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International Journal of Behavioral Medicine

, Volume 23, Issue 1, pp 30–38 | Cite as

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

  • John A. BaranoffEmail author
  • Stephanie J. Hanrahan
  • Anne L. J. Burke
  • Jason P. Connor
Article

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.

Keywords

Acceptance Chronic pain Contextual behavioral Psychological processes Reliable change index 

Notes

Acknowledgments

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.

Contributors

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.

Ethical Standards

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.

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 3.
    American Psychological Association Division 12 Society of Clinical Psychology. 2012. Psychological treatments. http://www.div12.org/PsychologicalTreatments/treatments.html. Accessed 23 Sep 2014.
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 7.
    Flor H, Turk C. Chronic pain: an integrated biobehavioral approach. Seattle: IASP Press; 2011.Google Scholar
  8. 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.CrossRefPubMedGoogle Scholar
  9. 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.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 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.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 19.
    McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107(1):159–66.CrossRefPubMedGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 21.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes. 2003;1(1):29–32.PubMedCentralCrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.PubMedCentralPubMedGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.Google Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.Google Scholar
  30. 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.CrossRefPubMedGoogle Scholar
  31. 31.
    Thompson M, McCracken LM. Acceptance and related processes in adjustment to chronic pain. Curr Pain Headache Rep. 2011;15(2):144–51.CrossRefPubMedGoogle Scholar
  32. 32.
    Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Hedges LV, Olkin I. Statistical methods for meta-analysis. Orlando: Academic; 1985.Google Scholar
  34. 34.
    Rosenthal R. Meta-analytic methods for social research. Newbury Park: Sage; 1993.Google Scholar
  35. 35.
    Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Introduction to meta-analysis. Chichester: Wiley; 2011.Google Scholar
  36. 36.
    Higgins J, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Orwin RG. A fail-safe N for effect size in meta-analysis. J Educ Stat. 1983;8(2):157–9.CrossRefGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  • John A. Baranoff
    • 1
    Email author
  • Stephanie J. Hanrahan
    • 1
    • 2
  • Anne L. J. Burke
    • 3
  • Jason P. Connor
    • 4
    • 5
  1. 1.School of PsychologyThe University of QueenslandBrisbaneAustralia
  2. 2.School of Human Movement StudiesThe University of QueenslandBrisbaneAustralia
  3. 3.Pain Management UnitRoyal Adelaide HospitalAdelaideAustralia
  4. 4.Discipline of PsychiatryThe University of QueenslandBrisbaneAustralia
  5. 5.Centre for Youth Substance Abuse ResearchThe University of QueenslandBrisbaneAustralia

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