Suffering and pain are not the same thing. Pain is unavoidable: loss, rejection, grief, physical injury, oppression. Suffering is what happens when we resist pain rather than move through it. Three evidence-based therapy approaches — Emotion-Focused Therapy, Dialectical Behavioral Therapy, and Acceptance and Commitment Therapy — each offer a different angle on the same insight: leaning toward pain, rather than bracing against it, is what reduces it.
Pain is inevitable
As a practicing psychologist, I know all too well that living means experiencing pain, yet I’ve learned that suffering is optional. Whether a breakup, a hurtful conversation with a family member, heartbreak, loneliness, a fractured ankle, or yet another microaggression: shit happens. Life happens.
We usually recognize pain in its physical form: a stinging burn from the stove, a migraine, a chronic backache. But discomfort and hurt also show up in our emotions, and pain can include grief, loss, and social exclusion. We all know longing hurts. When we experience rejection, the very same brain pathways that react to physical injury light up. Social Pain Overlap Theory describes how physical wounds and emotional wounds set off the same alarms in the brain that tell us we’re in pain.
Despite that pain is inevitable in life, most of us were never taught the best ways to respond to it. That applies especially to emotional pain. Some folks grew up in households where, if we cried too long or too loudly, we faced anger, cold shoulders, or silencing. Encouraged to suppress our pain, we didn’t learn how to self-regulate, receive emotional support, or respond to our own feelings with compassion.
We were left to try to regulate ourselves.
For some of us, growing up meant having to “focus on the positive,” earning worth through service, shrinking ourselves, hiding, masking, or putting everyone else’s needs ahead of our own. Later, tragedy, loss, rejection, and oppression didn’t get easier; the issues just rippled outward. Our upbringings, intergenerational patterns, and the white supremacy myth itself often discourage us from approaching our pain directly. As a result, we suffer more and miss out on the support and healing we need.
At times we are actively encouraged to suppress our feelings. Emotional suppression arrives through personal, familial, religious, cultural, or social channels. It sounds like: If you keep crying I’ll… It’s wrong to feel jealous. Don’t sit like that. Real men don’t… You disrespect your family by not being appreciative. Your lust is immoral. Your feelings for them are sinful.
Ouch.
When we suppress or ignore our emotions, we are pitting ourselves against our pain. A growing body of research supports the idea that resisting our pain only generates more suffering on top of the original pain. It can be tempting to resist by numbing, reaching for an opposite emotion, pretending the feeling isn’t there, or just wishing the pain away. But when we resist, we make our feelings stronger and bring suffering along in the process. Suppressing emotions creates physical stress in the body and is linked to heart health and cancer mortality. Therapy is about learning to step outside the survival strategies that once kept us intact but no longer serve us.
As the wisdom goes, Pain × Resistance = Suffering.
PAIN × RESISTANCE = SUFFERING
Buddhist teaching,
simplified by Shinzen Young
This has particular weight for those who have been historically and systemically oppressed. Pain is a disproportionate burden of racial and ethnic minorities, yet these folks are more likely to be undertreated for their acute pain, cancer pain, and chronic pain compared with white folks.
The growing field of research on pain and resistance illuminates how pain gets compounded, and also offers the promise of therapeutic methods that minimize suffering through leaning into emotions, seeking a compassionate audience, and developing acceptance.
How can therapy help us better approach our pain?
As a psychologist who works with queer and trans folks, multiracial adults, and third culture kids, I know that coping with pain isn’t easy to do alone. Therapy offers frameworks and strategies for moving beyond resistance and reducing suffering. Here are three that inform how we work at Panorama Therapy.
1. Suffering is optional when emotions are a guide: Emotion-Focused Therapy (EFT)
One of the main barriers to treating emotional pain is the resistance that often accompanies it. People who are prone to anxiety may have learned habits of emotional resistance early in life, making it harder later to learn proactive coping strategies. In counseling informed by Emotion-Focused Therapy (EFT), clients are guided to use their emotions as valuable sources of information rather than terrible states to endure or suppress.
EFT promotes a therapy space where vulnerability is met with warmth. It’s grounded in relentless empathy, which helps clients become aware of their pain while loosening unhelpful beliefs about the self and others.
