A randomized controlled trial comparing two guided self-help Acceptance and Commitment Therapy formats to education on pain

Acceptance and Commitment Therapy (ACT) is an evidence-based treatment for chronic pain, but accessibility remains a major challenge. Self-help interventions are promising as they offer a cost-effective solution and can be widely accessible, but no study has yet directly compared different formats of ACT self-help for chronic pain. Furthermore, most studies conducted so far have not compared to an active control condition. This study aimed to evaluate the effectiveness of guided self-help interventions (internet-delivered, bibliotherapy) based on ACT in comparison to an education intervention among adults from the community living with chronic pain. Participants (N = 297) were randomly assigned to an internet-delivered ACT condition, an ACT-based bibliotherapy condition, or an active control condition receiving education on pain through online pamphlets. Participants completed questionnaires at baseline, after the 9-week intervention, and at 3- and 6-month follow-ups. The primary outcome was pain disability at post-intervention and secondary outcomes were depression, anxiety, and quality of life. Results of mixed linear models showed statistically significant main effects of time for pain disability (F = 15.15, p = 0.000), depression (F = 6.82, p = 0.000), anxiety (F = 4.88, p = 0.003) and quality of life (F = 6.85, p = 0.000) for all three interventions. Findings suggest all three self-help formats can lead to reductions in pain disability, depression, anxiety, and improvements in quality of life. These findings have important implications for accessibility of care. Limitations and future directions will be discussed.

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