Psychological flexibility and catastrophizing as associated change mechanisms during online Acceptance & Commitment Therapy for chronic pain
Open accessAbstract
The underlying mechanisms of the effectiveness of cognitive behavioural interventions for chronic pain need further clarification. The role of, and associations between, pain-related psychological flexibility (PF) and pain catastrophizing (PC) were examined during a randomized controlled trial on internet-based Acceptance & Commitment Therapy (ACT) for chronic pain. We assessed (1) the unique and combined indirect effects of PF and PC on outcomes, and (2) the causality of relations between PF, PC and the primary outcome pain interference in daily life (MPI) during ACT. A total of 238 pain sufferers were allocated to either ACT, a control condition on Expressive Writing, or a waiting list condition. Non-parametric cross-product of coefficients mediational analyses and cross-lagged panel designs were applied. Compared to control conditions, both baseline to post-intervention changes in PF and PC seemed to uniquely mediate baseline to three-month follow-up changes in pain interference and psychological distress. Only PF mediated changes in pain intensity. Indirect effects were twice as large for PF (κ2 = .09-.19) than for PC (κ² PCS = .05-.10). Further assessment of changes during ACT showed, however, that only PF, and not PC, predicted subsequent changes in MPI, while early and late changes in both PF and PC predicted later changes in each other. In conclusion, only PF functioned as a direct, causal working mechanism during ACT, with larger indirect effects that occurred earlier than changes in PC. Additionally, PC may function as an indirect mechanism of change during ACT for chronic pain via its direct influence on PF.
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The number of studies doing formal mediational analyses of psychological flexibility and mindfulness in web-based ACT interventions is small.
“For mediators of change, the number of studies doing formal mediational analyses of psychological flexibility and mindfulness in web-based ACT interventions is small [7, 30].”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [30]
The Introduction (page unavailable) says knowledge from other randomized trials of mediating mechanisms in ACT for chronic pain is lacking, and describes this paper’s analysis of psychological flexibility in an internet-based intervention. That supports a scarcity claim in the narrower chronic-pain context, but the paper does not establish that few web-based ACT studies formally analyze both psychological flexibility and mindfulness as mediators. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPrevious studies have found a mediating relationship between psychological flexibility and improved psychological outcomes in ACT interventions.
“Previous studies have found a mediating relationship between psychological flexibility and improved psychological outcomes in ACT interventions (Lin et al., 2018; Trompetter et al., 2015).”
From ACT2COPE: A pilot randomised trial of a brief online acceptance and commitment therapy intervention for people living with chronic health conditions during the COVID-19 pandemic (2023) · cites this paper as Trompetter et al., 2015
Psychological flexibility is a mediator of change in ACT for reducing pain-associated disability.
“Psychological flexibility has been proposed as a mediator of change, specifically in ACT, for reducing pain-associated disability [25,29].”
The Trompetter et al. mediation finding further substantiates that psychological flexibility is a core component of the ACT model.
“In the study of Trompetter et al. [30] improvements in psychological flexibility mediated the effect of web-based ACT on psychological distress, further substantiating that psychological flexibility is a core component of the ACT model.”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [30]
In the study of Trompetter et al., improvements in psychological flexibility mediated the effect of web-based ACT on psychological distress.
“In the study of Trompetter et al. [30] improvements in psychological flexibility mediated the effect of web-based ACT on psychological distress, further substantiating that psychological flexibility is a core component of the ACT model.”
From How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms (2016) · cites this paper as [30]
Pain-specific expectations have been identified as one of the core mechanisms underlying placebo analgesia.
