Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

Sanabria‐Mazo, Juan P.; Colomer-Carbonell, Ariadna; Borrás, Xavier; Castaño-Asins, Juan R.; McCracken, Lance M.; Montero-Marín, Jesús; Pérez‐Aranda, Adrián; Edo, Sílvia; Sanz, Antoni; Feliu‐Soler, Albert; Luciano, Juan V.

doi:10.1016/j.jpain.2023.04.008

Cited by 15 publications

(14 citation statements)

References 77 publications

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“…Among the included RCTs, 10 (15.2%) studies 42 , 43 , 47 , 49 , 54 , 57 , 67 , 81 , 88 , 98 had a low overall risk of bias, 37 (56.1%) 33 , 35 , 36 , 38 – 40 , 44 , 45 , 48 , 50 – 52 , 59 – 61 , 63 – 66 , 68 – 71 , 73 , 75 – 78 , 84 – 87 , 91 – 94 , 97 exhibited some concerns, and 19 (28.7%) 34 , 37 , 41 , 46 , 53 , 55 , 56 , 58 , 62 , 72 , 74 , 79 , 80 , 82 , 83 , 89 , 90 , 95 , 96 had a high overall risk of bias. The majority of RCTs presented low risks of missing outcome data (72.7%) and randomization (75.8%).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 50 RCTs 33 – 36 , 38 , 40 , 41 , 43 – 46 , 48 , 49 , 51 – 54 , 56 – 62 , 64 , 65 , 67 – 70 , 72 , 74 – 76 , 78 – 84 , 88 – 91 , 93 – 95 , 97 , 98 involving 3733 participants and 7 categories of interventions were included in the NMA for depression with eight loops (Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…The biopsychosocial approach includes a wide variety of psychotherapies, such as CBT, psychological interventions, motivational interview, and goal setting; it achieves effective outcomes for the treatment of chronic pain and depression 36 , 107 . This NMA revealed that a biopsychosocial approach was remarkably associated with reducing depression and anxiety in CLBP.…”

Section: Discussionmentioning

confidence: 99%

“…CBT emphasizes the use of active and structured techniques to educate patients on how to recognize, monitor, and alter maladaptive thoughts, emotions, and behavior 108 . To date, CBT has become one of the most widely applied psychosocial treatments for patients with CLBP, and different forms of CBT, including acceptance and commitment therapy and behavioral activation therapy, have been developed and appeared beneficial for CLBP with depressive symptoms 10 , 33 , 34 , 36 – 38 . Furthermore, exercise, especially aerobic exercise, can substantially improve mental health, as reported in this study.…”

Section: Discussionmentioning

confidence: 99%

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Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

Zhou,

Zhang,

Shang

et al. 2023

International Journal of Surgery

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Objectives: Chronic low back pain (CLBP) can seriously impair the quality of life of patients and has a remarkable comorbidity with psychological symptoms, which, in turn, can further exacerbate the symptoms of CLBP. Psychological treatments are critical and nonnegligent for the management of CLBP, and thus, should attract sufficient attention. However, current evidence does not suggest the superiority and effectiveness of non-pharmacological interventions in reducing psychological symptoms among patients with CLBP. Thus, this study was designed to compare the effectiveness of non-pharmacological interventions for depression, anxiety, and mental health among patients with CLBP and to recommend preferred strategies for attenuating psychological symptoms in clinical practice. Methods: In this systematic review and network meta-analysis (NMA), PubMed, Embase Database, Web of Science, and Cochrane Library were searched from database inception until March 2022. Randomized clinical trials (RCTs) that compare different non-pharmacological interventions for depression, anxiety, and mental health among patients with CLBP were eligible. The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was used. Four reviewers in pairs and divided into two groups independently performed literature selection, data extraction, and risk of bias and certainty of evidence assessments. This NMA was conducted with a random effects model under a frequentist framework. The major outcomes were depression, anxiety, and mental health presented as the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Results: A total of 66 RCTs that randomized 4806 patients with CLBP met the inclusion criteria. The quality of evidence was typically low or some risks of bias (47 out of 66 trials, 71.3%), and the precision of summary estimates for effectiveness varied substantially. In addition, 7 categories of interventions with 26 specific treatments were evaluated. For depression, mind body therapy (pooled SMD = −1.20, 95% CI: −1.63 to −0.78), biopsychosocial approach (pooled SMD = −0.41, 95% CI: −0.70 to −0.12), and physical therapy (pooled SMD = −0.26, 95% CI: −0.50 to −0.02) exhibited remarkable effectiveness in reducing depression compared with the control group. For managing anxiety, mind body therapy (pooled SMD = −1.35, 95% CI: −1.90 to −0.80), multicomponent intervention (pooled SMD = −0.47, 95% CI: −0.88 to −0.06), and biopsychosocial approach (pooled SMD = −0.46, 95% CI: −0.79 to −0.14) were substantially superior to the control group. For improving mental health, multicomponent intervention (pooled SMD = 0.77, 95% CI: 0.14 to 1.39), exercise (pooled SMD = 0.60, 95% CI: 0.08 to 1.11), and physical therapy (pooled SMD = 0.47, 95% CI: 0.02 to 0.92) demonstrated statistically substantial effectiveness compared with the control group. The rank probability indicated that mind body therapy achieved the highest effectiveness in reducing depression and anxiety among patients with CLBP. Besides, the combined results should be interpreted cautiously based on the results of analyses evaluating the inconsistency and certainty of the evidence. Conclusion: This systemic review and NMA suggested that non-pharmacological interventions show promise for reducing psychological symptoms among patients with CLBP. In particular, mind body therapy and biopsychosocial approach show considerable promise, and mind body therapy can be considered a priority choice in reducing depression and anxiety. These findings can aid clinicians in assessing the potential risks and benefits of available treatments for CLBP comorbidity with psychological symptoms and provide evidence for selecting interventions in clinical practice. More RCTs involving different interventions with rigorous methodology and adequate sample size should be conducted in future research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

