Thorsell Cederberg, J. (2017) Acceptance for persons suffering from pain. Evaluation of acceptance-based interventions for adults with chronic pain and children with cancer experiencing acute pain. (Doctoral Dissertation). Uppsala University, Sweden.

It is increasingly clear that pain and emotions are closely interconnected. Pain does not only

cause psychological distress, but psychological distress also amplifies pain through neurological

mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging

the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts

increased pain tolerance and decreased pain intensity and discomfort in experimentally induced

pain and improved physical and psychosocial functioning for persons with chronic pain.

The overall aim of this thesis was to evaluate acceptance-based interventions for persons

suffering from pain.

In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic

pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with

life, physical functioning and pain intensity for the ACT group. Both the ACT and the control

group improved regarding depression and anxiety. In Study II the mediating effect of acceptance

for treatment change was evaluated, using data from Study I (n=64). The results showed indirect

effects of treatment via acceptance for physical functioning but not for satisfaction with life.

In Studies III and IV, instruments to measure psychological flexibility in relation to pain were

developed for children with cancer, and their parents respectively, using factor analysis. The

results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for

the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention

was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during

cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure

exercise. All participants reported reduced discomfort of pain, and three of the participants

reported reduced pain intensity.

The results suggest that a manualised ACT-based self-help intervention is a valuable addition

to the treatment repertoire for persons with chronic pain and that acceptance may mediate the

effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in

the context of acute pain in children with cancer are now available, although further validation

is needed. Lastly, the results indicate that an acceptance-based intervention may help children

undergoing cancer treatment to cope with pain.