Mediators of change in Acceptance and Commitment Therapy for pediatric chronic pain

Abstract

Even though psychological interventions are well established in the treatment of pediatric chronic pain, there is a clear need for further development, especially with severely disabled patients. However, optimizing effectiveness in psychological treatments for pain requires clarification of the mechanisms of action. Studies addressing change processes are scarce, however, particularly in relation to pediatric chronic pain. Acceptance and Commitment Therapy (ACT), as an extension of traditional cognitive behavior therapy, is essentially aimed at improving functioning by increasing the ability to act effectively in the presence of pain and distress, that is, psychological flexibility. ACT has shown promising results for both adult and pediatric chronic pain. In the present study, the mediators of change in an ACT-oriented treatment for pediatric chronic pain were examined using a bootstrapped cross product of coefficients approach. Pain interference and depression were used as outcome variables. Six different variables relevant to theories underlying ACT and cognitive behavior therapy were included in the analyses as possible mediators of change: pain impairment beliefs, pain reactivity, self-efficacy, kinesiophobia, catastrophizing, and pain intensity. Results illustrated that pain impairment beliefs and pain reactivity were the only variables that significantly mediated the differential effects of treatment on outcomes at follow-up. Also, these 2 mediators were shown to independently predict effects in outcome variables at follow-up while controlling for earlier effects in outcome, but only for the ACT condition. Although tentative, the pattern of results suggests that variables consistent with psychological flexibility mediate the effects of ACT-based interventions to improve functioning in patients with chronic debilitating pain.

Analyzing Change Processes Resulting from a Smartphone Maintenance Intervention Based on Acceptance and Commitment Therapy for Women with Chronic Widespread Pain

“…Possibly, this is due to differences in the methodology used to assess pain catastrophizing in these two studies (in the RCT study, the Pain Catastrophizing Scale (PCS) containing 13 items was used [42], but in the diaries the pain catastrophizing was assessed using three items from the PCS). However, the lack of a significant reduction in catastrophizing corresponds with a previous mediation analyses, in which data indicated that catastrophizing may not be a central change process in ACT-based treatment [18].…”

“…The objective of ACT is to improve functioning and quality of life by increasing psychological flexibility (PF) [17][18][19]. PF is defined as the ability to act in accordance with long-term goals and values also in the presence of interfering pain and distress.…”

“…Several studies based on ACT have demonstrated effects related to improvement of health outcomes in patients with chronic pain [18,[23][24][25][26], including internetbased interventions [27][28][29]. Studies have also investigated the impact of the different treatment components of ACT [26] as well as mediators of change, supporting the importance of both ACT consistent interventions and changes in processes related to PF [18]. However, to our knowledge, no study has yet investigated the change process of the core components of ACT resulting from a smartphone intervention.…”

Examining Affective-Motivational Dynamics and Behavioral Implications Within The Interpersonal Context of Pain

“…For instance, while other-orientation is hypothesized as fundamental to effective caregiving, flexible attunement to self-vs. other-oriented goals is likewise critical (e.g., engaging in appropriate self-care while caring for a loved one with chronic illness [see 61]). The notion of emotion regulatory flexibility is echoed in broader theoretical and clinical approaches which advocate flexible behavioural response to pain -e.g., attention to both pain and non-pain goals in accordance with situational demands and one's personal values [93].…”

Acceptance and Commitment Therapy for children and adolescents with physical health concerns

“…Change processes in ACT for pediatric chronic pain has been examined also in a paper by Wicksell et al [17 ]. Mediators of change were analyzed using a bootstrapped cross product of coefficients approach, using pain interference and depression as outcome variables.…”