Zhou,

Zhang,

Shang

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

show abstract

“… 52 Notably, internet-based ACT has consistently demonstrated effectiveness in reducing anxiety and depression, which are commonly comorbid conditions with chronic pain. 53 , 54 In this regard, Rickardsson and colleagues 55 – 57 have set a precedent, showing the efficacy of digital ACT in managing chronic pain through innovative microlearning formats. More recently, Catella and colleagues 20 conducted a pilot study comparing a digital self-guided ACT program for FM, referred to as FM-ACT (an early generation of STANZA®), with an active control group undergoing symptom tracking for FM (FM-ST).…”

Section: Discussionmentioning

confidence: 99%

Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia

Gallego,

Serrat,

Royuela-Colomer

et al. 2024

DIGITAL HEALTH

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Objective Fibromyalgia (FM) is a prevalent pain syndrome with significant healthcare and societal costs. The aim of the SMART-FM-SP study is to determine the effectiveness, cost-utility, and physiological effects in patients with FM of a digital intervention (STANZA®) currently marketed in the United States, which delivers smartphone-based, fully self-guided Acceptance and Commitment Therapy (Digital ACT) for treating FM-related symptoms. Methods A single-site, parallel-group, superiority, randomized controlled trial (RCT) will be conducted, including a total of 360 adults diagnosed with FM. Individuals will be randomly allocated (1:1:1) to treatment as usual (TAU), to TAU plus 12 weeks of treatment with Digital ACT, or to TAU plus 12 weeks of treatment with digital symptom tracking (i.e. FibroST). Participants will be assessed at baseline, post-treatment, and 6-month follow-up. An intention-to-treat analysis using linear mixed models will be computed to analyze the effects of Digital ACT on functional impairment (primary outcome), as measured by the Fibromyalgia Impact Questionnaire Revised at 6 months from the inception of the treatment. Secondary outcomes include impression of change, symptoms of distress, pain catastrophising, quality of life, cost-utility, and selected biomarkers (cortisol and cortisone, immune-inflammatory markers, and FKBP5 gene polymorphisms). The role of ACT-related processes of change will be tested with path analyses. Conclusions This study is the first RCT that tests Digital ACT for Spanish patients with FM. Results will be important not only for patients and clinicians, but also for policy makers by examining the cost-utility of the app in a public healthcare context.

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A third Generation therapies Approach in Long COVID patients: efficacy of an intervention program with Spanish adults

González-Moreno,

Pozuelo,

Manos

et al. 2024

Curr Psychol

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Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study)

Cited by 15 publications

References 77 publications

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

Comparative effectiveness of nonpharmacological interventions in reducing psychological symptoms among patients with chronic low back pain

Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia

A third Generation therapies Approach in Long COVID patients: efficacy of an intervention program with Spanish adults

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