The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain

Åkerblom, Sophia; Perrin, Sean; Fischer, Marcelo Rivano; McCracken, Lance M.

doi:10.1016/j.jpain.2015.03.007

Cited by 105 publications

(102 citation statements)

References 51 publications

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“…Possibly, people with these combined problems would benefit from treatment interventions targeting acceptance and other processes from the psychological flexibility model. This suggestion is consistent with results from earlier studies where pain-related acceptance [24,[74][75][76] and other processes from the psychological flexibility model [25-27, 36, 76] appear to play a role in relation to multiple treatment outcomes in the chronic pain field and particularly in pain populations with relatively high clinical complexity.…”

Section: Discussionsupporting

confidence: 91%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Åkerblom

Perrin²,

Fischer

et al. 2018

The Clinical Journal of Pain

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Objectives: The symptoms of Posttraumatic Stress Disorder (PTSD) and chronic pain are thought to interact to increase the severity and impact of both conditions, but the mechanisms by which they interact remain unclear. This study examines the relationship between PTSD and chronic pain and whether indices of psychological flexibility mediate the relationship between these two conditions.Methods: Standardized self-report measures of PTSD, pain severity, pain interference, depression, and psychological flexibility (pain-related acceptance, committed action, cognitive fusion, and values-based action) were obtained from 315 people seeking treatment for chronic pain who also reported at least one traumatic experience.Results: People seeking treatment for chronic pain reporting symptoms consistent with a current diagnosis of PTSD had significantly higher levels of pain severity, pain interference, depression, and cognitive fusion and lower levels of pain-related acceptance and committed action than those reporting symptoms below diagnostic threshold for PTSD. Pain-related acceptance, committed action, cognitive fusion and depression mediated the relationship between PTSD and pain severity/interference, with pain-related acceptance being the strongest mediator from the psychological flexibility model.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Åkerblom

Perrin²,

Fischer

et al. 2018

The Clinical Journal of Pain

Self Cite

View full text Add to dashboard Cite

show abstract

“…38,55 Acceptance has also been shown to buffer the effect of pain intensity on daily function 25 and to buffer the effects of catastrophic thinking on anxiety, depression, and disability. 53 Intervention studies show that treatments such as Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, Interdisciplinary Pain treatment, and Mindfulness-Based Stress Reduction increase pain acceptance, 1,6,11,19,35,52,54 and that these increases are associated with better treatment outcomes. 6,40,52 Maintenance of these improvements in acceptance has also been shown to be associated with maintenance of treatment-related gains in mood and function.…”

Section: Introductionmentioning

confidence: 99%

The role of pain acceptance on function in individuals with disabilities

Jensen

Smith

Alschuler

et al. 2016

Pain

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Having higher levels of pain acceptance has been shown to be associated positively with quality of life in patients with chronic pain, but its role in adjustment to chronic pain among individuals with physical disabilities living in the community is not known. Moreover, issues related to item overlap between measures of pain acceptance and measures of patient function have limited the conclusions that can be drawn from previous research in this area. To better understand the role that pain acceptance plays in patient function, we administered measures of pain acceptance, pain intensity, depressive symptoms, and function to 392 individuals with physical disabilities, and the pain, symptom, and function measures were readministered 3.5 years later. Analyses evaluated the main and interaction effects of initial pain acceptance on subsequent changes in pain and function. Having higher levels of pain acceptance-in particular as reflected by a willingness to engage in activities despite pain-resulted in less increase in pain intensity and more improvements in pain interference, physical function, depressive symptoms, and sleep quality. The findings indicate that previous research supporting the importance of pain acceptance to function in patients from health care settings extends to individuals with chronic pain living in the community. Moreover, they indicate that pain acceptance may have long-lasting (up to 3.5 years) beneficial effects on subsequent pain and function and on the association between change in pain and depression. Research to examine the potential benefits of community-based treatments that increase pain acceptance is warranted.

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“…In a larger study, including an analysis of mediation in an internet-based ACT treatment compared to an expressive writing condition or waiting list, once again PF appeared as the larger mediator of pain, pain interference, and psychological distress outcomes in comparison this time to catastrophizing, and as a more direct mediator of pain interference (44). We have shown that one component of psychological flexibility, acceptance, appears to act in a mediating role in pain management treatment designed around conventional methods of CBT (45). In this study, employing structural equation modelling, compared with changes in perceptions of life control, affective distress, or social support, change in acceptance was more highly related to improvements in pain interference and depression outcomes.…”

Section: Process and Mechanism In Actmentioning

confidence: 65%

Psychological approaches to chronic pain management: where are we coming from and where might we go?

McCracken¹

2017

Rev. Soc. Esp. Dolor.

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The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain

Cited by 105 publications

References 51 publications

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

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

The role of pain acceptance on function in individuals with disabilities

Psychological approaches to chronic pain management: where are we coming from and where might we go?

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