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Limited effects of phone coaching in an RCT of online self-guided acceptance and commitment therapy for chronic pain

APA Citation

Robinowitz, E.P., Ripley, G., Levin, M.E., Allen, P.A., & Delahanty, D.L. (2024). Limited effects of phone coaching in an RCT of online self-guided acceptance and commitment therapy for chronic pain. Journal of Contextual Behavioral Science, 34, 100828. https://doi.org/10.1016/j.jcbs.2024.100828

Publication Topic
ACT: Empirical
Publication Type
Article
Language
English
Abstract

Introduction

Over 80% of patients with Chiari Malformation (CM) struggle with moderate to severe disability due to neck pain and headaches. Self-guided online Acceptance and Commitment Therapy (ACT) is efficacious in addressing chronic pain. However, it is unclear whether adjunctive weekly phone coaching (a cost- and labor-intensive component of the intervention) contributes to, or provides additional benefit to, ACT's success.

Method

This study randomized 112 participants with CM to ACT + Coaching, ACT-Only, or WC (WC) groups. Participants completed a baseline survey, weekly assessments, a self-guided online ACT intervention, and a one-month follow-up survey. Primary outcomes were psychological flexibility (PF) and chronic pain acceptance; secondary outcomes included pain intensity, pain interference, depression, and anxiety.

Results

There were no differences between the ACT + Coaching and ACT-Only groups on chronic pain acceptance, pain interference, or anxiety; however, there was a small but statistically significant effect favoring ACT + Coaching for depression and PF. Compared to the WC group, both the ACT + Coaching and ACT-Only groups significantly improved in chronic pain acceptance, and anxiety. Adherence was high (91% completed all sessions) and equivalent between conditions. Participants reported coaching was helpful and important, but there were no group differences in intervention satisfaction.

Discussion

There were no differences between treatment groups on most outcomes, intervention satisfaction, engagement, or adherence. Online ACT without adjunctive phone coaching may be a cost- and time-efficient option to address chronic pain acceptance and anxiety, but additional research is needed to establish and improve efficacy for other outcomes.

Clinical Trials Registration

NCT05581472
To find the full text version of this article and other JCBS articles (as well as download a full text pdf.), ACBS members need to login and then access the JCBS ScienceDirect homepage here. Click here if you'd like to learn more about joining ACBS.

Comparing the Efficacy of ACT and Solution Focused Brief Therapy on Unconditional Self- Acceptance and Pain Anxiety among Patients with Breast Cancer

APA Citation

Baghernezhad, O., Hasanzadeh, R., & Abbasi, G. (2019). Comparing the Efficacy of ACT and Solution Focused Brief Therapy on Unconditional Self- Acceptance and Pain Anxiety among Patients with Breast Cancer. The Journal of Community Health, 6(3), 253-263. https://doi.org/10.32598/ajnpp.4.3.320

Publication Topic
ACT: Empirical
Publication Type
Article
RCT
Language
English
Keyword(s)
Acceptance and commitment therapy, Catastrophization, Chronic pain, Psychotherapy, ACT
Abstract

Introduction: Breast cancer affects the various aspects of mental health, aggravates mental stress, and challenges the person’s mental health because of the disturbance in the mental image of the subjects. It can also affect the mental status of these individuals. 
Objectives: The aim of the present study was to compare the efficacy of Acceptance and Commitment Therapy (ACT) and Solution-Focused Brief Therapy (SFBT) on pain catastrophizing and the psychological well-being of patients with breast cancer.
Materials and Methods: The present quasi-experimental study used a pretest-Post-test design with the control group. The statistical population of the present study included all patients with breast cancer referring to health centers and hospitals of Babol and Babolsar in 2018. A sample of 45 people was selected by a random sampling method, and 3 groups of 15 women with breast cancer were randomly divided into ACT, SFBT, and control groups. ACT and SFBT were performed for the experimental groups and no intervention was performed in the control group. To obtain the data, the pain catastrophizing scale and psychological well-being questionnaire were used. The data were analyzed by SPSS V. 23, using the multivariate analysis of covariance test.
Results: ACT and SFBT affected the pain catastrophizing (F=47.01, P<0.001) and psychological well-being (F=79.34, P<0.001) of patients with breast cancer. The ACT was more effective than the SFBT (P<0.01).
Conclusion: Both the ACT and SFBT had a desirable effect on reducing pain catastrophizing and increasing psychological well-being in patients with breast cancer, but the ACT was more effective than the SFBT.

Vilardaga, Davies, Vowles, & Sullivan. 2020

APA Citation

Vilardaga, R., Davies, P. S., Vowles, K. E., & Sullivan, M. D. (2020). Theoretical grounds of Pain Tracker Self Manager: An Acceptance and Commitment Therapy digital intervention for patients with chronic pain. Journal of Contextual Behavioral Science, 15, 172-180.

Publication Topic
ACT: Conceptual
Publication Type
Article
Language
English
Keyword(s)
Chronic pain, Digital health, Acceptance and commitment therapy, Health coaching, Pain psychology
Abstract

Objective
To report the theoretical basis and design of a novel digital Acceptance and Commitment Therapy (ACT) intervention for people with chronic pain, the Pain Tracker Self Manager (PTSM), which had promising efficacy in a recent pilot trial.

Methods
Content development by a multidisciplinary panel of experts in psychiatry, clinical psychology, nursing and social work, with feedback from a group of patients with chronic pain and their providers. Materials included paper-based sketching of a story character, visual metaphors, and a series of stories designed to deliver the theory-based components of our behavioral intervention.

Results
This development and design process resulted in 4 digitally delivered clinical modules that combine visual and verbal cues. In addition, it generated a series of novel ACT metaphors specifically tailored to patients with chronic pain: Pain: Injury vs. Threat, Life Navigation System, The Fog of Pain, and Get Rhythm. Consistent with ACT theory and the contextual behavioral science framework, PTSM utilized: perspective-taking, values clarification, acceptance strategies, and nursing and psychological care recommendations.

Discussion
Reports of the design and theoretical basis of digital health interventions are highly needed to increase the rigor of their development process and more progressively advance our body of knowledge. This pilot study developed and tested a series of ACT metaphors that can be readily used by ACT clinicians working with this population.

Conclusion
PTSM is a novel digital ACT intervention for patients with chronic pain with features directly linked to ACT processes and theory.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.

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