – 12th Jun 2025: 12 hours (12 CE credits)
References
Dindo, L., Van Liew, J. R., & Arch, J. J. (2017). Acceptance and commitment therapy: A transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics, 14, 546-553.
Konstantinou, P., Ioannou, M., Melanthiou, D., Georgiou, K., Almas, I., Gloster, A.T., Kassianos, A.P., & Karekla, M. (2023). The impact of acceptance and commitment therapy (ACT) on quality of life and symptom improvement among chronic health conditions: A systematic review and meta-analysis. Journal of Contextual Behavioral Science, 29, 240-253.
Lorençatto, Petta, C., Navarro, M.,, Bahamondes, L. & Matos A. (2006). Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand, 85, 88-92.
National Institute for Health and Care Excellence. (2019). Tinnitus: assessment and management. Retrieved from https://www.nice.org.uk/guidance/NG155
National Institute for Health and Care Excellence. (2021). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. Retrieved from https://www.nice.org.uk/guidance/NG1193
