Internet-Delivered Acceptance and Commitment Therapy for Adolescents with Chronic Pain and Their Parents: A Nonrandomized Pilot Trial

2020 ◽  
Vol 45 (9) ◽  
pp. 990-1004
Author(s):  
Vendela Zetterqvist ◽  
Charlotte Gentili ◽  
Jenny Rickardsson ◽  
Isabel Sörensen ◽  
Rikard K Wicksell
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Psychological Treatment ◽  
Pilot Trial ◽  
Evidence Base ◽  
Recruitment Rate ◽  
Outcome Evaluation ◽  
Commitment Therapy ◽  
Acceptance And Commitment

Abstract Background Acceptance and Commitment Therapy (ACT) is an empirically supported treatment for chronic pain in adults. There is also a small but growing evidence base of ACT for pediatric chronic pain. However, because of limited access to psychological treatment for pain, and geographical distances from pain facilities, many patients will not receive such treatment. Objective The aim of the study was to evaluate the feasibility and preliminary effects of an internet-delivered ACT for adolescents with chronic pain, and their parents. Methods In this nonrandomized pilot study 28 self-recruited adolescents, aged 13–17 years, received 8 weeks of internet-delivered ACT, while outcomes were assessed at pre-, posttreatment, and at follow-up (17–25 weeks). Parents of the adolescents received an 8-week internet-delivered parental program, and their outcomes were assessed at the same timepoints. Both treatments were guided by a therapist experienced in ACT and chronic pain. Results Some threats to feasibility were identified such as slow recruitment rate, low compliance and a delay in completion of follow-up assessments. Preliminary outcome evaluation showed that adolescents showed a large significant improvement on their main outcome (pain interference, d = 1.09), and parents a medium improvement on their main outcome, pain reactivity (d = 0.70). Improvements were also seen in adolescents’ depressive symptoms and insomnia severity. Conclusion The preliminary results of internet-delivered ACT are promising with regards to improvements in adolescent and parent outcome. Measures to improve feasibility are needed prior to conducting a larger randomized trial.

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.

Physical Activity of Patients With Chronic Pain Receiving Acceptance and Commitment Therapy or Cognitive Behavioural Therapy

2014 ◽  
Vol 31 (2) ◽  
pp. 131-143 ◽  
Author(s):  
Katherine VanBuskirk ◽  
Scott Roesch ◽  
Niloofar Afari ◽  
Julie Loebach Wetherell
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Cognitive Behavioural Therapy ◽  
Acceptance And Commitment Therapy ◽  
Psychological Treatment ◽  
Behavioural Therapy ◽  
Tailored Interventions ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Cognitive Behavioural

Physical activity is positively related to various indices of quality of life and is found to reduce symptoms in individuals with chronic pain. This manuscript presents findings from a post hoc analysis investigating whether treatment-related improvements from psychological treatment for chronic pain are mediated by changes in physical activity (PA). Secondary analyses sought to determine predictor variables of PA in patients with chronic pain and to determine the relationship between objective and self-report measurements of PA. The effect of psychological treatment on physical activity was assessed using accelerometers in a sample of participants with chronic pain in a randomised controlled trial comparing 8 weeks of acceptance and commitment therapy (ACT) to cognitive behavioural therapy (CBT). Participants wore actigraph accelerometers for 7 consecutive days at baseline, post-treatment, and at 6-month follow-up. Hierarchical linear modelling analyses found that the variance in physical activity was not significantly predicted by time (b = 104.67, p = .92) or treatment modality (b = −1659.34, p = .57). Women had greater increases in physical activity than did men (b = 6804.08, p = .02). Current ‘gold standard’ psychological treatments for chronic pain were not found to significantly increase physical activity, an important outcome to target in the treatment of physical and mental health. These results suggest that tailored interventions with greater emphasis on exercise may complement psychological treatment for chronic pain. In particular, gender-tailored interventions may capitalise on physical activity differences found between men and women.

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.

Efficacy of telehealth acceptance and commitment therapy for weight loss: a pilot randomized clinical trial

2021 ◽  
Author(s):  
Jonathan B Bricker ◽  
Kristin E Mull ◽  
Brianna M Sullivan ◽  
Evan M Forman
Keyword(s):  
Weight Loss ◽  
Acceptance And Commitment Therapy ◽  
Behavioral Therapy ◽  
Pilot Trial ◽  
Population Level ◽  
Baseline Body Mass Index ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Telephone Coaching

Abstract Telehealth coaching for weight loss has high population-level reach but limited efficacy. To potentially improve on this limitation, the purpose of this study was to determine the preliminary efficacy of the first known telephone coaching acceptance and commitment therapy (ACT) intervention for weight loss. A two-arm, stratified, individually randomized pilot trial comparing ACT (n = 53) with standard behavioral therapy (SBT; n = 52) was used for this study. Both interventions were delivered in 25 telephone coaching calls (15–20 min each) over a 12 month period. Weight was measured at baseline and 3, 6, and 12 month postrandomization follow-ups. Recruited from 32 U.S. states, participants were of mean age 40.7, 42% male, 34% racial/ethnic minority, and mean baseline body mass index of 34.3. Fractions of 10% or more scale-reported weight loss: 15% for ACT versus 4% for SBT at 3 month follow-up (N = 86; odds ratio [OR] = 4.61; 95% confidence interval [CI]: 0.79, 26.83), 24% for ACT versus 13% for SBT at 6 month follow-up (N = 72; OR = 2.45; 95% CI: 0.65, 9.23), 30% for ACT versus 30% for SBT at 12 month follow-up (N = 57; OR = 0.93; 95% CI: 0.28, 3.09). Fractions of 10% or more self-reported weight loss at 12 month follow-up: 25% for ACT versus 15% for SBT (N = 75; OR = 2.38; 95% CI: 0.68, 8.34). The conclusion of the study was the preliminary evidence that telephone coaching ACT may be efficacious for weight loss.

