JoAnne Dahl Talks with us About a New Approach to Dealing with Chronic Pain

New Harbinger Publications: What is the basic premise of ACT, and how do you and your coauthor recommend using it to help readers cope with chronic pain?

JoAnne Dahl: We apply the basic premises of ACT to chronic pain like this: Pain is normal, it is a vital sign and everyone has it. You cannot deliberately get rid of your pain for good—you can only do so temporarily. And when you try get rid of pain for good, you end up causing yourself more suffering in the long run.

In ACT, suffering is seen to be much more than pain itself, it is seen also as the struggle with difficult emotions, thoughts, unpleasant memories, unwanted sensations. As if pain weren’t enough, people think about their pain, worry about the pain, resent having pain, anticipate future pain, and dread the thought of a life with pain.

Pain and suffering are two different states of being. You don’t have to identify with your suffering, and if you do, you’ll cause yourself more suffering. Accepting your pain is a step to ridding yourself of your suffering. It’s kind of like victory by surrender. ACT can help you live a life you value, starting right now, even while you are experiencing pain.

NHP: You point out in Living Beyond Your Pain that most pain therapies are only partially effective and that living with pain despite medical or other treatments often leads people to feelings of depression and hopelessness—which make coping with their conditions that much harder. What advice does your book offer to people who have tried other treatments that didn’t work?

JD: As you say, most treatments for chronic pain simply don’t work that well. Individuals in pain need to know, first of all, that they are not alone in feeling frustrated with their pain management treatments. We know from large studies that these methods don’t work for most people, and we suspect that they probably even create more problems for people in pain. This means that the hopelessness that these people feel is legitimate and clearly based in reality.

One of the reasons we feel this hopelessness is because our society does a great job of promoting the desirability—to say nothing of possibility—of a pain-free life. If everything around you gives you the message that you shouldn’t have to feel pain, if you see ten commercials a day that claim to offer a magic pill for a pain free life, but you still are in pain—well, feeling hopelessness is pretty likely.

Feeling hopeless about unsuccessful attempts to get rid of pain sends us some important messages, though. The first is that the attempts to get rid of pain may be exactly as hopeless as we experience them. Listen carefully to this: It is the attempts to get rid of the pain that are hopeless,not the individual in pain or the experience of pain itself.

The second message is that all the energy we put into trying to get rid of pain needs to be taken away from doing more important things in life. Struggling in a hopeless battle rather than engaging in what you love to do is depressing.

This leads us to the third and most important message that hopelessness sends us. We don’t try to get rid of pain for no reason. We want to get rid of pain in order to live the life that we want to live. We want pain out of the way so that we can get back to the business of living. We wouldn’t feel depressed or hopeless if we didn’t want our lives back. Feelings of hopelessness help us start on the road to reclaiming our lives.

For these reasons, we shouldn’t try to avoid or alleviate hopelessness. We need to let it speak to us and help us on our way. Taking that feeling seriously may be the first step that gets us back on track. The question is, have we suffered enough? If the answer is yes, it might be time to let go of that struggle and start living.

NHP: Physical and mental pain seem to fuel each other, and this seems like it leads to even more suffering. How can we best reconcile these two kinds of pain?

JD: In an ACT way of thinking, physical and mental pain—anything from damaged tissue to a broken heart—are the inevitable consequences of living a vital life. The only way you can avoid pain is to avoid living. No one wants to be afflicted with an illness or abandoned by a loved one, but these are the risks you take in the game of life. You can’t have one without the other. If you want to give yourself the opportunity to love and be loved, you need to risk rejection. If you want to get into good physical shape, you need to use your body in ways that risk certain injuries.

ACT is not going to help you to avoid pain. What it will do is ask you to shift the way you deal with your personal experiences. Physical and mental pain are not things that can be solved, the way you might fix your car. Trying to solve these pain issues will undoubtedly create more suffering for you and, probably, the other people in your life. Acceptance of “what is” is the first step towards lessening suffering and living a valued life

NHP: You describe something in Living Beyond Your Pain you call “values illness.” Can you explain what this is and why it’s important to readers?

JD: If you have a values illness, you’ve put your valued life on hold in order to reduce your pain. The research on which ACT is based shows that the more we try to get rid of pain, the more we actually amplify it and get tangled in it—and the more our valued life gets pushed aside. Losing the life we want to live can lead us to depression. This condition is a struggle that we can’t win because it is against ourselves. One of the reasons we get into this fix in the first place is the cultural myth we talked about a minute ago, the one about a good life being a painless life. ACT offers a way out of this trap by helping us to refocus ourselves on living life and pursuing the things we value while we accepting pain as a given fact of life.

NHP: Essentially your book shows readers how to deal with chronic pain without “dealing” with the pain at all—and, instead, learning how to live richly with pain. This is very unlike other approaches to this problem. How did you come to this unusual (even revolutionary) perspective?

JD: From our professional experience in rehabilitation medicine, we realized that feelings of hopelessness are ubiquitous, not only among clients but among those dealing with clients—physicians, psychologists, vocational advisors, and even insurance companies. When it comes to chronic pain, modern Western medicine just doesn’t work that well, and no one seems to know what to do about it.

The medical model of “fixing” what is wrong just seems to make everything worse, and the personal and societal costs of this approach are astronomical. We recognized that trying to fix something that can’t be fixed was at the root of this problem.

ACT takes a totally different approach to pain “management,” suggesting that we accept the pain that cannot be fixed. Instead, we help people in pain utilize their resources to get back into the mainstream of life.

Remember that suffering is caused more by the struggle with the condition of pain than by the actual pain itself. When pain is unavoidable, it is bearable; when we try to avoid it, it becomes unbearable. ACT views pain as something beyond our control, but it identifies suffering as something we very much control. Professionals suffer the same hopelessness as their clients by trying to solve unsolvable problems. This is really what led us to these ideas in the first place.

NHP: After they get a handle on suffering, it seems like it would be easy for readers to slip back into old habits, returning to their habituated, “dirty” world of suffering. How can they best maintain their progress?

JD: Practice, practice, practice! ACT skills are somewhat counterintuitive to most of us, so we need regular practice to make them part of our lives. Once readers put down the book and go on their way, all kinds of familiar road blocks will arise before them. The only way to avoid those obstacles is to stay home and avoid life. Experiencing those obstacles that want to pull you off course is a sign that you’re on the right path! They wouldn’t show up if you were sitting at home twiddling your thumbs.

One of the best ways to lessen the effect these obstacles have on you is to start actively looking for them. “Looking for Mr. Discomfort” is an effective means of strengthening your skills. As you get back into your life, look for those thoughts and feelings that jump out at you, warn you of danger and try to pull you off course. Look at them with compassion and curiosity. They are a part of you and mostly just want to remind you of some past event that flopped. Accept them for what they are, and invite them to go along for the ride. We are creatures of habit and falling into an old familiar behavior will undoubtedly happen from time to time. Accept that as well, and give yourself time to examine this as a learning experience that will help you get back on track. Choose your life hundreds of times a day!