Psychological flexibility, acceptance and commitment therapy, and chronic pain

Most clinicians and researchers with interest in cognitive behavioral therapy (CBT) will recognize a trend in current treatment developments, including in the area of chronic pain. These developments are loosely called mindfulness and acceptance-based treatments, although it is possible to be more precise about these developments, their theoretical models and treatment processes. One of the specific therapies here is acceptance and commitment therapy (ACT), based on the psychological flexibility model. ACT extends from previous developments of CBT and integrates many of the current CBT-related variables into a smaller number of core therapeutic processes. There are now 10 published RCTs that support the efficacy of ACT for chronic pain and many empirical studies of specific processes from the psychological flexibility model. There is a remarkable success story here that has played out over a rather short period. At the same time there are challenges for the future: establishing appropriate outcome measures for ACT trials, finding ways to more comprehensively assess therapy processes, meeting the challenge of wide access, and treatment fidelity. This article will provide a brief review of the evidence on ACT for chronic pain and will discuss current challenges and opportunities for progress.