Michael E. DeBakey VA Medical Center - Houston, Texas
Acceptance and Commitment Training (ACT) Workshops
Prior to the COVID-19 pandemic, the Houston VA held monthly workshops to help Veterans facing total knee replacement learn skills to help them recover following surgery. The researchers responsible for this study are still serving our Veterans, but virtually via Zoom meetings, and the Veterans are loving the new format.
Acceptance and Commitment Training (ACT) workshops are led by Dr. Lilian Dindo from the Center for Innovations in Quality, Effectiveness, and Safety. The studies involve Veterans who are experiencing distress and/or high pain levels prior to surgery.
“Some of the Veterans don’t have experience using virtual programs like Zoom,” said Dindo, “and in those cases we deliver an iPad to the Veteran with Zoom already downloaded. We walk them through the setup process and make sure they have everything they need.”
“Pre-operative distress leads to increased risk for chronic post-operative pain and increased opioid use,” said Dindo who developed the workshop format and has been running these groups for several years. “We do these workshops because we have found them to be effective at reducing distress and improving pain outcomes in other similar studies. We have also found that patients who attend a workshop prior to surgery have better post-surgical outcomes.”
Navy and Vietnam-era Veteran Dr. Bill Rollwitz recently participated in the workshop prior to his knee replacement and found the workshop very informative.
“They disseminate good information about what is coming and what to expect,” said Rollwitz. “They really delve into pain management. It also gives you an opportunity to talk with people who are going through—or have been through—what you are about to experience. Sometimes when you deal with chronic pain, you feel like you are the only one. The group dynamic was exceptional."
By participating in theses ACT workshops Veterans also learn basic skills for when they get home—how to walk, turn and pivot, get up from a chair, and shower.
“I learned some really great information, like how you need to proof your house to use a walker. They discuss the little things you don’t think about but are so important,” Rollwitz said.
“It [ACT workshop] helped with the total process,” said Army Veteran Constance Daily, “from the actual surgery and what it entailed, to dealing with relatives and getting through the pain.”
The workshops begin by the Psychologists asking Veterans to list what and who is important to them. Answers like family, spouse, grandchildren, community, giving back, and spirituality (religion) are usually at the top of the list. The idea is to get the Veterans to focus on what they value and to keep these values in mind following surgery.
“If you are in pain, you may become fixated on that pain and get tunnel vision,” said Dr. Derrecka Boykin, Post-doctoral Fellow with the Mental Illness Research Education and Clinical Center. “We’re trying to teach Veterans how to cope with the pain better, to not lose sight of other things in your life because of the pain, and to focus on the people and things that are most important to you.”
“Quite frankly, there is a lot of anxiety prior to a major procedure like knee replacement,” said Rollwitz.
Two providers, usually psychologists, take each group through exercises designed to teach the Veterans how to get out of their own heads and focus on what they value.
“Take notice, step back,” said Boykin. “I’m in my head. I feel anxious … what am I going to do next?”
For Veterans who have had knee replacement surgery, it is so important not to dwell on their pain and situation, but to continue to move forward with physical therapy and activities that they enjoy. It can be easy to slip into depression or anxiety and ignore the things that are important to them, like going to family events, or out to dinner with their friends. Some Veterans may feel they are too much trouble or that they will be a burden. They can become prisoners to their condition.
“When you are in pain and hurting you tend to isolate,” confided Daily. “The workshop shows Veterans how to avoid missteps.”
“We’re trying to encourage Veterans to not let pain be a barrier that keeps them from living a meaningful life,” said Boykin. “As they go through surgery and recovery, we are hoping the things they learn here will help encourage them to do meaningful and important things even when it gets hard and negative thoughts start to creep in.”
“You don’t have to listen or buy into negative thoughts. The key is to allow your values to guide your steps, not your fears,” said Dindo.