Group Acceptance and Commitment Therapy for chronic pain: The effects of process variables

This study was conducted to investigate the effects of a group acceptance and commitment therapy(ACT) intervention for patients with chronic pain in comparison to a control group receiving treatment as usual. We also tried to examine whether pain acceptance and pain catastrophizing mediates the outcome of treatment. A total of 22 patients with chronic pain in a university tertiary rehabilitation center located in Daejeon, Korea were included in the study and randomized to either 8 weekly group sessions of ACT or to a control group receiving treatment as usual(TAU). To assess program effectiveness, pain acceptance, pain catastrophizing, depression, anxiety, physical function and mental function were assessed in the four stages (pre, post and follow-up after 1-3 months). As a result of the study, the ACT group showed significantly less pain catastrophizing and anxiety than the TAU group, and the pain acceptance and mental function level were improved. This treatment effect was maintained after 3 months of program termination, and the effect size varied from small size to large size. In addition, mediation analysis showed that pain catastrophizing mediates changes in anxiety and mental function levels. Pain acceptance did not show any mediating effect. These results suggest that ACT is not only more flexible in coping with persistent unpleasant pain experiences, but also is an effective psychological intervention that can successfully adapt to an individual's life despite pain.

한국어

이 연구는 만성통증 환자를 대상으로 집단 수용전념치료(Acceptance and Commitment Therapy; ACT)를 실시하 여 효과성을 검증하고, 치료과정변인(통증수용, 통증파국화)이 치료결과를 매개하는지 확인했다. 대전광역 시 소재 대학병원의 만성통증 환자를 대상으로 의학적 치료를 병행하는 ACT집단과 의학적 치료만을 받는 통제집단에 무선할당을 실시하여 ACT집단 11명, 통제집단 11명 총 22명의 자료가 분석에 포함되었다. ACT 프로그램은 총 8회기로 진행되었으며, 효과검증을 위해 사전, 사후, 종결 후 1․3개월에 통증수용, 통증파 국화, 우울, 불안 및 적응기능(신체기능, 정신기능)을 측정했다. 연구 결과, ACT집단이 통제집단에 비해 통 증파국화 및 불안 수준이 감소했고, 통증수용 및 정신기능이 향상되었으며 이러한 치료효과는 프로그램 종 결 3개월 후에도 유지되었다. 또한 매개분석 결과, 통증파국화가 불안 및 정신기능의 변화를 부분매개하는 것으로 나타났다. 이러한 결과는 ACT가 만성통증 환자에게 효과적인 심리적 개입일 뿐만 아니라 통증파국 화의 감소가 불안 및 정신기능과 같은 환자의 기능 개선을 촉진하는 중요한 치료기제임을 시사한다.