DBT for Chronic Pain: Validation, Mindfulness, and Radical Acceptance

Meet Your Instructor: Kirby Reutter, Ph.D., DBTC, LMHC, MAC

United States Department of Homeland Security

Key Points

Functional contextualism refers to the process of seeking to understand the context which influences a client’s behaviors.
Chain analysis is an important DBT tool that allows both the client and clinician to better understand the context and function of certain behaviors.
Validation is another important DBT intervention. Clients won’t be willing to change maladaptive behaviors until they first feel that you, as the therapist, understand their situation and the reason for their behaviors.
Our interviewees recommend the TAG sequence when teaching new behaviors to clients: teach, apply, generalize.
For chronic pain clients, mindfulness can be especially challenging—and all the more necessary. They tend to spend most of their time either reminiscing about before they had the chronic pain or fantasizing about the future, hoping it will go away, rather than dealing with their life as it’s unfolding right now in the present.
The DBT mindfulness practice follows the sequence of observe, describe, participate.
Individuals with chronic pain tend to reach a point of demoralization, a sense of helpless or hopeless despair that life will never get better. Physical, emotional, and spiritual pain all mutually exacerbate each other, leading to demoralization.
Radical acceptance helps clients acknowledge their pain instead of trying to avoid or escape it, which only makes the pain worse.
Radical acceptance, in conjunction with the meaning skill, also helps clients understand the twisted gift of their chronic pain, positive qualities that wouldn’t have developed without it.