A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy

Hann, Katie E. J.; McCracken, Lance M.

doi:10.1016/j.jcbs.2014.10.001

Cited by 230 publications

(232 citation statements)

References 50 publications

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“…A recent systematic review including 10 randomized controlled trials (N=623) in adults with chronic pain, investigating 15 outcome domains, showed that ACT seems to be efficacious, particularly with regard to outcomes of physical and emotional functioning, including anxiety and depression (Hann and McCracken, 2014).…”

Section: The Psychological Flexibility Modelmentioning

confidence: 99%

Towards a science and practice of resilience in the face of pain

Goubert

Trompetter

2017

European Journal of Pain

129

135

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. Electronic mail may be sent to Liesbet.Goubert@UGent.be. Conflicts of interestThe authors declare to have no conflicts of interest. 2 Statement of "significance":What does this review add? The resilience approach put forward in this review spotlights sustainability of positive outcomes (e.g. engagement in meaningful activities) in the presence of pain as an outcome to pursue beyond recovery of negative outcomes. We illuminate the evidence-base and practical application of promising resilience mechanisms (positive emotions, psychological flexibility, needs satisfaction).3 Abstract Background and Objective: The primary objective of this paper is to discuss how a resilience approach to (chronic) pain may advance our current understanding of (mal)adaptation to pain. Different resilience perspectives are described, and future challenges for research, prevention and treatment of (chronic) pain are discussed. Databases and Data Treatment:Literature searches were performed in Web of Science and PubMed to identify relevant literature on risk and resilience in the context of pain. Results:Resilience can be best defined as the ability to restore and sustain living a fulfilling life in the presence of pain. The Psychological Flexibility Model, the Broaden-and-Build Theory, and Self-Determination Theory are described as theories that may provide insight into resilience within the context of (chronic) pain. Conclusions:We describe how a resilience paradigm shifts the outcomes to pursue in pain research and intervention and argue the need for including positive outcomes in addition to negative outcomes. Psychological flexibility, positive affect and basic psychological needs satisfaction are described as potentially important resilience mechanisms with the potential to target both sustainability and recovery from pain. A resilience approach to chronic pain may have important implications for the prevention and treatment of chronic pain problems, as it may give specific indications on how to empower patients to continue living a fulfilling life (in the presence of pain).4

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Section: The Psychological Flexibility Modelmentioning

confidence: 99%

Towards a science and practice of resilience in the face of pain

Goubert

Trompetter

2017

European Journal of Pain

129

135

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“…In a systematic review of RCTs of ACT for adults with chronic pain, ten trials were identified, and small to large effect sizes were found on various measures of physical and psychological functioning favoring ACT. 7 At the same time the effectiveness of ACT for chronic pain can be improved. One way to do this is to examine the treatment processes underlying ACT, tease out the active ingredients, and enhance these treatment processes in treatment development and M A N U S C R I P T…”

Section: Introductionmentioning

confidence: 99%

Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning

Norton

McCracken

2017

The Journal of Pain

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Acceptance and Commitment Therapy (ACT) is based on the Psychological Flexibility (PF) model, which includes a therapeutic process, referred to as "self-as-context" (SAC). This study investigates whether ACT is associated with an effect on SAC and whether this effect is linked to treatment outcomes in people with chronic pain. 412 adults referred to a pain management center participated in the study. Participants completed measures of treatment processes (SAC, pain acceptance) and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon completion of treatment, and at nine-month follow-up.Paired sample t-tests and analyses of meaningful change were conducted to examine changes in processes and outcomes. Regression analyses with residualized change scores from process and outcome variables, and bivariate growth curve modeling were used to examine the association between change in SAC and change in outcomes. Participants significantly improved on all process and outcome variables at post-treatment (d=.38 to .98) and nine-month followup (d=.24 to .75). 42.0% to 67.5% participants showed meaningful improvements on each outcome at post-treatment and follow-up. Change in SAC was associated with change in outcomes (β=-.21 to -.31; r=-.16 to -.46). Results support a role for change in SAC in treatment as the PF model suggested. PerspectiveThis study shows the delivery of a treatment for chronic pain based on Acceptance and Commitment Therapy was associated with improved self-as-context (SAC) and improved M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTChange in Contextual Self 3 functioning for people with chronic pain, and increases in SAC were associated with improved functioning. These results can inform future treatment development.

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“…Acceptance Commitment Therapy (ACT) is a form of psychological treatment with clear research support for the treatment of chronic pain [22]. ACT has a general aim (across all problem areas or disorders) to increase psychological flexibility, or the ability to contact the present moment more fully as a conscious human being and to change or persist in behavior when doing so serves successful healthy functioning [23].…”

Section: Introductionmentioning

confidence: 99%

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

Åkerblom

Perrin²,

Fischer

et al. 2018

The Clinical Journal of Pain

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Objectives: The symptoms of Posttraumatic Stress Disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of psychological flexibility mediate the relationship between these two conditions.Methods: Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least one traumatic experience.Results: People seeking treatment for chronic pain reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the psychological flexibility model.

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A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: Outcome domains, design quality, and efficacy

Cited by 230 publications

References 50 publications

Towards a science and practice of resilience in the face of pain

Towards a science and practice of resilience in the face of pain

Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning

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

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