Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 1/2016

01-02-2016

Changes in Acceptance in a Low-Intensity, Group-Based Acceptance and Commitment Therapy (ACT) Chronic Pain Intervention

Authors: John A. Baranoff, Stephanie J. Hanrahan, Anne L. J. Burke, Jason P. Connor

Published in: International Journal of Behavioral Medicine | Issue 1/2016

Login to get access

Abstract

Background

Acceptance and commitment therapy has shown to be effective in chronic pain rehabilitation, and acceptance has been shown to be a key process of change. The influence of treatment dose on acceptance is not clear, and in particular, the effectiveness of a non-intensive treatment (<20 h) in a tertiary pain clinic is required.

Purpose

The purpose of the study was to assess the effectiveness of a low-intensity, acceptance and commitment therapy (ACT) group program for chronic pain. The study sought to compare, at both groups and individual patient levels, changes in acceptance with changes observed in previous ACT studies.

Methods

Seventy-one individuals with chronic pain commenced a 9-week ACT-based group program at an outpatient chronic pain service. In addition to acceptance, outcomes included the following: pain catastrophizing, depression, anxiety, quality of life, and pain-related anxiety. To compare the current findings with previous research, effect sizes from seven studies were aggregated using the random-effects model to calculate benchmarks. Reliable change indices (RCIs) were applied to assess change on an individual patient-level.

Results

The ACT intervention achieved a statistically significant increase in acceptance and medium effect size (d = 0.54) at a group level. Change in acceptance was of a similar magnitude to that found in previous ACT studies that examined interventions with similar treatment hours (<20 h). Results across other outcome measures demonstrated small to medium effect sizes (d = 0.01 to 0.48, mean = 0.26). Reliable improvement in acceptance occurred in approximately one-third (37.2, 90 % CI) of patients. Approximately three-quarters (74.3, 90 % CI) demonstrated reliable change in at least one of the outcome measures.

