ACT to Improve Psychological Flexibility and Chronic Pain

By John M. de Castro, Ph.D.


Hence, the ultimate goal of ACT is not to reduce symptoms or pain (although other simultaneous therapies may well be aimed at achieving this). Instead, its goal is to improve functioning by increasing psychological flexibility and the ability to act according to personal values, even in the presence of negative experiences, like pain.” – Painfocus


We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity.  At least 100 million adult Americans have common chronic pain conditions. It affects more Americans than diabetes, heart disease and cancer combined. Chronic pain accompanies a number of conditions. The most common forms are low back pain, osteoarthritis, and fibromyalgia.


The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.


Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.


In today’s Research News article “A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain.” See:

or see summary below or view the full text of the study at:

Scott and colleagues examine the relationship of changes in psychological flexibility to improvements in chronic pain produced by Acceptance and Commitment Therapy (ACT). They recruited patients who suffered from chronic pain of various types, with lower back pain the most common (43%). They were treated 4 days per week for four weeks with a group based ACT therapy. Before and after treatment they were measured for pain intensity, pain acceptance, daily functioning, depression, cognitive fusion, decentering, and goal directed activity.


They found that ACT was quite effective in improving chronic pain symptoms. It produced a large significant improvement in depression, moderate improvements in pain intensity, physical and social functioning, and chronic pain acceptance, and small improvements in goal directed activity and decentering. They further found that the processes of psychological flexibility, including chronic pain acceptance, cognitive fusion, and goal directed activity significantly predicted the magnitude of the improvements in the chronic pain symptoms. Hence, it appears that ACT increases psychological flexibility and as a result improves chronic pain.


It is important to identify how a particular therapy has its effects upon the disorder. This allows for improvements in the techniques and maximization of its effects. The fact that psychological flexibility was the key change produced by ACT suggests that future efforts should be to modify ACT to maximize its impact on psychological flexibility.


So, ACT to improve psychological flexibility and chronic pain.


“Mindfulness teaches people with chronic pain to be curious about the intensity of their pain, instead of letting their minds jump into thoughts like “This is awful.” It also teaches individuals to let go of goals and expectations. When you expect something will ease your pain, and it doesn’t or not as much as you’d like, your mind goes into alarm- or solution-mode. You start thinking thoughts like “nothing ever works.” “What we want to do as best as we can is to engage with the pain just as it is.” It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+


Study Summary

Scott, W., Hann, K. E. J., & McCracken, L. M. (2016). A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain. Journal of Contemporary Psychotherapy, 46, 139–148.



Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.

Improve Athletic Flexibility and Balance with Yoga

By John M. de Castro, Ph.D.


“She was injury-free because of yoga, stretching her body into difficult positions. “I’ve never seen such an improvement in my game, the difference it makes. I’m quicker, more nimble. Instead of being tighter, I’m more relaxed, more comfortable.” – Brenna Wise


Yoga practice has been shown to have a myriad of benefits for psychological and physical health. It is a mind-body practice that stresses both mental attention to present moment movements, breath control, and flexibility, range of motion, and balance. It can be practiced by anyone from children to seniors. Recently, there have been a number of high profile athletes who have adopted a yoga practice to improve their athletic performance. But, does yoga actually help elite athletes to perform at an even higher level? The ability of yoga to improve balance would seem to be a natural help for the athlete and the improvement in flexibility could well help the athlete resist injury.


In today’s Research News article “Impact of 10-weeks of yoga practice on flexibility and balance of college athletes.” See:

or below or view the full text of the study at:

Polsgrove, Eggleston, and Lockyer randomly assigned male college soccer and baseball players to yoga training or control groups. Both groups received their typical athletic workouts throughout the study. But, in addition, the yoga group were trained in yoga postures twice a week in one-hour sessions.


The yoga group had significant improvements in both flexibility and balance. Flexibility increased 21% in tests of shoulder flexibility and sit-reach. Balance was improved 32% in the stork-stand, a common yoga pose. In contrast, the control group declined in all measures. Joint angle measurements revealed that the yoga group had significant improvement in ankle dorsiflexion, hip and knee extension, and shoulder and knee flexion. Hence, yoga training appeared to produce significant improvements in balance, flexibility, and the range of joint movement.


