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Spinal cord injuries can have life changing effects on patients. These injuries cause damage to the bundle of nerves in the spinal cord that control most daily functions from walking to swallowing. For patients with spinal cord injuries, dealing with these changes and waiting to see progress may take a toll on their mental health.

Many patients with SCI may experience heightened anxiety and depression while adjusting to a new way of life. These feelings are natural for the recovery process but can create obstacles for making progress in physical and occupational therapy. Recent research at the University of Michigan says using acceptance and commitment therapy can help patients overcome these mental barriers. Acceptance and commitment therapy helps patients accept what they cannot change and create new personal goals for their recovery journey.

Acceptance and commitment therapy

Acceptance and commitment therapy is part of the third wave of cognitive behavioral therapy. The therapy centers around the idea that avoiding negative thoughts and emotions won’t work in the long term. This is a different approach than more traditional 1^st and 2^nd wave cognitive behavioral approaches that until recently, was the largest evidence-based model as a psychological intervention for management of distress in people with neurological injury. This newer practice is designed to help patients become their best selves no matter what is going on physically, cognitively, or emotionally. Using acceptance and commitment therapy with spinal cord injury patients can help them work through the emotions they’re feeling while working through the physical changes.

"If someone with a spinal cord injury says, 'I may never walk again', it's not helpful to ask them to change that thought because it might be true," said Brigid Waldron-Perrine, Ph.D., the lead author of the study and clinical associate professor at the University of Michigan.

"Acceptance and commitment therapy evokes psychological flexibility in patients, this approach focuses not on whether the thought is true or false, but whether it is helpful to be tangled up in it at this moment. Staying committed to acting on your values no matter what shows up inside you in the overarching goal," continued Waldron-Perrine, who is a psychologist by training and specializes in the psychological evaluation and care of people with neurological conditions including spinal cord injury.

Although there has been little research on the subject, Waldron-Perrine and her colleagues are investigating the effects of acceptance and commitment therapy specifically in neurorehabilitation populations.

Patients who have experienced spinal cord injuries and agreed to participate in the study were contacted by researchers to complete a survey that asked questions about how they respond to difficult situations, particularly as related to the components included in acceptance and commitment therapy, and their experiences of distress and resilience. The relationship between the components of acceptance and commitment therapy and outcomes related to quality of life were then explored. A subset of individuals then participated in a brief intervention to demonstrate the feasibility of using this treatment in this population.

"It is important for patients to be reminded that the situation they are in does not define them,” said Waldron-Perrine. “They are still a whole person and focusing on parts of themselves other than the injury might be a helpful approaching to coping.”

Another positive about acceptance and commitment therapy is that once the ideas are introduced, it is easy for patients to access content at home. Waldron-Perrine typically recommends various books, websites, apps and even specific YouTube videos that were created by other acceptance and commitment therapy practitioners. The videos are designed to portray metaphors and themes that can be easily remembered and repeated internally when negative thoughts and emotions arise.

These tools are intended to remind patients that difficult thoughts and feelings are part of the normal human experience, and it is important to acknowledge them but not give in to being controlled by them. No matter the thoughts, feelings, and physical sensations the person experiences, the self is consistent.

“I am the sky, not the clouds”

Waldron-Perrine relays an example from one metaphor that equates the human experience to clouds moving through the sky. No matter what happens with the clouds, the sky is still there behind them, and the storm will pass. An individual can remember themselves, “I am the sky, not the clouds.”

"I think that this is the secret sauce of life, really," Waldron-Perrine said. "It is always important to acknowledge the humanness that exists in everyone. If you have a neurological injury, you are going to have thoughts and feelings about it. We all, as humans, can get caught up in trying to change or avoid our thoughts, feelings and experiences. We can all also benefit from reminding ourselves of the stable self that experiences those difficult things. What’s most important in the path towards each of us being the best version of ourselves is taking action to move towards what’s important to us, making room for what shows up along the way.”

While acceptance and commitment therapy home therapy videos and books are useful, it’s important for people with spinal cord injury, or any condition that can contribute to emotional distress, seek a mental health professional if they are struggling.

Additional authors include Waldron-Perrine, B., Kisser, J., Robinett, E., Hanks, R.A., Kratz, A., & Dorenkamp, M.

Funding provided by the Craig H. Neilson Foundation

Papers cited:

“Association Between Acceptance and Commitment Therapy (ACT) Processes and Depressive Symptoms and Pain Interference in Persons With Spinal Cord Injury (SCI),” American Psychological Association. DOI: 10.1037

“Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study,” Archives of Physical Medicine and Rehabilitation. DOI: 10.1016