A Comprehensive Examination of Changes in Psychological Flexibility Following Acceptance and Commitment Therapy for Chronic Pain

Abstract

Acceptance and commitment therapy (ACT) for chronic pain aims to improve patient functioning by fostering greater psychological flexibility. While promising, ACT treatment process research in the context of chronic pain so far has only focused on a few of the processes of psychological flexibility. Therefore, this study aimed to more comprehensively examine changes in processes of psychological flexibility following an ACT-based treatment for chronic pain, and to examine change in these processes in relation to improvements in patient functioning. Individuals with chronic pain attending an interdisciplinary ACT-based rehabilitation program completed measures of pain, functioning, depression, pain acceptance, cognitive fusion, decentering, and committed action at pre- and post-treatment and during a nine-month follow-up. Significant improvements were observed from pre- to post-treatment and pre-treatment to follow-up on each of the treatment outcome and process variables. Regression analyses indicated that change in psychological flexibility processes cumulatively explained 6–27 % of the variance in changes in functioning and depression over both assessment periods, even after controlling for changes in pain intensity. Further research is needed to maximize the effectiveness of ACT for chronic pain, and to determine whether larger improvements in the processes of psychological flexibility under study will produce better patient outcomes, as predicted by the psychological flexibility model.

Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom

“…Differences in measures between studies may account for these discrepancies. In a nonrandomized study of patients receiving intensive interdisciplinary ACT for chronic pain, the pre-to Average pain 3 months 6.3 (5.5, 7.1) 5.9 (5.0, 6.8) 0.19 6.5 (5.9, 7.2) 6.2 (5.5, 6.9) 0.16 9 months 6.1 (5.3, 7.0) 5.9 (5.1, 6.8) 0.10 6.4 (5.7, 7.0) 6.2 (5.5, 6.9) 0.11 Average distress 3 months 5.5 (4.7, 6.4) 5.4 (4.6, 6.1) 0.05 5.7 (5.0, 6.5) 5.6 (4.9, 6.2) 0.06 9 months 5.5 (4.7, 6.4) 5.5 (4.8, 6.3) 0.01 5.6 (4.9, 6.3) 5.6 (5.0, 6.3) 0.01 BPI pain interference 3 months 5.7 (5.0, 6.3) 6.1 (5.4, 6.7) 0.24 5.9 (5.4, 6.5) 6.2 (5.7, 6.7) 0.20 9 months 5.4 (4.8, 6.1) 6.3 (5.7, 7.0) 0.54 5.8 (5.3, 6.4) 6.4 (5.9, 6.9) 0. post-treatment effects for acceptance, decentring, and committed action were comparable to the between-groups effects observed on these variables in the current study (Scott et al, 2016). The outcome estimates reported here may be used to perform sample size calculations for a larger trial.…”

“…Differences in measures between studies may account for these discrepancies. In a nonrandomized study of patients receiving intensive interdisciplinary ACT for chronic pain, the pre‐ to post‐treatment effects for acceptance, decentring, and committed action were comparable to the between‐groups effects observed on these variables in the current study (Scott et al., ).…”

The Relationship Between Posttraumatic Stress Disorder and Chronic Pain in People Seeking Treatment for Chronic Pain

“…The present results suggest that cognitive fusion is an important mediator of the relationship between PTSD and chronic pain. The results are in line with previous studies suggesting that cognitive fusion and similar processes, such as decentering and cognitive inflexibility, are related to functioning in chronic pain and separately to the severity of PTSD [27,28,30,68], and with models of PTSD which specify that the way a person processes and interprets an traumatic event plays an important role in the development and maintenance of symptoms and in response to treatment for PTSD [20,69,70]. Furthermore, the results are in accordance with a recent study where catastrophizing and fear-avoidance beliefs, other types of dysfunctional cognitive processes, have been identified as mediating factors of the relationship between PTSD and pain intensity [15].…”

“…Unauthorized reproduction of the article is prohibited. from a growing list of studies connecting processes from the theoretically-based and potentially integrative psychological flexibility model to the relationship between PTSD and chronic pain [6,33,34] and with studies connecting these processes, or other processes similar to those described in the this model, to the severity of pain and pain-related impairment, and separately to the severity of PTSD [24][25][26][27][28][29][30][31].…”

Psychological approaches to chronic pain management: where are we coming from and where might we go?

“…There are now relatively comprehensive tests of the role of facets of PF in improvements observed in intensive psychologically-based treatment for chronic pain (31,32). In our study on this topic we showed that improvements in acceptance, cognitive fusion, and committed action play a role both at post treatment and at a nine-month follow-up, accounting for more than 20% of the variance in improvements, particularly in social and emotional functioning (31).…”