Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash

Abstract

Cognitive behavior therapy (CBT) has made important contributions to chronic pain management, but the process by which it is effective is not clear. Recently, strong arguments have been raised concerning the need for theory driven research to e.g. identify mechanisms of change in CBT and enhance the effectiveness of this type of treatment. However, the number of studies addressing these issues is still relatively scarce. Furthermore, the arrival of varieties of CBT with seemingly different process targets increases the need for such information. The present study explored the processes of change in a previously reported successful randomized controlled trial evaluating the effectiveness of an exposure-based form of behavioral and cognitive therapy, Acceptance and Commitment Therapy (ACT), on improvement in pain-related disability and life satisfaction for patients suffering from whiplash-associated disorder (WAD). Several process variables relevant to theories underlying traditional CBT were included: pain, distress, kinesiophobia, self-efficacy, and the process primarily targeted by ACT: psychological inflexibility. Mediation analyses were performed using a non-parametric cross-product of the coefficients approach. Results illustrated that pain intensity, anxiety, depression, kinesiophobia, and self-efficacy did not have significant mediating effects on the dependent variables. In contrast, significant indirect effects were seen for psychological inflexibility on pain-related disability (pre- to post-change scores) and life satisfaction (pre- to post; pre- to 4-month follow-up change scores). Although tentative, these results support the mediating role of psychological inflexibility in ACT-oriented interventions aimed at improving functioning and life satisfaction in people with chronic pain.

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…38,71 Research into treatment process often reveals surprising findings. For example, numerous studies that show that very good treatment outcomes can be achieved for people with chronic pain without pain reduction 90,93,95 or without a substantial correlation between change in pain and improvement in other outcome domains. 50,52 If pain cannot be effectively reduced, the content of thoughts and beliefs about pain appears to be appropriate and necessary targets in treatment.…”

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

“…Unauthorized reproduction of the article is prohibited. from a growing list of studies connecting processes from the theoretically-based and potentially integrative psychological flexibility model to the relationship between PTSD and chronic pain [6,33,34] and with studies connecting these processes, or other processes similar to those described in the this model, to the severity of pain and pain-related impairment, and separately to the severity of PTSD [24][25][26][27][28][29][30][31].…”

A félelem és elkerülési hiedelmek krónikus fájdalomban. A FABQ kérdőív magyar változatának fordítása és validálása

“…Ezek közül a betegoktatás, illetve a pszichoterápia alkalmazása elsődleges. A fájda-lommal kapcsolatos diszfunkcionális gondolatok módo-sítása során azáltal, hogy a beteg másképp viselkedik, másképp mozog és aktívabban él, a fájdalommátrix-mű-ködés is módosul [5]. Több kutatás regressziós analízis-sel végzett értékelése során bebizonyosodott, hogy a fájdalmat jelentős mértékben befolyásolja a depresszió és a betegséggel kapcsolatos viselkedés és hiedelmek [6,7].…”