Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial.

Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain.

[1]  G. Olsson,et al.  The Chronic Pain Acceptance Questionnaire (CPAQ)‐further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia , 2009, European journal of pain.

[2]  Josefin Ahlqvist,et al.  Can Exposure and Acceptance Strategies Improve Functioning and Life Satisfaction in People with Chronic Pain and Whiplash‐Associated Disorders (WAD)? A Randomized Controlled Trial , 2008, Cognitive behaviour therapy.

[3]  J. Coyne,et al.  A randomized, controlled study of Internet peer‐to‐peer interactions among women newly diagnosed with breast cancer , 2010, Psycho-oncology.

[4]  W. Assendelft,et al.  Behavioural treatment for chronic low-back pain. , 2010, The Cochrane database of systematic reviews.

[5]  R. Kerns,et al.  Psychological treatment of chronic pain. , 2011, Annual review of clinical psychology.

[6]  T. Gordh,et al.  A Comparative Study of 2 Manual-based Self-Help Interventions, Acceptance and Commitment Therapy and Applied Relaxation, for Persons With Chronic Pain , 2011, The Clinical journal of pain.

[7]  S. Hayes,et al.  Relational frame theory, acceptance and commitment therapy, and a functional analytic definition of mindfulness , 2005 .

[8]  Lennart Bodin,et al.  Reliability and factor structure of the Multidimensional Pain Inventory – Swedish Language Version (MPI-S) , 1998, Pain.

[9]  M. Hogan,et al.  Validation of the Chronic Pain Acceptance Questionnaire (CPAQ) in an Internet sample and development and preliminary validation of the CPAQ-8 , 2010, PAIN.

[10]  L. McCracken.  Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain , 1998, Pain.

[11]  M. Lekander,et al.  Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial , 2009, PAIN.

[12]  Christopher Eccleston,et al.  Psychological therapies for the management of chronic pain (excluding headache) in adults. , 2012, The Cochrane database of systematic reviews.

[13]  K. Lorig,et al.  Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study. , 2002, Archives of internal medicine.

[14]  R. Kerns,et al.  Meta-analysis of psychological interventions for chronic low back pain. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[15]  Tom Buchanan,et al.  Internet-based Questionnaire Assessment: Appropriate Use in Clinical Contexts , 2003, Cognitive behaviour therapy.

[16]  John E. Cornell,et al.  Clinical Validation of the Quality of Life Inventory: A Measure of Life Satisfaction for Use in Treatment Planning and Outcome Assessment , 1992 .

[17]  L. McCracken,et al.  Acceptance and values-based action in chronic pain: a study of treatment effectiveness and process. , 2008, Journal of consulting and clinical psychology.

[18]  C. Eccleston,et al.  Acceptance-based treatment for persons with complex, long standing chronic pain: a preliminary analysis of treatment outcome in comparison to a waiting phase. , 2005, Behaviour research and therapy.

[19]  Gerhard Andersson,et al.  Internet administration of the Hospital Anxiety and Depression Scale in a sample of tinnitus patients. , 2003, Journal of psychosomatic research.

[20]  S. Linton,et al.  Coping strategies questionnaire (CSQ): Reliability of the swedish version of the CSQ , 1993 .

[21]  Gerard M Schippers,et al.  Missing Data Approaches in eHealth Research: Simulation Study and a Tutorial for Nonmathematically Inclined Researchers , 2010, Journal of medical Internet research.

[22]  D. Turk,et al.  The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) , 1985, Pain.

[23]  J. Atkinson,et al.  A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain , 2011, PAIN.

[24]  G. Andersson,et al.  Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial. , 2011, Behaviour research and therapy.

[25]  D. Fairchild,et al.  Disease management for chronic pain: barriers of program implementation with primary care physicians. , 2002, Pain medicine.

[26]  B. Collett,et al.  Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment , 2006, European journal of pain.

[27]  Apa Presidential Task Force on Evidence-Based Practice.  Evidence-based practice in psychology. , 2006 .

[28]  K. Carpenter,et al.  An Online Self-help CBT Intervention for Chronic Lower Back Pain , 2012, The Clinical journal of pain.

[29]  G. Andersson,et al.  Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial. , 2011, Journal of rehabilitation medicine.

[30]  The impact of a moderated e-mail discussion group on use of complementary and alternative therapies in subjects with recurrent back pain. , 2005, Patient education and counseling.

[31]  J. Lisspers,et al.  Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample , 1997, Acta psychiatrica Scandinavica.

[32]  L. McCracken,et al.  Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes. , 2010, Behaviour research and therapy.

[33]  Felipe Fregni,et al.  The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. , 2010, The journal of pain : official journal of the American Pain Society.

[34]  R. Snaith,et al.  The Hospital Anxiety and Depression Scale , 1983 .

[35]  Ernst T. Bohlmeijer,et al.  Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis , 2011, PAIN®.

[36]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[37]  C. Eccleston,et al.  The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups , 2008, PAIN.

[38]  L. McCracken,et al.  Acceptance of chronic pain , 2006, Current pain and headache reports.

[39]  D. Ahern,et al.  Chronic pain and functional impairment: assessing beliefs about their relationship. , 1988, Archives of physical medicine and rehabilitation.

[40]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[41]  C. Eccleston,et al.  Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache , 1999, Pain.

[42]  Alejandro R. Jadad,et al.  Can pain be managed through the Internet? A systematic review of randomized controlled trials , 2011, PAIN®.

[43]  G. Andersson,et al.  Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience , 2008 .

[44]  G. Brattberg.  Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial , 2006, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[45]  G. Andersson.  Using the Internet to provide cognitive behaviour therapy. , 2009, Behaviour research and therapy.

[46]  Paul Karoly,et al.  A randomized controlled evaluation of an online chronic pain self management program , 2012, PAIN.

[47]  Steven C Hayes,et al.  ScholarWorks @ Georgia State University , 2018 .

[48]  S. Hayes,et al.  Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change , 1999 .

[49]  D. Altman,et al.  Analysing controlled trials with baseline and follow up measurements , 2001, BMJ : British Medical Journal.

[50]  M. Zvolensky,et al.  The role of experiential avoidance in acute pain tolerance: a laboratory test. , 2006, Journal of behavior therapy and experimental psychiatry.

[51]  Per Carlbring,et al.  Internet vs. paper and pencil administration of questionnaires commonly used in panic/agoraphobia research , 2007, Comput. Hum. Behav..

[52]  G. Andersson,et al.  Internet-administered cognitive behavior therapy for health problems: a systematic review , 2007, Journal of Behavioral Medicine.

[53]  C. Eccleston,et al.  Coping or acceptance: what to do about chronic pain? , 2003, Pain.

[54]  S. Hayes,et al.  Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash , 2010, European journal of pain.

[55]  Christopher Eccleston,et al.  Acceptance of chronic pain: component analysis and a revised assessment method , 2004, Pain.

[56]  A. Barak,et al.  A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions , 2008 .

[57]  Francis J. Keefe,et al.  The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment , 1983, Pain.

[58]  Michael J. Constantino,et al.  Catastrophizing, depression and pain-related disability. , 2011, General hospital psychiatry.

[59]  Gerhard Andersson,et al.  Controlled trial of Internet-based treatment with telephone support for chronic back pain , 2004, Pain.