Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics. These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment. Further, improvements appear to be mediated by changes in the processes specified within the theoretical model.
Outcomes of an abbreviated interdisciplinary treatment for chronic pain based on a particular theoretical model are presented. Assessment took place at treatment onset and conclusion, and at a 3-month follow-up when 78 patients At the 3-month follow-up, Changes in measures of psychological flexibility significantly mediated changes in disability, depression, pain-related anxiety, number of medical visits, and the number of classes of prescribed analgesics.
These results add to the growing body of evidence supporting interdisciplinary acceptance and commitment therapy for chronic pain, particularly with regard to the clinical significance of an abbreviated course of treatment. The first pair, technically termed defusion and acceptance, relates to the decreased efforts for pain control assessed here. The second pair, values clarity and committed action, was reflected in the engagement in valued activities items.
The third pair, present-focused awareness and self-as-context, were not assessed in the present study. Although the treatment package included content specific to these aspects of pain responding, it was not assessed as part of the weekly diary data.
In hindsight, this exclusion represents a limitation as it is possible that within-treatment change in these responses may also be relevant in the prediction of treatment success or failure. This study also has other limitations. Perhaps foremost among these from a methodological standpoint are the lack of a comparison condition and absence of an assessment of steady state responding prior to the intervention. In addition, while the emphasis on data evaluation on a case-by-case basis allows perhaps a more fine-grained analysis of patterns of change over treatment, it is not clear if the relatively small sample size included in this study will generalize to the wider population.
One final limitation is apparent from a conceptual level of analysis. Although this study attempted to focus more fully on the measurement of altered stimulus functions of pain in those with chronic pain, it was not a true test. Rather, this was an observational study where a pattern of responding, theorized to be a proxy indicator of altered stimulus function, was specified and then evaluated relative to patient data.
Taking these caveats into consideration, our findings are the first to attempt to examine the theoretical underpinnings of ACT for chronic pain in this way. Supplementary data associated with this article can be found in the online version at http: Conflict of interest statement. Dr Vowles was employed by the rehabilitation hospital where the data presented in this manuscript was collected during the time of its collection. Fink and Cohen have no conflicts of interest to disclose. National Center for Biotechnology Information , U.
J Contextual Behav Sci. Author manuscript; available in PMC Nov 4. Fink , a and Lindsey L.
Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at J Contextual Behav Sci. See other articles in PMC that cite the published article. Abstract In chronic pain treatment, a primary goal is reduced disability.
Acceptance and Commitment Therapy, Chronic pain, Change processes. Participants Data were provided by 21 patients Within-treatment diary At the mid-point of each of the four weeks of treatment, each patient completed a four item diary. Table 1 Weekly diary questions. Rate how bad your pain was overall in the past week. Rate how much effort you put in to making pain or upsetting thoughts, feelings, or memories go away this past week.
Rate how willing were you were to have pain and distress in the past week. Rate how effective you were this past week in making progress in the areas of your life that that matter to you. Open in a separate window. Pain control Two items were constructed to assess the degree to which patients were engaging in the struggle for pain control.
Engagement in valued activity A method similar to that used in the development of the items assessing pain control effort was used for the items concerning engagement in valued activity. Treatment program The treatment program was provided within a rehabilitation hospital located in the Midlands of the United Kingdom. Analytic approach Overall, analyses sought to determine how patterns of change in the weekly diary data related to the success or failure of treatment.
There was a problem providing the content you requested
These two steps resulted in patients being assigned to one of four possible categories: Treatment success with change in ACT processes: Reliable reduction in disability accompanied by decreased pain control efforts and increased engagement in valued activity. Treatment failure without change in ACT processes: Treatment success without change in ACT processes: Treatment failure with change in ACT processes: Reliable reduction in disability accompanied by decreased pain control efforts and increased change in the diary data.
Results The proportion of patients who evidenced reliable change in disability on the RCI was consistent with previous work in this area e. Discussion From the perspective of modern behavior analysis, a primary purpose of the treatment of chronic pain is to alter responses to pain, such that responses contribute to decreased disability or at the very least do not contribute to increased disability. Supplementary Material Supplemental Material Click here to view.
Supplementary material Supplementary data associated with this article can be found in the online version at http: Footnotes Conflict of interest statement Dr Vowles was employed by the rehabilitation hospital where the data presented in this manuscript was collected during the time of its collection. Acceptance and Commitment Therapy for chronic pain. Website on research-supported psychological treatments. The course of non-malignant chronic pain: A year follow-up of a cohort from the general population.
European Journal of Pain. The sickness impact profile: Development and final revision of a health status measure.
- Hands-On Project Office: Guaranteeing ROI and On-Time Delivery!
- Housing Policy and Economic Power: The Political Economy of Owner Occupation.
- There was a problem providing the content you requested.
- Star Trek: Deep Space Nine: Fearful Symmetry?
Survey of chronic pain in Europe: European Jounal of Pain. Practical methods for pain intensity measurements. Core outcome measures for chronic pain clinical trials: The course of chronic pain in the community: Results of a 4-year follow-up study. The linical importance of changes in the 0 to 10 numeric rating scale for worst, least, and average pain intensity: Analyses of data from clinical trials of duloxetine in pain disorders.
Clinical importance of changes in chronic pain intensity measured on an point numerical pain rating scale. Behavioral methods for chronic pain and illness. Gaskin DJ, Richard P. The economic costs of pain in the United States. Acceptance and commitment therapy: The process and practice of mindful change. Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology. Self-report scales and procedures for assessing pain in adults.
Turk DC, Melzack R, editors. Handbook of pain assessment.
Contextual cognitive-behavioral therapy for chronic pain. Acceptance and Commitment Therapy and mindfulness for chronic pain: Model, process, and progress.