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It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.

International academic rankings that compare world universities have proliferated recently. In accordance with latter conceptual and methodological advances in academic rankings approaches, five selection criteria are defined and four international university rankings are selected. A comparative analysis of the four rankings is presented taking into account both the indicators frequency and its weights. Results show that, although some indicators differ considerably across selected rankings and even many indicators are unique, indicators referred to research and scientific productivity from university academic staff have a prominent role across all approaches. The implications of obtained data for main rankings consumers are discussed.

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This study tests the effectiveness of an acceptance/defusion intervention in reducing experimentally induced generalized avoidance. After the formation of two 6-member equivalence classes, 23 participants underwent differential conditioning with two elements from each class: A1 and B1 were paired with mild electric shock, whereas A2 and B2 were paired with earning points. Participants learned to produce avoidance and approach responses to these respective stimuli and subsequently showed transfer of functions to non-directly conditioned equivalent stimuli from Class 1 (i.e., D1 and F1 evoked avoidance responses) and Class 2 (i.e., D2 and F2 evoked approach responses). Participants were then randomly assigned to either a motivational protocol (MOT) in which approaching previously avoided stimuli was given a general value, or to a defusion protocol (DEF) in which defusion (a component of Acceptance and Commitment Therapy) was trained while approaching previously avoided stimuli was connected to personally meaningful examples. A post-hoc control group (CMOT) was conducted with 16 participants to control for differences in protocol length between the former two groups. All participants in the DEF group showed a complete suppression of avoidance responding in the presence of Class 1 stimuli (A1-F1 and additional novel stimuli in relation to them), as compared to 40% of participants in the MOT condition and 20% in the CMOT condition. The acceptance/defusion protocol eliminated experimentally induced avoidance responding even for stimuli that elicited autonomic fear responses.

People with chronic pain may benefit from the capacity to contact their thoughts and feelings from a perspective as a "separate observer," to see them as transient, and to experience them as cognitively "defused."

There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.

This study compares the effect of an acceptance-based protocol (ACT) and a cognitive control-based (CONT) protocol on three measures of pain coping: tolerance, self-report, and believability. Specific methodological controls were employed to further isolate the role of the value of participating in a pain task, compared to previous investigations on the alteration of the function of aversive stimulation. Twenty participants were randomly assigned to one of the conditions (ACT vs. CONT), and a pre-post design was used. In the ACT condition, the protocol established a relation of coordination between the pain-related thoughts and the actions in the valued direction. In the CONT condition, the protocol established a relation of opposition between the same aspects. Results show an increase in pain tolerance and a reduction of self-reported pain at posttest for both conditions. However, ACT participants showed significantly lower believability of pain than did CONT participants. Conceptual and clinical implications are discussed.