Elsevier

Behavior Therapy

Volume 45, Issue 3, May 2014, Pages 390-401
Behavior Therapy

A Comprehensive Examination of the Model Underlying Acceptance and Commitment Therapy for Chronic Pain

https://doi.org/10.1016/j.beth.2013.12.009Get rights and content

Highlights

  • A comprehensive examination of the ACT model in chronic pain was performed.

  • Factor analysis indicated moderate relations among the ACT processes, consistent with the model.

  • SEM analyses indicated significant relations with key measures of patient functioning.

  • This is the first study to comprehensively examine the ACT model; fit with the data was acceptable.

Abstract

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.

Section snippets

Participants

All participants attended an assessment appointment within an interdisciplinary pain rehabilitation service located in Staffordshire, UK. In total, data were collected from 274 of the 292 (93.8%) consecutive patients seen by the service over a 30-month period. Participant age averaged 51.7 years (SD = 14.8). The majority were female (71.9%) and White European (96.1%). Most were married or cohabitating (63.8%; divorced, 13.1%; single, 14.1%; widowed, 8.6%). Participants averaged 12.8 years of formal

Data Integrity

The left-sided panels of Table 1, Table 2 provide descriptive information for all study measures. Internal consistency ratings (Cronbach’s α) for all measures were above 0.77 (range: 0.77 – 0.92). Evaluation of data distributions indicated that the majority of variables were normally distributed and non-kurtotic. The only exception was for the variable assessing highest pain in the past week, for which there was evidence of significant kurtosis (value = 2.43). Essentially, and as would be

Discussion

The primary purpose of the present analyses was to examine the ACT model, as represented by measures of the identified processes of psychological flexibility, in relation to specific aspects of functioning in individuals with chronic pain. A number of preliminary statistical analyses were performed to help inform a structure for the final model, the fit of which was ultimately examined via SEM. Fit of this final model to the data was acceptable, as the ACT processes both correlated with one

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

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