“Pain-specific expectations have also been identified as one of the core mechanisms underlying placebo analgesia 365, 366.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [366]
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117 · see citing works
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139 · see citing works
SPSS and SAS procedures for estimating indirect effects in simple mediation models
Preacher, K. J., & Hayes, A. F. (2004) · Behavior Research Methods, Instruments, & Computers · doi:10.3758/bf03206553 · Cited by 17,383 · see citing works
The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227 · see citing works
Introduction to mediation, moderation, and conditional process analysis :
Hayes, A. F., & names (2015) · Cited by 7,004 · see citing works
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · see citing works
Analysis of Incomplete Multivariate Data
Schafer, J. L. (1997) · doi:10.1201/9781439821862 · Cited by 6,012 · see citing works
Analysis of Incomplete Multivariate Data
Booth, D. E., & Schafer, J. L. (2000) · Technometrics · doi:10.2307/1271466 · Cited by 5,627 · see citing works
Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
Vlaeyen, J. W. S., & Linton, S. J. (2000) · Pain · doi:10.1016/s0304-3959(99)00242-0 · Cited by 4,931 · see citing works
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., Kerns, R. D., Stucki, G., Allen, R. R., Bellamy, N., et al. (2005) · Pain · doi:10.1016/j.pain.2004.09.012 · Cited by 3,732 · see citing works
Core outcome domains for chronic pain clinical trials: IMMPACT recommendations
Turk, D. C., Dworkin, R. H., Allen, R. R., Bellamy, N., Brandenburg, N., Carr, D. B., Cleeland, C., Dionne, R., Farrar, J. T., Galer, B. S., et al. (2003) · Pain · doi:10.1016/j.pain.2003.08.001 · Cited by 3,510 · see citing works
Preacher, K. J., & Kelley, K. (2011) · Psychological Methods · doi:10.1037/a0022658 · Cited by 3,060 · see citing works
Mediators and Moderators of Treatment Effects in Randomized Clinical Trials
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.10.877 · Cited by 2,562 · see citing works
Eysenbach, G. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e11 · Cited by 2,524 · see citing works
Writing About Emotional Experiences as a Therapeutic Process
Pennebaker, J. W. (1997) · Psychological Science · doi:10.1111/j.1467-9280.1997.tb00403.x · Cited by 2,486 · see citing works
Theoretical perspectives on the relation between catastrophizing and pain
Sullivan, M. J. L., Thorn, B., Haythornthwaite, J. A., Keefe, F., Martin, M., Bradley, L. A., & Lefebvre, J. C. (2001) · The Clinical Journal of Pain · doi:10.1097/00002508-200103000-00008 · Cited by 2,472 · see citing works
SPINHOVEN, P., ORMEL, J., SLOEKERS, P. P. A., KEMPEN, G. I. J. M., SPECKENS, A. E. M., & HEMERT, A. M. V. (1997) · Psychological Medicine · doi:10.1017/s0033291796004382 · Cited by 2,158 · see citing works
The West Haven-Yale Multidimensional Pain Inventory (WHYMPI)
Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985) · Pain · doi:10.1016/0304-3959(85)90004-1 · Cited by 2,128 · see citing works
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634 · see citing works
Veehof, M. M., Oskam, M.-J., Schreurs, K. M. G., & Bohlmeijer, E. T. (2011) · PAIN · doi:10.1016/j.pain.2010.11.002 · Cited by 792 · see citing works
Self-citationUnderstanding how and why psychotherapy leads to change
Kazdin, A. E. (2009) · Psychotherapy Research · doi:10.1080/10503300802448899 · Cited by 728 · see citing works
Treatment of chronic non-cancer pain
