scholarly journals Acceptance and Commitment Therapy and Exercise: Can They Help Older Adults Manage Chronic Pain?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 289-290
Author(s):  
Dara K Y Leung ◽  
Annabelle P C Fong ◽  
Wai-Wai Kwok ◽  
Angie K Y Shum ◽  
Tianyin Liu ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Pain Management ◽  
Acceptance And Commitment Therapy ◽  
Physical Functioning ◽  
Psychological Flexibility ◽  
Chronic Pain Management ◽  
Pain Acceptance ◽  
Acceptance And Commitment ◽  
Body Strength

Abstract Chronic pain is common among older adults and affects their physical and psychological well-being. While exercise can reduce pain and promote physical functions, psychological interventions may enhance pain management by addressing the psychosocial contributors to the prolonged pain. Acceptance and Commitment Therapy (ACT) is a psychological intervention that emphasizes on psychological flexibility, values, and mindfulness. This approach may be particularly helpful in dealing with chronic pain, where symptoms can be beyond one’s control. This single group pre-post study investigated the feasibility and efficacy of an intervention combining ACT and exercise for chronic pain management in older adults. The intervention consisted of 16 sessions delivered over eight weeks. ACT and exercises were modified according to the individual’s capability when needed. Clinical outcomes regarding pain severity and interference, pain acceptance, value of life, depression, anxiety, and physical functioning were assessed. Twenty-four older adults attended all sessions and completed the assessments. Preliminary results showed that, while participants experienced similar level of pain after the intervention, they reported less pain interference on mood and enjoyment of life, and improved chronic pain acceptance, pain self-efficacy, success at living their values, committed action, depressive symptoms, physical functioning in the lower body strength, aerobic and endurance, agility and dynamic balance, and upper body strength (all p<.050). This study lends support to the feasibility of a combined ACT and exercise intervention for chronic pain management in older adults. The efficacy of ACT may not be directly on reducing pain, but on increased psychological flexibility to co-live with pain.

Process-outcome associations in an interdisciplinary treatment for chronic pain and comorbid mental disorders based on Acceptance and Commitment Therapy

Pain Medicine ◽  
2021 ◽  
Author(s):  
Ludwig Ohse ◽  
Ronald Burian ◽  
Eric Hahn ◽  
Hannah Burian ◽  
Thi Minh Tam Ta ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Mental Disorders ◽  
Clinical Outcomes ◽  
Acceptance And Commitment Therapy ◽  
Psychological Flexibility ◽  
Post Treatment ◽  
Interdisciplinary Treatment ◽  
Pain Acceptance ◽  
Acceptance And Commitment ◽  
Comorbid Mental Disorders

Abstract Objective Numerous studies support the effectiveness of Acceptance and Commitment Therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). Subjects Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. Methods Pre- to post-treatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. Results Pre- to post-treatment effect sizes were mostly moderate to large (r between |0.21| and |0.62|). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between |0.30| and |0.54|) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). Conclusion The present investigation suggests that changes in pain acceptance, mindfulness and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients that often has a severe course of illness and has seldom been studied.

scholarly journals MECHANISM OF ACTION: AGE DIFFERENCES IN RESPONSE TO ACCEPTANCE AND COMMITMENT THERAPY FOR CHRONIC PAIN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S809-S809
Author(s):  
Julie L Wetherell ◽  
Matthew Herbert ◽  
Niloofar Afari
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Therapy ◽  
Pain Interference ◽  
Younger Adults ◽  
Pain Acceptance ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Abstract A recent randomized comparison of Acceptance and Commitment Therapy (ACT) vs. Cognitive-Behavioral Therapy for chronic pain found a clear age interaction effect, such that older adults benefitted more from ACT. In a subsequent study comparing ACT delivered in person to ACT delivered via telehealth to a sample of veterans (N=128, mean age 51.9, SD 13.3, range 25-89), we found no significant age by modality interactions, suggesting that older veterans responded as well as younger people did to telehealth delivery. Consistent with our previous findings, we found a trend for older adults to experience greater reduction in pain interference (p = .051) and significantly greater reduction in pain severity (p = .001) than younger adults following ACT. In younger veterans, change in pain acceptance from baseline to posttreatment was related to change in pain interference from baseline to 6-month follow-up (r = -.38), but change in pain interference from baseline to posttreatment was not related to change in pain acceptance from baseline to follow-up (r = .14), suggesting that, consistent with the ACT model, increased pain acceptance at posttreatment was related to reduced pain interference at follow-up. By contrast, in older veterans, both correlations were significant and of comparable magnitude (rs = -.43 and -.46, respectively), providing no support for the idea that change in pain acceptance drove change in pain interference. Overall, our findings suggest that ACT may work better in older adults with chronic pain than in younger adults, but via a different mechanism.