These are important changes in the physical abilities of the athletes. Although logically, these improvements would be expected to translate to improved athletic performance and lower occurrence of sports injuries, this was not investigated in the present study and remains for future research. It should be mentioned that the yoga training used emphasized the physical aspects of yoga. Mental discipline is also very important for athletic performance. It seems reasonable that future research should also include various aspects of the mental training that occurs in a typical yoga training.


Regardless, improve athletic flexibility and balance with yoga.


“I wanted my body to feel that way all the time. I became looser, and I only missed one game due to injury. It helped me remain injury-free, and helped my agility and athleticism.” – Eric Stutz


CMCS – Center for Mindfulness and Contemplative Studies


Study Summary

Polsgrove, M. J., Eggleston, B. M., & Lockyer, R. J. (2016). Impact of 10-weeks of yoga practice on flexibility and balance of college athletes. International Journal of Yoga, 9(1), 27–34.




With clearer evidence of its benefits, coaches, and athletes may better see that yoga has a role in optimizing performance.


To determine the impact of yoga on male college athletes (N = 26).


Over a 10-week period, a yoga group (YG) of athletes (n = 14) took part in biweekly yoga sessions; while a nonyoga group (NYG) of athletes (n = 12) took part in no additional yoga activity. Performance measures were obtained immediately before and after this period. Measurements of flexibility and balance, included: Sit-reach (SR), shoulder flexibility (SF), and stork stand (SS); dynamic measurements consisted of joint angles (JA) measured during the performance of three distinct yoga positions (downward dog [DD]; right foot lunge [RFL]; chair [C]).


Significant gains were observed in the YG for flexibility (SR, P = 0.01; SF, P = 0.03), and balance (SS, P = 0.05). No significant differences were observed in the NYG for flexibility and balance. Significantly, greater JA were observed in the YG for: RFL (dorsiflexion, l-ankle; P = 0.04), DD (extension, r-knee, P = 0.04; r-hip; P = 0.01; flexion, r-shoulder; P = 0.01) and C (flexion, r-knee; P = 0.01). Significant JA differences were observed in the NYG for: DD (flexion, r-knee, P = 0.01: r-hip, P = 0.05; r-shoulder, P = 0.03) and C (flexion r-knee, P = 0.01; extension, r-shoulder; P = 0.05). A between group comparison revealed the significant differences for: RFL (l-ankle; P = 0.01), DD (r-knee, P = 0.01; r-hip; P = 0.01), and C (r-shoulder, P = 0.02).


Results suggest that a regular yoga practice may increase the flexibility and balance as well as whole body measures of male college athletes and therefore, may enhance athletic performances that require these characteristics.


Promote Physical and Mental Well-Being with Tai Chi


By John M. de Castro, Ph.D.


“Tai Chi exercise had positive effects on the self-assessed physical and mental health of college students. Scores on the mental health dimension appeared to be particularly sensitive to change. Colleges/universities might consider offering Tai Chi as a component of their ongoing physical activity programs available to students.” – Y. T. Wang


Many people have fond memories of their college years. It is likely, however, that they forgot about the stress and angst of those years. The truth is that college is generally very stressful for most students, from the uncertainty of freshman year, to the social stresses of emerging adulthood, to the anxiety of launching into a career after senior year. Evidence for the difficulties of these years can be found in college counseling centers which are swamped with troubled students. In fact, it’s been estimated that half of all college students report significant levels of anxiety and depression.


Being able to perform at an optimum level is important in college. It would be very helpful if a

safe and effective way could be found to reduce stress, depression and anxiety in college students. Mindfulness training has been shown to reduce anxiety, stress, and depression . So, mindfulness training would appear to be well suited to deal with the problems of college students. The ancient eastern practice of mindful movement Tai Chi has been shown to reduce stress, depression, and anxiety. Hence, it would make sense to investigate whether Tai Chi practice might be effective for improving college student angst.


