Acceptance

Acceptance means allowing an uncomfortable experience to be here in the present, rather than trying to push it away or get rid of it. It applies to things outside our direct control, such as pain, anxiety, and negative thoughts that arise. It is a core concept in the psychological approach known as Acceptance and commitment therapy, and is often discussed alongside Mindfulness.

Contrary to a common misconception, acceptance does not mean “just put up with it and get on with your life.” It does not mean liking pain or giving up. Rather, it means being able to redirect the energy spent struggling with pain toward something else. As a metaphor, it is like letting go of the rope in a tug-of-war, freeing both hands. Letting go does not make the rope disappear, but you can now use your hands to do other things.

When chronic pain persists for a long time, it is easy to think, “The pain has to go away before I can get my everyday life back.” This can mean being active only when the pain eases and stopping everything on days when it is severe. Acceptance reverses this order, encouraging you to look for things you can do even with pain present.

This concept began to receive substantial attention in chronic pain research with McCracken’s 1998 study. A study of 160 adults with chronic pain found that those who were more accepting of their pain had less pain-related anxiety, avoidance, and depression, spent more time being active, and were better able to remain engaged in work. These differences remained even after accounting for pain intensity. In other words, it was not simply that milder pain was easier to accept.

A subsequent 2023 meta-analysis pooling results from 21 randomized controlled trials involving 1,962 participants found that acceptance-based programs such as ACT produced large improvements in pain-related functioning, depression, and pain acceptance scores compared with control groups. Pain intensity, quality of life, and anxiety also showed changes in the direction of improvement. The greatest change can be seen as being less about how much pain there is and more about how people live with it.

Values-based action is an approach that involves continuing to choose actions suited to the situation and aligned with what matters to you, rather than focusing on eliminating uncomfortable sensations. It often comes up in discussions of chronic pain because activity can gradually decrease when reducing pain becomes the sole criterion for what you do.

It helps to distinguish goals from values here. A goal is an endpoint that is either reached or not, such as “climb to the mountain summit this weekend.” A value is a direction for your actions, such as “spend time with my family in nature.” Even if you are not feeling well enough to go to the mountains today, that value does not disappear. Walking in a nearby park or looking at photos from walks and talking about them with your family can keep you moving in the same direction. Values such as health, relationships, learning, and work are not boxes to check off once and be done with; they are directions you continue to choose and follow.

In ACT, this ability to acknowledge discomfort while continuing to act in line with your values is called psychological flexibility. It is used alongside Cognitive defusion, which involves taking a step back from pain-related thoughts rather than becoming overly caught up in them.

• Name what you are feeling right now. Try describing it without judgment, such as, “There is a pulling sensation in my lower back, and worried thoughts are coming up.”
• Take stock of the time you have spent trying to push pain away. Simply noticing how much time and energy have gone into fighting pain can help you see a direction forward.
• Write down one thing that matters to you. Choose something you value, whether it is family, work, or a hobby.
• Choose a small action you can take today. Something manageable with your body as it is now, such as walking for 10 minutes or calling a friend, is enough.
• Try to keep moving in the same direction even on days when pain is severe. Even if you reduce your activity level, try to continue small actions aligned with your values rather than stopping completely.

Acceptance is not a replacement for treatment, but a mindset to use alongside it. If your pain suddenly changes or you develop symptoms that are different from usual, it is best to check your physical condition first.