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Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self

  • Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
  • Published:
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Abstract

Acceptance and commitment therapy (ACT) is one of the so called “third-wave” cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to “self” appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance•• Of major importance

  1. Turk DC, Burwinkle TM. Clinical outcomes, cost-effectiveness, and the role of psychology in treatments for chronic pain sufferers. Professional Psychol Res Pract. 2005;36(6):602.

    Article  Google Scholar 

  2. Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7(11):779–93.

    Article  PubMed  Google Scholar 

  3. Williams ACdC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. The cochrane library. 2012.

  4. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change: Guilford Press; 1999

  5. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. New York: Guilford Press; 2011. This book provides a thorough introduction to a contemporary functional contextual model of human suffering and behavior change (the psychological flexibility model) and presents many examples of clinical methods and a number of clinically relevant examples.

  6. McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014;69(2):178. Provides a review of progresses and challenges of Cognitive Behavioral Therapy (CBT) in the treatment of chronic pain, with emphasis on recent development such as mindfulness-based approaches including Acceptance and Commitment Therapy.

    Article  PubMed  Google Scholar 

  7. Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol. 2011;7:141–68.

    Article  PubMed  Google Scholar 

  8. McCracken LM. Contextual cognitive-behavioral therapy for chronic pain. Progress in Pain Research and Management. Seattle: IASP Press; 2005. This book provides an overview of the application of contextual approaches to individuals with chronic pain. Specific experiential exercises and clinical material are included.

  9. Barnes-Holmes Y, Hayes SC, Barnes-Holmes D, Roche B. Relational frame theory: a post-Skinnerian account of human language and cognition. New York: Kluwer Academic/ Plenum Publishers; 2001. This book provides a thorough introduction of a theory of human language and cognition, Relational Frame Theory (RFT), including materials of basic and applied behavior analysis.

  10. Pepper SC. World hypotheses: a study in evidence: Univ of California Press; 1942

  11. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25.

    Article  PubMed  Google Scholar 

  12. Öst L-G. Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behav Res Ther. 2008;46(3):296–321.

    Article  PubMed  Google Scholar 

  13. Powers MB. Zum Vörde Sive Vörding MB, Emmelkamp PM. Acceptance and commitment therapy: a meta-analytic review. Psychother Psychosom. 2009;78(2):73–80.

    Article  PubMed  Google Scholar 

  14. Cavanagh K, Strauss C, Forder L, Jones F. Can mindfulness and acceptance be learnt by self-help?: a systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clin Psychol Rev. 2014;34(2):118–29. This paper represents a carefully done review generally focused on lower intensity versions of mindfulness and acceptance, important because these types of treatments are frequently being considered in the current era of increasing demands for easier access and lower costs.

    Article  PubMed  Google Scholar 

  15. Ruiz FJ. A review of Acceptance and Commitment Therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther. 2010;10(1):125–62.

    Google Scholar 

  16. Ruiz FJ. Acceptance and commitment therapy versus traditional cognitive behavioral therapy: a systematic review and meta-analysis of current empirical evidence. Int J Psychol Psychol Ther. 2012;12(3):333–58.

    Google Scholar 

  17. Hann KE, McCracken LM. A systematic review of randomized controlled trials of Acceptance and Commitment Therapy for adults with chronic pain: outcome domains, design quality, and efficacy. J Contextual Behav Sci. 2014;3(4):217–27. This article is a useful summary of current evidence for ACT for chronic pain based on a systematic review of RCTs. It is focused mostly on primary and secondary measurement domains and measures but also presents a summary of the positive effects of ACT particularly for physical and emotional functioning.

    Article  Google Scholar 

  18. Levin ME, Hildebrandt MJ, Lillis J, Hayes SC. The impact of treatment components suggested by the psychological flexibility model: a meta-analysis of laboratory-based component studies. Behav Ther. 2012;43(4):741–56. This article usefully summarizes the non-clinical experimental literature related to ACT processes, including 66 studies. It presents a rather positive account particularly for the benefits of acceptance, cognitive defusion, present moment, mixed mindfulness, values and value plus mindfulness.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Wicksell RK, Olsson GL, Hayes SC. Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. Eur J Pain. 2010;14(10):1059. e1-. e11.

    Article  PubMed  Google Scholar 

  22. McCracken LM, DaSilva P, Skillicorn B, Doherty R. The Cognitive Fusion Questionnaire: a preliminary study of psychometric properties and prediction of functioning in chronic pain. Clinical J Pain. 2014;30(10):894–901.

    Article  Google Scholar 

  23. Fresco DM, Segal ZV, Buis T, Kennedy S. Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression. J Consult Clin Psychol. 2007;75(3):447.

    Article  PubMed  Google Scholar 

  24. Fresco DM, Moore MT, van Dulmen MH, Segal ZV, Ma SH, Teasdale JD, et al. Initial psychometric properties of the experiences questionnaire: validation of a self-report measure of decentering. Behav Ther. 2007;38(3):234–46.

    Article  PubMed  Google Scholar 

  25. McCracken LM, Gutiérrez-Martínez O, Smyth C. Decentering” reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning. Health Psychol. 2013;32(7):820.

    Article  PubMed  Google Scholar 

  26. McCracken LM, Barker E, Chilcot J. Decentering, rumination, cognitive defusion, and psychological flexibility in people with chronic pain. J Behav Med. 2014;37(6):1215–25.

    Article  PubMed  Google Scholar 

  27. McHugh L. A contextual behavioral science approach to the self and perspective taking. Current Opinion in Psychology. 2015

  28. Hayes S. Knowing selves. Behaviour therapist. 1995;18:94-.

  29. Foody M, Barnes-Holmes D, Barnes-Holmes Y. The role of self in acceptance and commitment therapy. In The Self and Perspective Taking. Oakland, CA: New Harbinger Publications; 2012. p. 125–42. This chapter provides an introduction of the conceptualization of the self in the context of Relational Frame Theory and Acceptance and Commitment Therapy.