In today’s Research News article “A systematic review of the health benefits of Tai Chi for students in higher education”

Webster and colleagues review the published literature on the effectiveness of Tai Chi practice in improving college student physical and psychological states. They found that that the preponderance of evidence in the literature reported that Tai Chi practice significantly improved muscular flexibility. But the most interesting effects were in the psychological domain with Tai Chi practice significantly reducing depression, anxiety, symptoms of compulsion, somatization symptoms, hostility, and symptoms of phobia, and improved interpersonal sensitivity.


Hence, the published scientific literature suggests that Tai Chi practice can be of significant benefit for college students, improving them physically and improving their psychological well-being. Tai Chi practice is a gentle mindful movement practice. It is safe, having few if any adverse consequences, and effective with college students. This suggests that the engagement in Tai Chi practice should be encouraged in college promoting the physical and mental well-being of the students.



“Of all the exercises, I should say that T’ai Chi is the best. It can ward off disease, banish worry and tension, bring improved physical health and prolong life. It is a good hobby for your whole life, the older you are, the better. It is suitable for everyone – the weak, the sick, the aged, children, the disabled and blind. It is also an economical exercise. As long as one has three square feet of space, one can take a trip to paradise and stay there to enjoy life for thirty minutes without spending a single cent.” ~T.T. Liang


CMCS – Center for Mindfulness and Contemplative Studies


Improve Physical and Cognitive Function with Tai Chi

By John M. de Castro, Ph.D.


“Because Tai Chi may impact cognitive function via a diverse and potentially synergistic set of mechanistic pathways, it is plausible that it may offer benefits superior to interventions that target only single pathways (e.g., aerobic training or stress reduction alone)” – Peter Wayne


The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly. It is obviously important to investigate methods to improve balance and decrease the number of fall in the elderly.


Perhaps more troubling than the physical decline is the mental deterioration that occurs with aging. This is called age related cognitive decline and includes decreases in memory, attention, and problem solving ability. This occurs to everyone as they age, but to varying degrees. Some deteriorate into a dementia, while others maintain high levels of cognitive capacity into very advanced ages. It is estimated that around 30% of the elderly show significant age related cognitive decline. But, remember that this also means that 70% of the elderly retain reasonable levels of cognitive ability.


It is, therefore, important to investigate methods to slow the mental decline during aging. Some promising methods are contemplative practices which have been shown to restrain age related declines. One particularly promising method is the ancient eastern practice of Tai Chi. It is particularly promising due to the fact that it is both a physical and a mental practice. Indeed, tai chi practice has been shown to slow cognitive decline in aging.


In today’s Research News article “Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults”

Taylor-Piliae and colleagues randomly assigned sedentary adults over 60 years of age to either a tai chi practice, a physical exercise program, or attention (healthy aging) training. Training occurred twice a week in 90-minute classes and three times per week in home practices. They measured the physical and mental capabilities of the participants at 6 and 12 months of training. They found that both the tai chi and exercise groups improved in both flexibility and balance in comparison to the control condition. At 6 months the tai chi group was superior with balance while the exercise group was superior in flexibility, but at 12 months the two groups were equivalently superior to the control group in both flexibility and balance. In contrast, only the tai chi group demonstrated improved levels of cognitive function including memory and semantic fluency at both 6 and 12 months.


These results suggest that both tai chi and exercise are effective in slowing the physical decline with aging but tai chi has the added benefit of also slowing the cognitive decline. Since tai chi is safe, with no known adverse effects, and a gentle practice it is very appropriate for an aging population. Also, since it can be taught and practiced in groups and easily maintained at home, it is a very inexpensive intervention. This makes it almost ideal for aging individuals on fixed incomes.


The results suggest that tai chi practice may be helpful in preventing falls as a result of improvement in balance and flexibility and slow the mental decline with aging. This indicates that tai chi practice should be recommended for elderly individuals to help maintain their physical and mental abilities. So, improve physical and cognitive function with tai chi.


“There is growing evidence that Tai Chi can significantly reduce the risk of cognitive impairment and improve cognitive function.” – Exercise Medicine Australia


CMCS – Center for Mindfulness and Contemplative Studies