Turk, D. C., Wilson, H. D., & Cahana, A. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60402-9 · Cited by 716 · see citing works
Smeets, R. J. E. M., Vlaeyen, J. W. S., Kester, A. D. M., & Knottnerus, J. A. (2006) · The Journal of Pain · doi:10.1016/j.jpain.2005.10.011 · Cited by 629 · see citing works
Van Damme, S., Crombez, G., Bijttebier, P., Goubert, L., & Van Houdenhove, B. (2002) · Pain · doi:10.1016/s0304-3959(01)00463-8 · Cited by 579 · see citing works
Turner, J. A., Holtzman, S., & Mancl, L. (2007) · Pain · doi:10.1016/j.pain.2006.09.005 · Cited by 530 · see citing works
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., Solomon, B. C., Lehman, D. H., Liu, L., Lang, A. J., et al. (2011) · PAIN · doi:10.1016/j.pain.2011.05.016 · Cited by 508 · see citing works
Acceptance and Values-Based Action in Chronic Pain: A Study of Treatment Effectiveness and Process
Vowles, K. E., & McCracken, L. M. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.3.397 · Cited by 500 · see citing works
Leeuw, M., Goossens, M. E. J. B., van Breukelen, G. J. P., de Jong, J. R., Heuts, P. H. T. G., Smeets, R. J. E. M., Köke, A. J. A., & Vlaeyen, J. W. S. (2008) · Pain · doi:10.1016/j.pain.2007.12.009 · Cited by 393 · see citing works
Arbisi, P. A., & Ben‐Porath, Y. S. (1995) · Psychological Assessment · doi:10.1037/1040-3590.7.4.424 · Cited by 302 · see citing works
McCracken, L. M., & Gutiérrez-Martínez, O. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.004 · Cited by 283 · see citing works
Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T., & Andersson, G. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.02.010 · Cited by 281 · see citing works
Spinhoven, P., ter Kuile, M., Kole‐Snijders, A. M. J., Mansfeld, M. H., den Ouden, D., & Vlaeyen, J. W. S. (2004) · European Journal of Pain · doi:10.1016/j.ejpain.2003.08.003 · Cited by 274 · see citing works
Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2010.05.001 · Cited by 259 · see citing works
Trompetter, H. R., Bohlmeijer, E. T., Veehof, M. M., & Schreurs, K. M. G. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9579-0 · Cited by 255 · see citing works
Self-citationVowles, K. E., McCracken, L. M., & Eccleston, C. (2007) · European Journal of Pain · doi:10.1016/j.ejpain.2006.12.007 · Cited by 253 · see citing works
Boersma, K., Linton, S., Overmeer, T., Jansson, M., Vlaeyen, J., & de Jong, J. (2004) · Pain · doi:10.1016/j.pain.2003.03.001 · Cited by 228 · see citing works
Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreurs, K. M. G. (2012) · Psychological Medicine · doi:10.1017/s0033291711001206 · Cited by 209 · see citing works
Self-citationArch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H., & Craske, M. G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.007 · Cited by 194 · see citing works
Trompetter, H. R., ten Klooster, P. M., Schreurs, K. M. G., Fledderus, M., Westerhof, G. J., & Bohlmeijer, E. T. (2013) · Psychological Assessment · doi:10.1037/a0033813 · Cited by 184 · see citing works
Self-citationPatient Functioning and Catastrophizing in Chronic Pain: The Mediating Effects of Acceptance
Vowles, K. E., McCracken, L. M., & Eccleston, C. (2008) · Health Psychology · doi:10.1037/0278-6133.27.2(suppl.).s136 · Cited by 179 · see citing works
Wicksell, R. K., Lekander, M., Sorjonen, K., & Olsson, G. L. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.11.015 · Cited by 176 · see citing works
Burns, J. W., Glenn, B., Bruehl, S., Harden, R. N., & Lofland, K. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00029-9 · Cited by 174 · see citing works
A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.