scholarly journals Evaluating the Open and Engaged Components of Acceptance and Commitment Therapy in an Online Self-Guided Website: Results from a Pilot Trial

2019 ◽  
pp. 014544551987866 ◽  
Author(s):  
Julie M. Petersen ◽  
Jennifer Krafft ◽  
Michael P. Twohig ◽  
Michael E. Levin
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Psychosocial Functioning ◽  
Pilot Trial ◽  
Post Treatment ◽  
Optimal Outcomes ◽  
Online Platforms ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
High Satisfaction

Online acceptance and commitment therapy (ACT) is promising for treating a range of psychological problems. Component research can further clarify which components are needed for optimal outcomes in what contexts. Online platforms provide a highly controlled format for such research. In this pilot trial, 55 adults were randomized to: ACT-Open (i.e., acceptance, defusion components), ACT-Engaged (i.e., values, committed action), or ACT-Combined (i.e., acceptance, defusion, values, committed action). Each condition was 12 sessions over 6 weeks, with assessments at baseline, post-treatment, and 4-week follow-up. ACT-Open, ACT-Engaged, and ACT-Combined all significantly improved from pre- to post-treatment on mental health, psychosocial functioning, and components of psychological flexibility. Compared to ACT-Combined, ACT-Open improved less on psychosocial functioning at post-treatment, and ACT-Engaged worsened on functioning at follow-up. The platform was acceptable with high satisfaction ratings. Results support the feasibility of conducting online ACT component research, which will be tested in a fully powered non-inferiority trial.

scholarly journals ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain—A Pilot Trial

Pain Medicine ◽  
2020 ◽  
Author(s):  
Charlotte Gentili ◽  
Vendela Zetterqvist ◽  
Jenny Rickardsson ◽  
Linda Holmström ◽  
Laura E Simons ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Behavioral Health ◽  
Acceptance And Commitment Therapy ◽  
Primary Outcome ◽  
Pilot Trial ◽  
Empirical Support ◽  
Pain Interference ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Secondary Outcomes

Abstract Background Acceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients’ everyday lives. Objective ACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain. Methods The study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models. Results The sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = –1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up. Conclusion The results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.

scholarly journals Values-based action in fibromyalgia: results from a randomized pilot of acceptance and commitment therapy

2013 ◽  
Vol 1 (3) ◽  
pp. 34 ◽  
Author(s):  
Jennifer L. Steiner ◽  
Leah Bogusch ◽  
Silvia M. Bigatti
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Intimate Relationships ◽  
Education Group ◽  
Nonrestorative Sleep ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Differential Pattern ◽  
Changes Over Time

Fibromyalgia Syndrome (FMS) is a chronic pain condition characterized by pain, fatigue, and nonrestorative sleep. The disruptive symptoms of FMS are associated with reductions in quality of life related to family, intimate relationships, and work. The present study was part of a randomized pilot study of an 8-week Acceptance and Commitment Therapy (ACT) intervention compared to education in a sample of 28 women with FMS. The Chronic Pain Values Inventory was administered at baseline, postintervention, and 12 week follow-up. Both groups showed significant improvements in family success, which were maintained at follow-up. Groups showed a differential pattern of success in work. The ACT group demonstrated significant, maintained improvements in success in intimate relationships, while the education group reported no changes over time. Findings suggest that both interventions may lead to improvements in valued living; however different interventions may be best suited for certain valued domains. The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent.

Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One‐Year Follow‐Up

2020 ◽  
Vol 18 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Máire‐Bríd Casey ◽  
Niamh Cotter ◽  
Caoimhe Kelly ◽  
Lisa Mc Elchar ◽  
Cian Dunne ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Case Series ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
One Year

scholarly journals Acceptance and Commitment Therapy for Chronic Pain: Does Post-traumatic Stress Disorder Influence Treatment Outcomes?

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1728-1736 ◽  
Author(s):  
Matthew S Herbert ◽  
Anne L Malaktaris ◽  
Cara Dochat ◽  
Michael L Thomas ◽  
Julie Loebach Wetherell ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Depressive Symptoms ◽  
Treatment Outcomes ◽  
Acceptance And Commitment Therapy ◽  
Traumatic Stress ◽  
Post Traumatic Stress ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Post Traumatic

AbstractObjectiveThe aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain.DesignLongitudinal.SettingVeterans Affairs San Diego Healthcare System.SubjectsA total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83).MethodsLinear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up.ResultsParticipants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels.ConclusionsPTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.

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