Changes in Acceptance in a Low-Intensity, Group-Based Acceptance and Commitment Therapy (ACT) Chronic Pain Intervention
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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.
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.
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.
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.
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.
KeywordsAcceptance Chronic pain Contextual behavioral Psychological processes Reliable change index
Jason Connor is supported by an Australian National Health and Medical Research Council (NH&MRC) Career Development Fellowship (APP1031909). The authors would like to thank the patients of the Royal Adelaide Hospital (RAH) Pain Management Unit, who attended the sessions and completed the questionnaires. Thanks are also extended to the staff at the RAH Pain Management Unit and Psychology Department for their support of this project.
Anne Burke provided clinical management of the pain program. The statistical analysis was conducted by Dr John Baranoff, under the guidance of Dr Jason Connor. An initial draft of the manuscript was written by Dr John Baranoff. All authors contributed to and approved the final draft.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
Conflict of Interest
The authors declare that they have no competing interests.
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