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The mediating role of acceptance in multidisciplinary cognitive behavioral therapy for chronic pain

Åkerblom, Sophia LU ; Perrin, Sean LU ; Rivano, Marcelo LU and McCracken, Lance (2015) In Journal of Pain 16(7). p.606-615
Abstract
Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify

treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants

attended a... (More)
Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify

treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants

attended a five-week outpatient multidisciplinary program with self-report data collected at assessment, post-treatment, and at 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to three outcomes: pain interference, pain intensity, and depression. Results indicate that effect sizes for the treatment were within the ranges reported in the CBT for pain literature. Pain-related acceptance was not related to pain intensity, which is in line with past empirical evidence and the treatment objectives in Acceptance and Commitment Therapy (ACT). Otherwise, pain-related acceptance was the strongest mediator across the different indices of outcome. Accumulating results like these

suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome. Potential mediators of outcome in a CBT-based treatment for adult chronic pain were investigated using multilevel structural equation modeling. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment. These data may help clinicians and researchers better understand processes of change and improve the choice and development of treatment methods. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acceptance, Acceptance and commitment therapy (ACT), cognitive behavioural therapy (CBT), chronic pain, mediator, multilevel structural equation modeling
in
Journal of Pain
volume
16
issue
7
pages
606 - 615
publisher
Elsevier
external identifiers
  • pmid:25840330
  • wos:000357767400002
  • scopus:84934348771
ISSN
1526-5900
DOI
10.1016/j.jpain.2015.03.007
language
English
LU publication?
yes
id
7ef858ff-0175-4ea4-8237-18d66499459c (old id 5142269)
date added to LUP
2015-03-02 14:52:12
date last changed
2017-09-10 03:13:24
@article{7ef858ff-0175-4ea4-8237-18d66499459c,
  abstract     = {Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify<br/><br>
treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants<br/><br>
attended a five-week outpatient multidisciplinary program with self-report data collected at assessment, post-treatment, and at 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to three outcomes: pain interference, pain intensity, and depression. Results indicate that effect sizes for the treatment were within the ranges reported in the CBT for pain literature. Pain-related acceptance was not related to pain intensity, which is in line with past empirical evidence and the treatment objectives in Acceptance and Commitment Therapy (ACT). Otherwise, pain-related acceptance was the strongest mediator across the different indices of outcome. Accumulating results like these<br/><br>
suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome. Potential mediators of outcome in a CBT-based treatment for adult chronic pain were investigated using multilevel structural equation modeling. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment. These data may help clinicians and researchers better understand processes of change and improve the choice and development of treatment methods.},
  author       = {Åkerblom, Sophia and Perrin, Sean and Rivano, Marcelo and McCracken, Lance},
  issn         = {1526-5900},
  keyword      = {acceptance,Acceptance and commitment therapy (ACT),cognitive behavioural therapy (CBT),chronic pain,mediator,multilevel structural equation modeling},
  language     = {eng},
  number       = {7},
  pages        = {606--615},
  publisher    = {Elsevier},
  series       = {Journal of Pain},
  title        = {The mediating role of acceptance in multidisciplinary cognitive behavioral therapy for chronic pain},
  url          = {http://dx.doi.org/10.1016/j.jpain.2015.03.007},
  volume       = {16},
  year         = {2015},
}