Conclusions

The low-intensity, group-based ACT intervention was effective at a group level and showed a similar magnitude of change in acceptance to previous ACT studies employing low-intensity interventions. Three-quarters of patients reported reliable change on at least one outcome measure.
Literature
1.
Vowles KE, Wetherell JL, Sorrell JT. Targeting acceptance, mindfulness, and values-based action in chronic pain: findings of two preliminary trials of an outpatient group-based intervention. Cogn Behav Pract. 2009;16(1):49–58.CrossRef
2.
Wetherell JL, Afari N, Rutledge T, Sorrell JT, Stoddard JA, Petkus AJ, et al. A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011;152(9):2098–107.CrossRefPubMed
3.
4.
McCracken LM, Gutiérrez-Martínez O. Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy. Behav Res Ther. 2011;49(4):267–74.CrossRefPubMed
5.
McCracken LM, Vowles KE, Eccleston C. Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005;43(10):1335–46.CrossRefPubMed
6.
McCracken LM, Jones R. Treatment for chronic pain for adults in the seventh and eighth decades of life: a preliminary study of acceptance and commitment therapy (ACT). Pain Med. 2012;13(7):860–7.CrossRefPubMed
7.
Flor H, Turk C. Chronic pain: an integrated biobehavioral approach. Seattle: IASP Press; 2011.
8.
McCracken LM, Morley S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. J Pain. 2014;15(3):221–34.CrossRefPubMed
9.
McCracken LM, Sato A, Taylor GJ. A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results. J Pain. 2013;14(11):1398–406.PubMedCentralCrossRefPubMed
10.
Reneman MF, Dijkstra A, Geertzen JH, Dijkstra PU. Psychometric properties of chronic pain acceptance questionnaires: a systematic review. Eur J Pain. 2010;14(5):457–65.CrossRefPubMed
11.
Fish RA, McGuire B, Hogan M, Morrison TG, Stewart I. Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8. Pain. 2010;149(3):435–43.CrossRefPubMed
12.
Fish RA, Hogan MJ, Morrison TG, Stewart I, McGuire BE. Willing and able: a closer look at pain willingness and activity engagement on the Chronic Pain Acceptance Questionnaire (CPAQ-8). J Pain. 2013;14(3):233–45.CrossRefPubMed
13.
Baranoff J, Hanrahan SJ, Kapur D, Connor JP. Validation of the chronic pain acceptance questionnaire-8 in an Australian pain clinic sample. Int J Behav Med. 2014;21(1):177–85.CrossRefPubMed
14.
Rovner GS, Årestedt K, Gerdle B, Börsbo B, McCracken LM. Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish chronic pain cohort. J Rehabil Med. 2014;46(1):73–80.CrossRefPubMed
15.
Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain. 1983;17(1):33–44.CrossRefPubMed
16.
Robinson ME, Riley JL, Myers CD, Sadler IJ, Kvaal SA, Geisser ME, et al. The Coping Strategies Questionnaire: a large sample, item level factor analysis. Clin J Pain. 1997;13(1):43–9.CrossRefPubMed
17.
Hirsh AT, George SZ, Riley JL, Robinson ME. An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire. Eur J Pain. 2007;11(1):75–81.CrossRefPubMed
18.
Stewart MW, Harvey ST, Evans IM. Coping and catastrophizing in chronic pain: a psychometric analysis and comparison of two measures. J Clin Psychol. 2001;57(1):131–8.CrossRefPubMed
19.
McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107(1):159–66.CrossRefPubMed
20.
Rodero B, García-Campayo J, Casanueva B, del Hoyo YL, Serrano-Blanco A. Luciano, JV Research Validation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia. Health Qual Life Outcome. 2010;8:37–46.CrossRef
21.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
22.
23.
Herrmann C. International experiences with the Hospital Anxiety and Depression Scale-a review of validation data and clinical results. J Psychosom Res. 1997;42(1):17–41.CrossRefPubMed
24.
Gandek B, Sinclair SJ, Kosinski M, Ware Jr JE. Psychometric evaluation of the SF-36 health survey in Medicare managed care. Health Care Financ Rev. 2004;25(4):5–25.PubMedCentralPubMed
25.
Hopman WM, Berger C, Joseph L, Towheed T, van den Kerkhof E, Anastassiades T, et al. Stability of normative data for the SF-36: Results of a three-year prospective study in middle-aged Canadians. Can J Public Health. 2004;95(5):387–91.PubMed
26.
Calsyn DA, Saxon AJ, Bush KR, Howell DN, Baer JS, Sloan KL, et al. The Addiction Severity Index medical and psychiatric composite scores measure similar domains as the SF-36 in substance-dependent veterans: concurrent and discriminant validity. Drug Alcohol Depend. 2004;76(2):165–71.CrossRefPubMed
27.
Ware Jr JE, Kosinski M, Keller SD. SF-36 Physical and Mental Health Summary Scales: A User’s Manual. Boston: The Health Institute, New England Medical Center; 1994.
28.
McCracken LM, Dhingra L. A short version of the Pain Anxiety Symptoms Scale (PASS--20): Preliminary development and validity. Pain Res Manag. 2002;7(1):45–50.PubMed
29.
McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale (PASS): A multimodal measure of pain-specific anxiety symptoms. Behav Ther. 1993;1:183–4.
30.
Coons MJ, Hadjistavropoulos HD, Asmundson GJ. Factor structure and psychometric properties of the Pain Anxiety Symptoms Scale‐20 in a community physiotherapy clinic sample. Eur J Pain. 2004;8(6):511–6.CrossRefPubMed
31.
Thompson M, McCracken LM. Acceptance and related processes in adjustment to chronic pain. Curr Pain Headache Rep. 2011;15(2):144–51.CrossRefPubMed
32.
33.
Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic; 1985.
34.
Rosenthal R. Meta-analytic methods for social research. Newbury Park: Sage; 1993.
35.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2011.
36.
37.
Orwin RG. A fail-safe N for effect size in meta-analysis. J Educ Stat. 1983;8(2):157–9.CrossRef
38.
Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12–9.CrossRefPubMed
39.
Han X, Geffen S, Browning M, Kenardy J, Geffen G. Outcome evaluation of a multidisciplinary pain management programme comparing group with individual change measures. Clinical Psychologist. 2011;15(3):133–8.CrossRef
40.
Vowles KE, McCracken LM. Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. J Consult Clin Psychol. 2008;76(3):397–407.CrossRefPubMed
41.
Vowles KE, McCracken LM, Eccleston C. Processes of change in treatment for chronic pain: the contributions of pain, acceptance, and catastrophizing. Eur J Pain. 2007;11(7):779–87.CrossRefPubMed
Metadata
Title
Changes in Acceptance in a Low-Intensity, Group-Based Acceptance and Commitment Therapy (ACT) Chronic Pain Intervention
Authors
John A. Baranoff
Stephanie J. Hanrahan
Anne L. J. Burke
Jason P. Connor
Publication date
01-02-2016
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 1/2016
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-015-9496-9

Other articles of this Issue 1/2016

International Journal of Behavioral Medicine 1/2016 Go to the issue

OriginalPaper

Patients’ Expectations Predict Surgery Outcomes: A Meta-Analysis

OriginalPaper

Engagement in New Dietary Habits—Obese Women’s Experiences from Participating in a 2-Year Diet Intervention

OriginalPaper

Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?

OriginalPaper

Spirituality, Religiosity, and Health: a Comparison of Physicians’ Attitudes in Brazil, India, and Indonesia

Acknowledgments

Acknowledgment of Reviewers – 2015

OriginalPaper

Workplace Stress and Working from Home Influence Depressive Symptoms Among Employed Women with Young Children