Outcome Studies: Chronic Pain
- Greco, L. A., Blomquist, K. K., Acra, S., & Moulton, D. (2006). Acceptance and Commitment Therapy for Adolescents with Functional Abdominal Pain: Results of a Pilot Investigation. Manuscript submitted for publication.
- Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial. Pain, 141(3), 248-257.
- Vowles, K. E., Wetherell, J. L., & Sorrell, J. T. (2009). Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognitive and Behavioral Practice, 16, 49-58.
- Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76, 397-407.
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Wicksell, R.K., Ahlqvist, J., Bring, A., Melin, L. & Olsson, G.L. (2008). Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial. Cognitive Behaviour Therapy
Included people (adults) with longstanding pain due to whiplash (WAD). A 10-session protocol was compared with a wait list control group, and found significant improvements following treatment in functioning and life satisfaction, as well as in psychological flexibility (as measured with PIPS).
- McCracken, L. M., MacKichan, F., & Eccleston, C. (2007). Contextual cognitive-behavioral therapy for severely disabled chronic pain sufferers: Effectiveness and clinically significant change. European Journal of Pain, 11, 314-322.
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Wicksell R.K, Melin, L. & Olsson, G.L. (2007). Exposure and acceptance in the rehabilitation of children and adolescents with chronic pain.European Journal of Pain, 11, 267-274.
Open trial with 14 adolescents. Good outcomes that continue to improve through follow up.
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McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335-1346.
108 chronic pain patients with a long history of treatment are followed through an ACT-based 3-4 week residential treatment program. Measures improved from initial assessment to pre-treatment on average only 3% (average of 3.9 month wait), but improved on average 34% following treatment. 81% of these gains were retained through a 3 month follow up. Changes in acceptance predicted positive changes in depression, pain related anxiety, physical disability, psychosocial disability, and the ability to stand. Positive outcomes were also seen in a timed walk, decreased medical visits, daily rest due to pain, pain intensity, and decreased pain medication use.
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Dahl, J., Wilson, K. G., & Nilsson, A. (2004). Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behavior Therapy, 35, 785-802.
A small randomized controlled trial shows that a four hour ACT intervention reduced sick day usage by 91% over the next six months compared to treatment as usual in a group of chronic pain patients at risk for going on to permanent disability.
Mediation Analyses
- Wicksell, R. K., Olsson, G. L., Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in acceptance and commitment therapy for patients with chronic pain following whiplash. European Journal of Pain.
Case Studies: Chronic Pain
- Kleen, M., & Jaspers, J. P. C. (2007). Women should not be allowed to run. Acceptance and commitment therapy (ACT) with a pain disorder. Translated from: Vrouwen horen niet hard te lopen. Acceptance and commitment therapy (ACT) bij een pijnstoornis. Gedragstherapie, 40, 7-26.
- Wicksell, R. K., Dahl, J., Magnusson, B., & Olsson, G. L. (2005). Using Acceptance and Commitment Therapy in the rehabilitation of an adolescent female with chronic pain: A case example. Cognitive and Behavioral Practice, 12, 415-423. Shows dramatic improvement with a 14 year old chronic pain patient using a values focused ACT protocol.
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Luciano, C., Visdómine, J.C., Gutiérrez, O., & Montesinos, F. (2001). ACT (Acceptance and Commitment Therapy) and chronic pain. Análisis y Modificación de Conducta, 27, 113, 473-502.
Describes the use of ACT in the treatment of chronic pain and shows resulting data. Case study.
Micro/Component Studies: Chronic Pain
- Vowles, K., McNeil, D.W., Bates, M., Gallimore, P. & McCall, C. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38, 412-425.
- A number of other micro/component studies have examined the impact of brief ACT interventions on performance in pain inducing preparations and are listed here.
Correlational Studies: Chronic Pain
- McCracken, L. M., & Zhao-O'Brien, J. (2010). General psychological acceptance and chronic pain: There is more to accept than pain itself. European Journal of Pain, 14, 170-175.
- McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance and values in patients with chronic pain. Health Psychology, 27, 215-220.
- Vowles, K. E., McCracken, L. M., & Eccleston, C. (2008). Patient functioning and catastrophizing in chronic pain: The mediating effects of acceptance. Health Psychology, 27, S136-S143.
- Wicksell, R. K., Renofalt, J., Olsson, G. L., Bond, F. W., & Melin, L. (2008). Avoidance and cognitive fusion - Central components in pain related disability? Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS). European Journal of Pain, 12, 491-500.
- McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63-69.
- McCracken, L. M., & Vowles, K. E. (2007). Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument.Journal of Pain, 8, 339-349.
- McCracken, L. M., Vowles, K. E., & Gauntlett-Gilbert, J. (2007). A prospective investigation of acceptance and control-oriented coping with chronic pain. Journal of Behavioral Medicine, 30, 339-349.
- Vowles, K. E., McCracken, L. M., & Eccleston, C. (2007). Processes of behavior change in interdisciplinary treatment of chronic pain: Contributions of pain intensity, catastrophizing, and acceptance.European Journal of Pain, 11, 779-787.
- McCracken, L. M. (2006). Toward a fully functional, flexible, and defused approach to pain in young people. Cognitive and Behavioral Practice, 13, 182-184.
- McCracken, L. M., & Eccleston, C. (2006). A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. European Journal of Pain, 10(1), 23-29.
- McCracken, L. M., & Yang, S. (2006). The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain, 123, 137-145.
- McCracken, L. M. (2005). Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain, 113, 155-159.
- McCracken, L. M., & Eccleston, C. (2005). A prospective study of acceptance of pain and patient functioning with chronic pain. Pain, 118, 164-169.
- McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method.Pain, 107, 159-166.
- McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204.
- Viane, I., Crombez, G., Eccleston, C., Poppe, C., Devulder, J., Van Houdenhove, B., & De Corte, W.(2003). Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal. Pain, 106(1/2), 65-73.
- McCracken, L. M., Spertus, I. L. , Janeck, A. S., Sinclair, D., & Wetzel, F. T. (1999). Behavioral dimensions of adjustment in persons with chronic pain: Pain-related anxiety and acceptance. Pain, 80, 283-289.
- McCracken, L. M. (1999). Behavioral constituents of chronic pain acceptance: Results from factor analysis of the Chronic Pain Acceptance Questionnaire. Journal of Back & Musculoskeletal Rehabilitation, 13, 93-100.
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McCracken, L. M. (1998). Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain, 74, 21-27.
This study is based on a pain related early version of the AAQ. Greater acceptance of pain was associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status. A relatively low correlation between acceptance and pain intensity showed that acceptance is not simply a function of having a low level of pain. Regression analyses showed that acceptance of pain predicted better adjustment on all other measures of patient function, independent of perceived pain intensity. This work is replicated, refined and extended in McCracken, L. M. & Eccleston, C. (2003). Coping or acceptance: What to do about chronic pain. Pain, 105, 197-204. and McCracken, L. M. , Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain: Component analysis and a revised assessment method. Pain, 107, 159-166.