Mechanisms of change in acceptance and commitment therapy for primary headaches

Abstract

Background: Despite the demonstrated effectiveness of behavioural headache interventions, it is not yet known which intervention processes account for treatment responses. Acceptance and commitment therapy (ACT), an emerging behavioural intervention for headaches, proposes psychological flexibility (PF) processes as the mechanisms via which intervention change occurs. This is the first study examining these processes of change variables on headache-related disability and quality of life (treatment outcome). Methods: Data originated from a Randomized Clinical Trial evaluating the efficacy of ACT for primary headaches. Ninety-four individuals with primary headaches (M = 43 y; 84% females; M headache frequency/month = 9.30) were randomized to either an ACT-based or a Wait-list control group (N = 47 in each). Participants completed questionnaires related to their headache experiences and PF processes at pre-(T1), post-treatment (T2), and 3-month follow-up (T3). Results: Following a bootstrapped cross product of coefficients approach, results demonstrated mediating effects of headache acceptance, cognitive defusion, avoidance of headache, and mindfulness in the ACT group compared to control on parameters of headache-related disability and quality of life at post and 3-month follow-ups. Conclusions: These findings demonstrate that changes in certain PF processes lower disability and improve quality of life in headache sufferers, supporting that ACT works via its proposed mechanisms of change. Interventions for headache management may be optimized if they target increases in headache acceptance, defusion from thoughts, and mindfulness. Significance: Psychological flexibility (PF) guides the ACT approach, an emerging behavioral headache intervention that focuses on optimizing head pain adjustment via flexible responses to pain. It targets at increasing daily functioning rather than preventing or controlling headache episodes. Pain acceptance, cognitive defusion, and mindfulness act as processes of functional change in ACT, lowering disability and increasing daily functioning and quality of life. These components can upgrade the established effectiveness of behavioral headache interventions with personalized, modularized therapeutic targets that can help headache sufferers re-establish optimal daily functioning even in fluctuating and persistent headache episodes. Trial registration: clinical trials.gov registry (NCT02734992).

A meta‐analytic review of acceptance‐based interventions for migraine

“…Indeed, quantitative analyses consistently demonstrate that improvements in pain‐related disability are attributable to living a values‐consistent lifestyle 43,44 and increased acceptance of negative internal states 43,45 . Mediation analyses from an RCT examining the efficacy of ACT among a mixed migraine sample 46 demonstrated that increased headache acceptance and decreased avoidance of headache explained the relationship between treatment efficacy and improved disability. This suggests core processes of psychological flexibility (i.e., acceptance, defusion, and mindfulness) are mechanisms of change among acceptance‐based interventions for migraine.…”

An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial

“…Larger studies on Vet Flexiquit with longer-term outcomes are necessary to better understand the efficacy of the intervention, either alone or in combination with peer or professional support. Some ACT interventions have demonstrated greater effects at long-term follow-up, possibly because additional time and practice may be needed for consolidation to occur when presented with new, counterintuitive information [ 26 , 49 ]. This study was also conducted during the COVID-19 pandemic, which represents a unique context in which to study the effects of tobacco treatment.…”

A randomized trial examining the effect of yoga on dietary lapses and lapse triggers following behavioral weight loss treatment

“…This is consistent with its historical predecessors, in a fashion more recently adopted by psychotherapeutic interventions such as Acceptance and Commitment Therapy (ACT). Yoga has thus been linked to increased mindfulness and compassion 11,20,28 —like ACT 32,33 —with both in turn having implicated mechanisms on intervention outcome 33–35 . Increased mindfulness could increase one's awareness of craving and satiety mechanisms, while increased self‐compassion toward oneself during negative affect could synergistically help one to stop eating, independent of why eating originally began.…”