Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

2011 ◽  
Vol 49 (4) ◽  
pp. 267-274 ◽  
Author(s):  
Lance M. McCracken ◽  
Olga Gutiérrez-Martínez
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Psychological Flexibility ◽  
Processes Of Change ◽  
Commitment Therapy ◽  
Acceptance And Commitment

scholarly journals P120 Development and analysis of acceptance and commitment therapy (ACT)-informed group and 1-1 psychological interventions for a rheumatology population

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Lorraine Maher-Edwards ◽  
Alexandra Quigley ◽  
David Gillanders ◽  
Nora Ng
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Psychological Flexibility ◽  
Evidence Base ◽  
Effect Sizes ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
One To One

Abstract Background Psychiatric comorbidities are common in patients living with rheumatological conditions and are associated with poorer health outcomes and treatment response. The evidence-base for psychological intervention in this population is scarce. Acceptance- and mindfulness-based cognitive therapies are of increasing popularity. Acceptance and Commitment Therapy (ACT) is a psychological therapy with a robust evidence-base for mood disorders and long-term health conditions, in particular in chronic pain populations. ACT aims to help clients to develop skills to identify and let go of unhelpful patterns of symptom control and avoidance so that they can move towards important life areas (values) and goals. Research has consistently shown that higher levels of acceptance (a component of psychological flexibility) in chronic illness is associated with better quality of life and emotional well-being. No studies have looked at the effects of ACT-based interventions in rheumatology. This study aimed to: Develop and pilot I) a 6-week group and II) a brief (up to 6 sessions) one to one intervention based on Acceptance and Commitment Therapy (ACT) in a rheumatology population. Outcomes were evaluated using patient satisfaction data, qualitative feedback and quantitative outcomes using a range of questionnaires measuring mood, quality of life and psychological flexibility. Methods Patients attending a rheumatology psychology service received either group OR brief one to one intervention delivered by a qualified psychologist. Group consisted of 6 sessions; each session was 3 hours (18 hours total). The brief one to one intervention consisted of up to 6 one-hour face to face sessions (max 6 hours total). A range of outcome measures were administered pre- and post-treatment. Paired t-tests were conducted, and the Jacobson and Truax method used to calculate Reliable Change Index and Clinically Significant Change criteria. Effect sizes were calculated using Cohens’ d. For comparison published data in chronic pain populations were used. Results Patients responded well to ACT-based interventions: with improvements in mood, psychological flexibility and quality of life. All effect sizes were large and compared favourably to published trials in chronic pain populations. Group participants showed significant improvements in depression and psychological flexibility pre- to post- treatment. On the other hand, participants who received the brief one to one intervention showed significant improvements on all measures. Overall those who had group therapy showed smaller improvements in outcome measures, rated themselves as less improved and were less satisfied with their therapy than those that received up to 6 sessions of individualised therapy. Conclusion A brief one to one intervention of up to 6 sessions of ACT-based psychological therapy conferred good benefit for a rheumatology population and outperformed group therapy. More studies are needed to understand whether this effect is generalisable and longer-term outcomes. Disclosures L. Maher-Edwards None. A. Quigley None. D. Gillanders None. N. Ng None.

Acceptance and Commitment Therapy for the Treatment of Chronic Pain and Coexisting Depression: A Single-Case Study

2019 ◽  
Vol 18 (4) ◽  
pp. 254-269 ◽  
Author(s):  
Charlie N. Knowlton ◽  
Alena Kryvanos ◽  
Megan Poole ◽  
Michael Christopher ◽  
Theresa Lafavor
Keyword(s):  
Chronic Pain ◽  
Acceptance And Commitment Therapy ◽  
Single Case ◽  
Psychological Flexibility ◽  
Single Case Study ◽  
Reliable Change ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Patient Reported

Pain resulting from chronic medical conditions (CMCs) can create debilitating effects globally across domains of functioning in the lives of those it impacts. There currently remain no treatment options to eliminate associated pain entirely, leaving care efforts often to manage the disabling effects and consequential depression. Acceptance and commitment therapy (ACT) has recently been introduced as an alternative treatment approach, emphasizing the commitment to engage in actions that contribute to a fulfilling life even in the face of disability through the fostering of psychological flexibility. For patients who do not respond to traditional psychological approaches, ACT may offer a sensible substitute. This single-case study delineates ACT for chronic pain and comorbid depression using standardized and patient-centered outcome measures across areas of general symptom functioning, therapeutic processes, and flexibility surrounding pain associated with CMCs. Clinical significance and reliable change were calculated using the reliable change index, in conjunction with patient-reported behavioral engagement and subjective assessment. Results indicate significant improvement across areas of depression, psychological flexibility, and flexibility in relating to pain endured from CMCs. The patient reported perceived improvement in quality of life and no longer viewed herself as a “professional patient.” This case study illustrates the potential of shifting from restraining and extinguishing symptoms to fostering a stance of willingness to reengage in a valued life while continuing to live with CMCs.

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