Pain isn’t the problem – pain just IS

The first noble truth of Buddhism declares that life is suffering. The answer in Buddhism (as well as other contemplative religious traditions) is not to change the suffering itself but to change our relationship to the suffering and pain. Religion is at its best when it helps us to engage in practices that encourage us to let go of clinging to, escaping from, and otherwise having our lives be unduly influenced by existential pains. With this kind of open and willing stance toward our pains, we are more freely able to move forward in our lives in ways that reflect and define what matters most to us.

ACT (acceptance and commitment therapy) is an evidence-based set of practices designed to help to change our relationship to pain rather than getting caught up in the madness of controlling our experience to avoid pain.

ACT and psychological flexibility

Psychological flexibility is the intended outcome of ACT. It is defined as one’s capacity to contact painful private experiences (thoughts, emotions, body sensations, memories, etc.) while continuing to make decisions that serve one’s cherished values. As an outcome variable, psychological flexibility has been found to be predictive of health outcomes across a number of treatment issues including: anxiety, depression, substance abuse, weight gain, mental health stigma, chronic pain, and psychosis among other treatment targets (Hayes, S.C., Bond, F.W., Masuda, A., & Lillis, J. 2006). It’s emerging as a more important treatment target than a reduction of symptoms.

A model of 6 processes involved in psychological flexibility can be contrasted with their 6 counterparts (see the table below).

Most often this model of psychological flexibility and its related processes is depicted in the Hexaflex diagram (see below).

The left side of the model consists of the processes (acceptance and cognitive defusion) aimed at cultivating an open and non-attached stance toward one’s experience. The middle two processes (present moment awareness and self-as-context) are grounding and expanding processes. They help one build a quality of awareness that is attentive to what is here, now and to also notice this awareness and experience “self” from an expansive and compassionate consciousness. Together the left and middle processes of the hexaflex are very similar to the mechanisms at work in various forms of mindfulness practice.

Steven Hayes, the founder of ACT, has characterized a practice of mindfulness meditation without clarified values/purpose and committed action as a kind of psychological Xanax. In other words, if the purpose is to just help us feel relaxed and calm then these mindfulness practices are just another way to avoid our experience of pain – which in turn will create more pain.

The right side of the model includes the processes that complete the dialectic. Values clarification and committed action are processes that western culture is more familiar with. The term “values” used here refers to qualities and attributes that we want to guide our choices. Values are unattainable by definition. They are the quality with which we want to live. Committed action includes the things we can do (with our feet, hands, body, words) that are alined with our values. Often we think of them as goals – but they are really only workable toward psychological flexibility if they are in the service of our values.

Try it out – experiential exercise

If you want to experience how these processes might work for you, see if you are willing to try the following exercise:

Take a moment to sit quietly and still.

Focus on the sensation of your breathing-

or notice the feeling of the surface that you’re sitting, standing, or lying down on.

Let yourself open up to whatever comes to your awareness.

Now summon your courage… and turn your attention to any particularly painful thought or emotion that has been reoccurring for you in the past few months (or longer). Since you’re a human – there’s likely some kind of uncomfortable web of thoughts and emotions that are painful to sit with.

Let the pain take the form of a word or phrase. It’s really hard, but try your best to allow yourself to contact and sit with that pain.

See if you can soften up to the experience of the painful thoughts/emotions. Let them in without a struggle – notice them as parts of your experience that, though painful, are separate from your identity as a “self.” Notice the painful thoughts as leaves on a stream floating down a river and around a bend, or notice them as if they are cars on a freeway that go by you and out of view and are replaced with other cars – maybe of the same make and model.

Now consider how this painful web of thoughts and emotions might give you a clue as to what is of value to you. Values seem to be present as an inverted version of our deepest pains. In the case of shame or resentment felt in the context of close relationships – the value is likely to be related to being in trusting, close relationships. In the case of disappointment about one’s perceived underachievement or lack of success, the value may be building and sharing one’s talents and gifts.

Take a moment and notice what values pop up for you in relation to your pain. If contacting your pain and inverting it in this way doesn’t easily allow you to identify your values consider these questions:

• If I were 90 years old and looking back on my life, what values would I want to identify as having guided my life?

Or this one:

• What attributes and qualities would I want to be written about me on my tombstone?

Morbid… I know. When you have identified and clarified values in relation to the painful thoughts you identified, then you can ask yourself some form of question such as:

• What small thing can I do today, to enact this value?

Or maybe this:

• What specifically can I do to serve this value today?

You can use whatever questions or lists that help you identify a relevant choice or goal that is in line with your clarified values. Choose one action that can be completed today. Commit to it, write it down, and do it. Find out what works in completing this value driven action. It often helps to have environmental reinforcers (a list, a smartphone reminder, a supportive confidant) when we are trying to engage in behaviors that we have been avoiding or that are breaking old patterns.

Live life today

As you go about your day, new and old pains will show up. See if you can allow them to be there while staying grounded in the moment. It’s natural that you will find yourself avoiding your experience sometimes. Be kind to yourself as you bring your awareness back to the present. Back to what you really care about in life today.

Opening up to and contacting experience – especially internal pain, while moving forward with value driven actions. This is the process of building psychological flexibility in a nutshell. This is a way to approach the old human problem of both accepting the reality of life and committing to living life as fully and freely as possible.

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Hayes, S.C., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy. 44(1), 1-25.