Living beyond your pain – an Acceptance & Commitment Therapy approach to pain management

Well, that was a title and a half!
Yes, today’s review is about Living Beyond Your Pain, a workbook written by Joanne Dahl & Tobias Lundgren, with a foreword by the ubiquitous Steven Hayes, and yes, it’s published by New Harbinger Publications (again!). I want to promise, with my hand upon my heart, that I’m not in their pay-packet, and I will review something published by someone else very soon!!

Anyway, this book is based on the ACT model, which suggests that rather than trying to control your thoughts or the uncontrollable (your chronic pain), it’s preferable to live aligned to your values, and bring pain along for the ride. By neither focusing on, nor ignoring pain and judgements about your pain, it’s possible to take committed action and do valued activities instead of avoiding activities because of your pain.

Initially the ACT approach can be a little difficult to grasp, or at least that was my first impression. After reading quite a lot including the Association for Contextual Behavioural Therapy website, I have learned a bit more about it, but I still think the description in Living Beyond Your Pain is a basically sound one. Not easy to understand – but perhaps that’s because the approach itself is so different from the standard CBT approaches.

The workbook is, like all the other New Harbinger Publications books, well-designed with lots of white space, clear layout, and plenty of space for personalising and completing activities throughout.

It starts with establishing that most other strategies have not worked – creating a concept that I like of ‘creative hopelessness’ or ‘positive surrender’. To a Western audience, the very idea of surrendering or losing control to something that is unwanted is quite a strange idea, but as the authors in this workbook point out ‘Have you ever come to a point in your struggle with pain where you simply said ‘I can’t fix this’? What did that feel like? You may have experienced some grief, but wasnt there also a certain freedom?’….’We define creative hopelessness as a place where new possibilities for changing your life arise.’

Like most of the other workbooks, it also has chapters on ‘what is chronic pain?’, awareness of thoughts – and distinguishing between thoughts and the person thinking the thoughts. In terms of skills, the book covers the practice of ‘mindfulness’. This originally buddhist practice involves becoming immersed in sensations happening NOW rather than thinking about, recalling, predicting or even labelling the experiences. It is a meditation practice, but in this book it’s described as becoming a ‘watcher’ or ‘observer’ of your own thoughts – and not judging or evaluating your experiences or thoughts.

The workbook also, and very importantly, covers the ACTION part of the ACT practice. Not only is mindfulness used, but acting according to what is important or valued – and sticking to that action. By being appreciative of why you want to do something in a positive way is a much more enjoyable experience than gritting your teeth and ‘just getting on with it’.

Finally, the book finishes with ways to maintain action, and how to face barriers that are certain to be in the way of making forward momentum.

The strengths of this book are, like all New Harbinger workbooks, great layout, authoritative authors, the individual learning activities all the way through so the content is readily made relevant to the individual, and the use of a relatively new approach to living with chronic pain. Some of the activities, especially around ‘values illness’ and what people have given up to avoid experiencing pain are particularly profound and challenging when used with people who have chronic pain, and can be very persuasive for helping people consider what is important in their lives.

What I found less helpful was the slightly complex and convoluted way that ACT was described (mind you, I haven’t found anything much easier either!), and it does require good cognitive function (these concepts are abstract). As with any workbook, the reader would have to be committed to making his or her way through the whole workbook, and it’s definitely much easier to do this with a therapist helping the process. I would also have loved some more diagrams – they really make the points so much more easily.

To summarise? I wouldn’t use this book as a first-line approach to pain management, and I think it would be very important to do some further learning around the ACT approach before starting to use this workbook with clients. On the other hand, excerpts from this book are great – especially the concept of ‘clean pain’ which is essentially about experiencing the sensations and ‘dirty pain’ which is about judgements about having that pain.

Living Beyond Your Pain
Using Acceptance & Commitment Therapy to Ease Chronic Pain
By Joanne Caroline Dahl, Tobias Lundgren
Publisher: New Harbinger Publications
ISBN: 1572244097
EAN: 9781572244092
Format: Paperback, 169 pages
Published In: United States, May 2006
Other Editions: Paperback, USA $56.99
$34.20 from Fishpond – reduced from $45.99,


  1. Thanks for this review. I agree that the ACT workbooks I’ve seen (like “Get Out of Your Mind and into Your Life”) have tended to be difficult for individuals to follow on their own, but great resources for therapists. Some of the images are really very helpful, like the “clean/dirty pains” you mentioned, or the “leaves on a stream” image. Therapists of many different orientations can find something helpful in the ACT approach.

    Thanks again,

  2. Hi Roger
    Thanks for that comment and for visiting! I also like the ‘leaves on a stream’ image and also there’s one about enclosing your thoughts in a giant bubble and allowing them to float away! I’m really appreciating the ‘take action’ component of this, and the positive focus on what people want in their lives instead of what they don’t want. Good stuff! And you’re right, you can use aspects of this workbook despite your therapeutic orientation. I’m looking forward to you stopping by again!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.