Processes of change in Acceptance and Commitment Therapy and Applied Relaxation for long-standing pain
Abstract
BACKGROUND: The utility of cognitive behavioural (CB) interventions for chronic pain has been supported in numerous studies. This includes Acceptance and Commitment Therapy (ACT), which has gained increased empirical support. Previous research suggests that improvements in pain catastrophizing and psychological inflexibility are related to improvements in treatment outcome in this type of treatment. Although a few studies have evaluated processes of change in CB-interventions, there is a particular need for mediation analyses that use multiple assessments to model change in mediators and outcome over time, and that incorporate the specified timeline between mediator and outcome in the data analytic model. METHODS: This study used session-to-session assessments to evaluate if psychological inflexibility, catastrophizing, and pain intensity mediated the effects of treatment on pain interference. Analyses were based on data from a previously conducted randomized controlled trial (n = 60) evaluating the efficacy of ACT and Applied Relaxation (AR). A moderated mediation model based on linear mixed models was used to analyse the data. RESULTS: Neither catastrophizing nor pain intensity mediated changes in pain interference for any of the treatments. In contrast, psychological inflexibility mediated effects on outcome in ACT but not in AR. CONCLUSIONS: Results add to previous findings illustrating the role of psychological inflexibility as a mediator in ACT.
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Previous studies have shown that psychological inflexibility is a more important mediator of changes in pain interference during ACT than, e.g., pain intensity.
“Previous studies have shown that psychological inflexibility is a more important mediator of changes in pain interference during ACT than, e.g., pain intensity [12].”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [12]
The pattern of PII and PIPS improving significantly over time during ACT while pain intensity did not is in line with previous studies on treatment effects published by our group.
“The pattern found, of PII and PIPS improving significantly over time during ACT while pain intensity did not, is in line with the previous studies on treatment effects published by our group [12,13,31,39,40,41,42].”
From Baseline Pro-Inflammatory Cytokine Levels Moderate Psychological Inflexibility in Behavioral Treatment for Chronic Pain (2022) · cites this paper as [12]
Psychological flexibility is a key component in the change process in ACT treatment, mediating the treatment effect on pain interference, catastrophizing and anxiety.
“psychological flexibility is a key component in the change process in ACT treatment, mediating the treatment effect on pain interference, catastrophizing and anxiety (Wicksell et al., 2011; Kemani et al., 2016)”
From Evaluation of a Novel Psychological Intervention Tailored for Patients With Early Cognitive Impairment (PIPCI): Study Protocol of a Randomized Controlled Trial (2020) · cites this paper as Kemani et al., 2016
Improvements in psychological flexibility skills may take time, mostly seen after three to six months beyond completion of intervention, and may not be immediately noticeable.
“Yet improvements in psychological flex ibility skills may take time- mostly seen after three to six months beyond the completion of intervention- and may not be immediately noticeable (Kemani, Hesser, Olsson, Lekander, & Wicksell, 2016; Lin, Klatt, McCracken, Baumeister, 2018; McCracken & Gutirrez-Martinez, 2011; Vowles, Witkiewitz, Levell, Sowden, Ashworth, 2017; Vasiliou et al.,”
From An ACT self-help intervention for adults with a visible difference in appearance: A pilot feasibility and acceptability randomized controlled study. (2023) · cites this paper as Kemani, Hesser, Olsson, Lekander, & Wicksell, 2016
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“Psychological inflexibility was related to inflammatory levels in the previous study [25], and we investigated pain interference as an outcome variable in this study, as pain interference has been shown to be related to changes in psychological inflexibility in previous research [12].”
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Self-citationProfiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain
Kruger, E., Ashworth, J., Sowden, G., Hickman, J., & Vowles, K. E. (2022) · The Journal of Pain · doi:10.1016/j.jpain.2022.06.005 · Cited by 5 · see citing works
- Authors
- Kemani, M. K., Hesser, H., Olsson, G. L., Lekander, M., & Wicksell, R. K.
- Affiliations
- Karolinska University Hospital (SE)
- Linköping University (SE)
- Stockholm University (SE)
- Corresponding author
- Kemani, M.K.
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2015-12-18
- Volume
- 20
- Issue
- 4
- Pages
- 521-531
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2214858340
- Cited by
- 39
- References
- 52
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 6 · 2022: 6 · 2021: 5 · 2020: 4 · 2019: 9 · 2018: 3 · 2017: 1 · 2016: 2 · 2015: 1
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kommunfullmäktige, Stockholms Stad
- Karolinska Institutet
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- acceptance and commitment therapy, applied relaxation, chronic pain, change processes, psychological inflexibility, pain catastrophizing, pain intensity, pain interference, moderated mediation, cognitive-behavioural intervention
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Pain Measurement, Relaxation Therapy, Treatment Outcome, Catastrophization, Chronic Pain, Acceptance and Commitment Therapy
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