If you're living with a chronic illness, you're in the right place.

Wednesday, July 17, 2013

Acceptance: Part 1

I was trolling recent research publications and came across a 2012 study where the authors had designed a new questionnaire to measure acceptance in people living with Irritable Bowel Syndrome.  The idea of acceptance is pretty straightforward in that we no longer try to control, avoid, or fight our situation but rather engage in a "willing contact" with everything that comes with it.  In the case of a chronic illness, we do all that we can to get the right treatments and improve its symptoms as much as we can but also accept that there will be times we don't feel well - and that's OK.

There's an entire field of psychology called Acceptance and Commitment Therapy, or ACT, pioneered by psychologist Steven Hayes in the 1980s, that is gaining in popularity.  ACT comes from the cognitive behavioral therapy (CBT) theory, but is different in several ways.  I've used some ACT principles with some of my clients, especially those who are really struggling with accepting that they have a chronic condition.

One of the principles of ACT is we get stuck in unhealthy behaviors when we are driven by FEAR:

Fusion with your thoughts
Evaluation of your experience
Avoidance of your experience
Reason-giving for your behavior

What the heck does that mean?  What the handy acronym is getting at is that we become more distressed when our often abstract, negative thoughts are made very real, in that if I think this it must be real or true.  And because these thoughts must be real or true, we spend a lot of time evaluating them, expanding upon them, or simply repeating them over and over in similar formats.  We may try to avoid or block out these thoughts as much as possible, and to do this we may change our behaviors as to avoid making things worse or potentially putting ourselves in a tight spot.  Finally, we come up with reasons why we have to do these things because there really is no other logical way to deal with the situation.

We're in a tight spot!
Let's take the experience of pain, since that comes with many different chronic illnesses.  Logically, we try to avoid pain at all costs because, well, pain sucks.  If we've been living with pain for a while, our thoughts, emotions and behaviors may become very wrapped up in our pain experiences.  Subsequently, we may try to do everything in our power to avoid experiencing the pain, as well as the thoughts and emotions that go along with it.  This usually translates into behaviors, as we try to figure out what causes the pain so we can make sure we don't put ourselves in situations that cause pain.  Makes perfect sense, doesn't it?

According to ACT, the problem isn't necessarily with the mere presence or content of our thoughts about pain but how we respond to these thoughts and how these responses interfere with our personal values and goals.  A lot of people living with chronic pain conditions say that they feel like their life has been placed on hold for a long time, and that they haven't been able to do X, Y or Z because of the mental and physical energy being devoted to their pain and its management.

So what can we do?  In my next post, I'll review some of the strategies for greater acceptance and coping with chronic illness.  Stay tuned.

Dr. T