Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

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Abstract

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.

Section snippets

Participants

Participants were patients who attended treatment at a tertiary care pain rehabilitation unit in southwest England between September 2006 and June 2009. All participants reported persistent pain of 3 months duration or longer and significant levels of pain-related distress and disability, and agreed with the rehabilitative focus nature of treatment. Participants were excluded from treatment if they required further medical tests or procedures or had conditions sufficient to interfere with

Preliminary analysis

From the larger database including the current sample there were no demographic differences between those who attended the follow-up and those who did not attend, except that follow-up completers had slightly more years of education, t (280) = 1.78, p = .08. With regard to the primary process and outcome measures, follow-up attenders and non-attenders were not different on any of the process measure or on pain-related anxiety, medical visits, or pain, as measured at pre-treatment, all t < 1.4, all p > 

Discussion

This study assessed the outcomes and processes of change in an ACT-based, interdisciplinary, group treatment for chronic pain. Immediately following treatment and at 3-month follow-up, participants reported significantly lower levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits and pain intensity in comparison to the start of treatment. Almost all effect sizes relative to treatment onset remained at a medium or large level at the 3-month follow-up,

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