scholarly journals Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults

Pain Medicine ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. e68-e78 ◽  
Author(s):  
Mary R Janevic ◽  
Varick Shute ◽  
Susan L Murphy ◽  
John D Piette
Keyword(s):  
Older Adults ◽  
Chronic Pain ◽  
African American ◽  
Pain Management ◽  
Feasibility Trial ◽  
Chronic Pain Management ◽  
Step Counts ◽  
African American Adults ◽  
Activity Trackers ◽  
Wearable Activity Trackers

Abstract Background Wearable activity trackers may facilitate walking for chronic pain management. Objective We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. Design Randomized controlled pilot and feasibility trial. Subjects Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). Methods Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. Results More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. Conclusions With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.

scholarly journals Neural Mechanisms of Acceptance and Commitment Therapy for Chronic Pain: A Network-Based fMRI Approach

2021 ◽  
Vol 15 ◽  
Author(s):  
Semra A. Aytur ◽  
Kimberly L. Ray ◽  
Sarah K. Meier ◽  
Jenna Campbell ◽  
Barry Gendron ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Outcomes ◽  
Depression Scale ◽  
The United States ◽  
Functional Improvement ◽  
Pain Acceptance ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Over 100 million Americans suffer from chronic pain (CP), which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year (Institute of Medicine, 2011). Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy (CBT) can be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy (ACT) has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions (Gutierrez et al., 2004). However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women (n = 9) with chronic musculoskeletal pain. Functional magnetic resonance imaging (fMRI) data were collected pre- and post-ACT, and changes in functional connectivity (FC) were measured using Network-Based Statistics (NBS). Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire (AAQ-II), the Chronic Pain Acceptance Questionnaire (CPAQ), the Center for Epidemiologic Studies Depression Scale (CES-D), and the NIH Toolbox Neuro-QoLTM (Quality of Life in Neurological Disorders) scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection (default mode, DMN), emotion (salience, SN), and cognitive control (frontal parietal, FPN). These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies.

scholarly journals P120 Development and analysis of acceptance and commitment therapy (ACT)-informed group and 1-1 psychological interventions for a rheumatology population

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Lorraine Maher-Edwards ◽  
Alexandra Quigley ◽  
David Gillanders ◽  
Nora Ng
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Psychological Flexibility ◽  
Evidence Base ◽  
Effect Sizes ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
One To One

Abstract Background Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence-base for psychological intervention in this population is scarce. Acceptance- and mindfulness-based cognitive therapies are of increasing popularity. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a robust evidence-base for mood disorders and long-term health conditions, in particular in chronic pain populations. ACT aims to help clients to develop skills to identify and let go of unhelpful patterns of symptom control and avoidance so that they can move towards important life areas (values) and goals. Research has consistently shown that higher levels of acceptance (a component of psychological flexibility) in chronic illness is associated with better quality of life and emotional well-being. No studies have looked at the effects of ACT-based interventions in rheumatology. This study aimed to: Develop and pilot I) a 6-week group and II) a brief (up to 6 sessions) one to one intervention based on Acceptance and Commitment Therapy (ACT) in a rheumatology population. Outcomes were evaluated using patient satisfaction data, qualitative feedback and quantitative outcomes using a range of questionnaires measuring mood, quality of life and psychological flexibility. Methods Patients attending a rheumatology psychology service received either group OR brief one to one intervention delivered by a qualified psychologist. Group consisted of 6 sessions; each session was 3 hours (18 hours total). The brief one to one intervention consisted of up to 6 one-hour face to face sessions (max 6 hours total). A range of outcome measures were administered pre- and post-treatment. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. For comparison published data in chronic pain populations were used. Results Patients responded well to ACT-based interventions: with improvements in mood, psychological flexibility and quality of life. All effect sizes were large and compared favourably to published trials in chronic pain populations. Group participants showed significant improvements in depression and psychological flexibility pre- to post- treatment. On the other hand, participants who received the brief one to one intervention showed significant improvements on all measures. Overall those who had group therapy showed smaller improvements in outcome measures, rated themselves as less improved and were less satisfied with their therapy than those that received up to 6 sessions of individualised therapy. Conclusion A brief one to one intervention of up to 6 sessions of ACT-based psychological therapy conferred good benefit for a rheumatology population and outperformed group therapy. More studies are needed to understand whether this effect is generalisable and longer-term outcomes. Disclosures L. Maher-Edwards None. A. Quigley None. D. Gillanders None. N. Ng None.

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