    Google Scholar 

  30. James W. The principles of psychology. New York: H. Holt and Company; 1890.

    Book  Google Scholar 

  31. Schmidt AJ. Cognitive factors in the performance level of chronic low back pain patients. J Psychosom Res. 1985;29(2):183–9.

    Article  CAS  PubMed  Google Scholar 

  32. Krol B, Sanderman R, Suurmeijer T, Doeglas D, van Rijswijk M, van Leeuwen M. Disease characteristics, level of self-esteem and psychological well-being in rheumatoid arthritis patients. Scand J Rheumatol. 1994;23(1):8–12.

    Article  CAS  PubMed  Google Scholar 

  33. Chang C-L, Chiu C-M, Hung S-Y, Lee S-H, Lee C-S, Huang C-M, et al. The relationship between quality of life and aerobic fitness in patients with rheumatoid arthritis. Clin Rheumatol. 2009;28(6):685–91.

    Article  PubMed  Google Scholar 

  34. Bengtsson M, Sjoberg K, Candamio M, Lerman A, Ohlsson B. Anxiety in close relationships is higher and self-esteem lower in patients with irritable bowel syndrome compared to patients with inflammatory bowel disease. European J Intern Med. 2013;24(3):266–72.

    Article  Google Scholar 

  35. Armentrout DP. The impact of chronic pain on the self‐concept. J Clin Psychol. 1979;35(3):517–21.

    Article  CAS  PubMed  Google Scholar 

  36. Thomas MR, Lyttle D. Patient expectations about success of treatment and reported relief from low back pain. J Psychosom Res. 1980;24(6):297–301.

    Article  CAS  PubMed  Google Scholar 

  37. García-Martínez AM, De Paz JA, Márquez S. Effects of an exercise programme on self-esteem, self-concept and quality of life in women with fibromyalgia: a randomized controlled trial. Rheumatol Int. 2012;32(7):1869–76.

    Article  PubMed  Google Scholar 

  38. Tang NK, Goodchild CE, Hester J, Salkovskis PM. Mental defeat is linked to interference, distress and disability in chronic pain. Pain. 2010;149(3):547–54.

    Article  PubMed  Google Scholar 

  39. Tang NK, Salkovskis PM, Hanna M. Mental defeat in chronic pain: initial exploration of the concept. Clinical J Pain. 2007;23(3):222–32.

    Article  Google Scholar 

  40. Tang NK, Shum S-H, Leung PWL, Chen P-P, Salkovskis PM. Mental defeat predicts distress and disability in Hong Kong Chinese with chronic pain. Clin J Pain. 2013;29(9):830–6.

    Article  PubMed  Google Scholar 

  41. Toner BB, Garfinkel PE, Jeejeebhoy KN, Scher H, Shulhan D, Di Gasbarro I. Self-schema in irritable bowel syndrome and depression. Psychosom Med. 1990;52(2):149–55.

    Article  CAS  PubMed  Google Scholar 

  42. Pincus T, Pearce S, McClelland A, Turner-Stokes L. Self-referential selective memory in pain patients. Br J Clin Psychol. 1993;32(3):365–74.

    Article  PubMed  Google Scholar 

  43. Pincus T, Pearce S, McClelland A. Endorsement and memory bias of self-referential pain stimuli in depressed pain patients. Br J Clin Psychol. 1995;34(2):267–77.

    Article  PubMed  Google Scholar 

  44. Waters SJ, Keefe FJ, Strauman TJ. Self-discrepancy in chronic low back pain: relation to pain, depression, and psychological distress. J Pain Symptom Manag. 2004;27(3):251–9.

    Article  Google Scholar 

  45. Goossens ME, Kindermans HP, Morley SJ, Roelofs J, Verbunt J, Vlaeyen JW. Self‐discrepancies in work‐related upper extremity pain: relation to emotions and flexible‐goal adjustment. Eur J Pain. 2010;14(7):764–70.

    Article  PubMed  Google Scholar 

  46. Morley S, Davies C, Barton S. Possible selves in chronic pain: self-pain enmeshment, adjustment and acceptance. Pain. 2005;115(1–2):84–94.

    Article  PubMed  Google Scholar 

  47. Costa J, Pinto-Gouveia J. Acceptance of pain, self-compassion and psychopathology: using the Chronic Pain Acceptance Questionnaire to identify patients′ subgroups. Clin Psychol Psychother. 2011;18(4):292–302.

    Article  PubMed  Google Scholar 

  48. Costa J, Pinto-Gouveia J. Experiential avoidance and self-compassion in chronic pain. J Appl Soc Psychol. 2013;43(8):1578–91.

    Article  Google Scholar 

  49. McCracken LM, Vowles KE. Acceptance of chronic pain. Curr Pain Headache Rep. 2006;10(2):90–4.

    Article  PubMed  Google Scholar 

  50. Thompson M, McCracken LM. Acceptance and related processes in adjustment to chronic pain. Curr Pain Headache Rep. 2011;15(2):144–51.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Health Psychology Section, Psychology Department, King’s College London, Guy’s Campus, London, SE1 9RT, UK

    Lin Yu & Lance M. McCracken

  2. INPUT Pain Management, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Lance M. McCracken

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  1. Lin Yu
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Correspondence to Lance M. McCracken.

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Lin Yu and Lance M. McCracken declare that they have no conflict of interest.

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This article is part of the Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

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Yu, L., McCracken, L.M. Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self. Curr Pain Headache Rep 20, 12 (2016). https://doi.org/10.1007/s11916-016-0541-4

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