Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes?

Herbert, Matthew S.; Malaktaris, Anne; Dochat, Cara; Michael, Thomas; Wetherell, Julie Loebach; Afari, Niloofar

doi:10.1093/pm/pny272

Cited by 15 publications

(9 citation statements)

References 39 publications

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“…The finding that baseline severity of PTSD showed no relationship to pain outcomes in the treatment for chronic pain studied here is consistent with those from three previous studies, two involving chronic pain patients receiving multidisciplinary treatment from specialist pain services (Andersen et al, 2014;, and one involving combat veterans provided individual sessions of Acceptance and Commitment Therapy (ACT) for pain (Herbert et al, 2019). While not a primary aim of the study, baseline levels of depression and anxiety also did not predict pain intensity or interference at follow-up.…”

Section: Discussionsupporting

confidence: 90%

“…Higher levels of emotional distress, depression and anxiety at baseline have been associated with poorer outcomes in cognitive behavioural therapy (CBT) for chronic pain (Linton et al, ; Miles et al, ; Trompetter, Bohlmeijer, Lamers, & Schreurs, ; Turner, Holtzman, & Mancl, ), although a few studies have presented contradictory findings for depression (Davis & Zautra, ; Wetherell et al, ). We are only aware of three studies investigating whether baseline levels of PTSD predict pain outcomes in treatments for chronic pain, and these generally found no relationship (Andersen, Andersen, & Andersen, ; Herbert et al, ; Siqveland, Ruud, & Hauff, ).…”

Section: Introductionmentioning

confidence: 99%

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Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

Åkerblom

Perrin

Fischer

et al. 2020

European Journal of Pain

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Background The relevance of post‐traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre‐treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain. Methods Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group‐based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self‐report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12‐month follow‐up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia. Results Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12‐month follow‐up. There were no overall significant changes in PTSD symptom severity at post‐treatment or follow‐up, but 24.6% of the participants showed potential clinically significant change at follow‐up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment. Conclusions Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain‐focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment. Significance Pain‐focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain‐focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

Åkerblom

Perrin

Fischer

et al. 2020

European Journal of Pain

View full text Add to dashboard Cite

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“…The results are consistent with previous studies on the effectiveness of ACT on diseases associated with pain and focus on the acceptance component [ 38 – 42 ]; for example, in an investigation by Herbert et al, the effectiveness of ACT for chronic pain was studied. The results suggested that applying this treatment to patients with chronic pain could significantly lead to reduced pain severity and depression symptoms and increased chronic pain acceptance [ 43 ]. In another study, Scott et al investigated the efficacy of an Internet-based acceptance and commitment therapy.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial

et al. 2020

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Introduction: Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy. Methods: This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22. Results: The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P \ 0.01). Conclusion: The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy. Clinical Trail Registration: This study was registered at the Iranian Registry of Clinical Trials (IRCT20180205038630N4).

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“…After a review of the title and abstract and the removal of duplicates, 38 trials were identified as potentially eligible. Of them, 17 were further excluded for the following reasons: 11 were derived from the same study population as other included articles, [21][22][23][24][25][26][27][28][29][30][31][32] 3 compared two different forms of ACT, [33][34][35] and 2 reported no relevant outcomes. 36,37 Finally, 21 trials were included in the systematic review.…”

Section: Literature Search and Trial Selectionmentioning

confidence: 99%

The Efficacy of Acceptance and Commitment Therapy for Chronic Pain

Yuen

Yang

2023

The Clinical Journal of Pain

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Objectives: Previous meta-analyses of a small number of trials showed that acceptance and commitment therapy (ACT) might improve chronic pain. Many new trials have been published afterward, and the factors that may impact the efficacy of ACT are less understood. We, therefore, conducted an updated systematic review with meta-analysis to investigate the efficacy of ACT for people with chronic pain.Methods: Randomized controlled trials that investigated the efficacy of ACT in clinical or community setting for adult populations with chronic pain were included. The methodological quality of trials was assessed with the Cochrane Risk of Bias tool. Standardized mean differences between ACT and comparison groups in their effects on 6 outcomes (ie, pain acceptance, quality of life, painrelated functioning, pain intensity, anxiety, and depression) were pooled across studies.Results: Of the 3171 records identified, 21 trials with 1962 participants were included for analysis. The comparison groups included active treatment and waitlist control/usual care. The standardized mean difference was 0.67 (95% CI: 0.48, 0.87) for pain acceptance, 0.43 (95% CI: 0.29, 0.57) for quality of life, −0.88 (95% CI: −1.14, −0.63) for pain-related functioning, −0.45 (95% CI: −0.62, −0.27) for pain intensity, −0.35 (95% CI: −0.54, −0.15) for anxiety, and −0.74 (95% CI, −0.98, −0.50) for depression, all favoring ACT. Subgroup analyses showed that the effects were statistically significant across almost all subgroups and for some outcomes were greater in the trials conducted in people with a specific diagnosis (as compared with those conducted in people with general chronic pain), the trials with waitlist or usual care control, the trials with a greater number of sessions of ACT, and the trials with a longer ACT intervention.Discussion: ACT is effective and comparable to, if not better than, some other available active treatments for chronic pain.

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Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes?

Cited by 15 publications

References 39 publications

Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

Treatment outcomes in group‐based cognitive behavioural therapy for chronic pain: An examination of PTSD symptoms

The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial

The Efficacy of Acceptance and Commitment Therapy for Chronic Pain

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