EFT treatment moves through three major phases: building emotional awareness while getting to know your therapist; exploring unhelpful emotional responses that may be sustaining suffering; and a transformation phase, where you explore underlying or alternative emotions and reflect on root feelings to create new meaning.
Research shows that EFT has solid applications for folks receiving gender-affirming care. In one case example, a young transfeminine client was guided in EFT to access her emotions, move out of hopelessness, and deepen her self-compassion while setting firmer limits in relationships that weren’t holding her well.
The goal of EFT is to help people reclaim, rather than become desensitized to, painful feelings and memories. We always have the opportunity to build or reclaim new beliefs about ourselves, our relationships, and the world. Emotion-Focused Therapy offers the chance to turn feeling your feelings into your superpower.
2. Suffering is optional when you accept your pain: Dialectical behavioral therapy (DBT)
The central goal of Dialectical Behavioral Therapy is to encourage acceptance while building ways to cope with pain, regulate emotions, and improve relationships. The premise of DBT is a “dialectic:” acceptance AND change. No way AND yes-huh.
Studies have found that the more accepting we are of ourselves, the more likely we are to be happy, because acceptance helps buffer against reacting to and amplifying negative mental experiences when something goes wrong. If you can accept your painful emotions without criticizing or judging them, you’re less likely to be stressed. Over time, you’re less unhappy, you feel healthier, and your quality of life improves.
DBT effectively targets structural and internalized stigma, including in studies with gender and sexual minorities. It does this by directly and explicitly addressing the impact of social and self-invalidation. Depending on your experiences of stigma, varying applications of DBT can help: mindfulness, emotion regulation, distress tolerance, and interpersonal skills. I’m like, win, win, win.
3. And it all feels better when you can be psychologically flexible: Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy combines mindfulness and self-acceptance to build psychological flexibility: the ability to engage with painful content in a way that’s adaptable. ACT starts from the premise that suffering is a natural and inevitable condition for all of us. Seems bleak, right?
On the contrary, ACT has the unique goal of helping clients build a full life alongside the existence of pain. The good and the bad always coexist.
ACT proposes that it’s the preoccupation with and struggle against our pain that hurts us the most, like irritating a scab, rather than the presence of pain alone. In a study of how anxiety worsens, researchers demonstrated the cost of fighting against it: avoiding meaningful activities, not pursuing career or relationship goals. Fighting isn’t the only option. In the same study, ACT therapists taught clients new ways of being with anxiety:
Simply noticing and experiencing anxiety for what it is. Letting go of efforts to avoid it. Learning to re-engage in personally valued activities, even in the presence of unwanted anxiety. See this short video on this ACT principle.
Focusing on your values and changing your relationship to pain, from resistance to acceptance, has the paradoxical effect of reducing the discomfort. If it sounds like magic, it kind of is.
Meta-analytic research has shown that symptom reduction is a by-product of re-engaging in life in meaningful ways and increasing acceptance of painful internal experiences. Embracing life and pain comes first; lessened pain comes later. Ask us for help.
Suffering is optional, especially with help and connection
Pain is inevitable, but suffering is optional. Leaning into your pain can feel like the hardest thing, and you don’t have to do it alone. These three frameworks inform how we show up as affirming therapists for LGBTQ+ and trans folks, BIPOC and multiracial adults, neurodivergent people, and high-achieving adults who are done white-knuckling through it.
To accept does not mean to give up. It means you stop spending energy resisting pain and generating additional suffering in the process. The strategies you build in therapy help soften that resistance and carry you through what you’re facing now.
Before you go, here’s a brief acceptance exercise to keep close. Whenever you find yourself stuck in resistance, come back to it.
At Panorama Therapy, I work virtually with adults across the US who are ready to stop fighting their pain and start moving through it. Reach out if this is the work you’re looking for.
Go ahead, talk back.
What resonated with you here? What do you want to know more about? What’s a goal you might set for yourself around the pain you’re facing? Share your thoughts in the comments below.
Miranda Nadeau, Ph.D.(https://www.panorama-therapy.com/)