‘Every person wants to have control over their pain, and the human reaction is to try to avoid or solve it.’ Hester Trompetter knows that this act of human nature is counterproductive, though. ‘Some aches cannot be avoided or solved, and the technique will boomerang heavier discomfort to the patient.’ Hester explains that because of the previous, many people start to do only what they have to do, and refrain from things they want to do. ‘They simply lack the energy and time with all the efforts spent on reducing the pain.’
Grumpy Old Men
The PhD candidate likes to illustrate her research with a metaphor. ‘Look at Waldorf and Statler, the two grumpy old men in the theatre of the Muppet Show. They always complain, but still the show goes on. The same applies to constant pain. The negative thoughts surrounding the agony are always there, but you can choose what you do with them.’
Hester’s research evaluates Acceptance & Commitment Therapy. ACT helps patients to gain insights into the impact that fruitless attempts to control pain have on their lives. They are challenged to re-evaluate what they value and what they want to do in life. Patients are encouraged to transform their thoughts from “I wanted to have fun but I felt pain” into “I wanted to have fun and I felt pain.”
ACT Treatment
ACT consists of several processes. The most important ones are acceptance, life values and mindfulness. Broad terms, indeed. There are multiple ways how these processes can be operationalized in therapy.
At the start of treatment, for example, patients can list all their previous attempts to loose or live with the pain. This can be very demotivating. Hester calls this the process of “creative hopelessness”: ‘People will become so desperate that they are open towards alternatives.’ From this moment on, Hester helps patients to interpret moments of hurt in such a way that they do not let those demons decide how to live life anymore.
Another technique is to make patients determine their important life values, and map to what extent they currently live in correspondence with them. Often, there is a large discrepancy. ‘Goals are then formulated and carried out step by step to minimize this inconsistency between current and valued status quo,’ Hester elaborates.
In addition to acceptance and re-evaluating life values, mindfulness is a central component of ACT. Patients perform exercises to regain contact with their experiences and to be more aware of the present instead of past or future.
Help yourself
Hester’s research approach can be described as thorough. ‘There were insufficient valid ACT scales available. I develop and test ACT scales in order to measure the processes. Next to that, we have implemented ACT as therapy in 9 rehabilitation centres in The Netherlands. The patients receive multidisciplinary treatment, and we develop systematic plans on how they can use the ACT method in the best way. This includes the training of rehabilitation professionals. It helps us to apply our knowledge to daily practice. Next to that, I follow 4 patients on a daily basis for 100 days. In this way, I gain a deeper understanding of the unfolding of therapeutic principles over time within individuals.’
But that is not all. Hester has large ambitions and has begun to realize them. ‘Me and my colleagues are currently testing if we can use ACT as online self-help tool. In the trail, 238 people followed 9 online modules in 9 weeks. Patients download instructions and receive weekly feedback from therapists by e-mail. We are now investigating what type of patients benefit from such an online approach and what patients do not.’
Will we ever live in a world where pain doesn’t matter? Hester disagrees. ‘You cannot say that pain does not matter because it does matter. We live in a world where everyone wants to live pain-free and carefree. But this is not realistic. Sooner or later we all encounter hurt and pain, and sometimes we can do nothing more than accept that. Nobody promised us anything, we just have to make the best of it.’