McCracken, L. M., & Vowles, K. E. (2008) · Health Psychology · doi:10.1037/0278-6133.27.2.215 · Cited by 168 · see citing works
A Brief Web-Based Screening Questionnaire for Common Mental Disorders: Development and Validation
Donker, T., Straten, A. V., Marks, I., & Cuijpers, P. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1134 · Cited by 166 · see citing works
Vowles, K. E., Wetherell, J. L., & Sorrell, J. T. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.08.001 · Cited by 144 · see citing works
Psychological factors and treatment opportunities in low back pain
Pincus, T., & McCracken, L. M. (2013) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2013.09.010 · Cited by 144 · see citing works
Thorsell, J., Finnes, A., Dahl, J., Lundgren, T., Gybrant, M., Gordh, T., & Buhrman, M. (2011) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e318219a933 · Cited by 136 · see citing works
Psychometric properties of the Multidimensional Pain Inventory, Dutch language version (MPI-DLV)
Lousberg, R. L., van Breukelen, G., Groenman, N. H., Schmidt, A. J. M., Arntz, A. R., & Winter, F. A. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00137-5 · Cited by 132 · see citing works
(1996) · Cited by 105 · see citing works
Attention to pain and fear of pain in patients with chronic pain
Crombez, G., Viane, I., Eccleston, C., Devulder, J., & Goubert, L. (2013) · Journal of Behavioral Medicine · doi:10.1007/s10865-012-9433-1 · Cited by 89 · see citing works
Acceptance as a process variable in relation to catastrophizing in multidisciplinary pain treatment.
Baranoff, J., Hanrahan, S. J., Kapur, D., & Connor, J. P. (2013) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00165.x · Cited by 61 · see citing works
Cognitive Behavioral Therapy for Chronic Pain
Vranceanu, A.-M., Stone, M. T., Wallace, T., & Kulich, R. (2017) · Springer eBooks · doi:10.1007/978-3-319-29294-6_5 · Cited by 49 · see citing works
Trompetter, H. R., Bohlmeijer, E. T., van Baalen, B., Kleen, M., Köke, A., Reneman, M., & Schreurs, K. M. G. (2014) · European Journal of Psychological Assessment · doi:10.1027/1015-5759/a000191 · Cited by 35 · see citing works
Self-citationLeven met pijn. De kunst van het aanvaarden.
Veehof, M. M., Schreurs, K. M. G., Hulsbergen, M., & Bohlmeijer, E. T. (2010) · University of Twente Research Information · Cited by 8 · see citing works
Self-citationLeven met pijn. Praktijkboek voor behandelaars.
Schreurs, K. M. G., & Hulsbergen, M. L. (2011) · University of Twente Research Information · Cited by 7 · see citing works
Self-citation
Flagged first, then by citations
2 of the 58 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Hayes, A. F. (2013b). Introduction to mediation, moderation, and conditional process analysis. New York, NY US: Guilford Press.
- Hayes, S. C., Strosahl, K., & Wilson, K. G. (2012). Acceptance & Commitment Therapy: The process and practice of mindful change (2nd. ed.). Guilford Press.
Cited by
Sorted by citations
Hayes, A. F., & Rockwood, N. J. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.11.001 · Cited by 2,350 · see citing works
Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719 · see citing works
Weinrib, A. Z., Azam, M. A., Birnie, K. A., Burns, L. C., Clarke, H., & Katz, J. (2017) · British Journal of Pain · doi:10.1177/2049463717720636 · Cited by 178 · see citing works
Towards a science and practice of resilience in the face of pain
Goubert, L., & Trompetter, H. R. (2017) · European Journal of Pain · doi:10.1002/ejp.1062 · Cited by 177 · see citing works
Self-citationPsychological Interventions for the Treatment of Chronic Pain in Adults
Driscoll, M. A., Edwards, R. R., Becker, W. C., Kaptchuk, T. J., & Kerns, R. D. (2021) · Psychological Science in the Public Interest · doi:10.1177/15291006211008157 · Cited by 176 · see citing works
Thompson, E. M., Destree, L., Albertella, L., & Fontenelle, L. F. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.07.002 · Cited by 168 · see citing works
Psychological Flexibility as a Resilience Factor in Individuals with Chronic Pain
Gentili, C., Rickardsson, J., Zetterqvist, V., Simons, L. E., Lekander, M., & Wicksell, R. K. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02016 · Cited by 148 · see citing works
New generation psychological treatments in chronic pain
McCracken, L. M., Yu, L., & Vowles, K. E. (2022) · BMJ · doi:10.1136/bmj-2021-057212 · Cited by 123 · see citing works
Trindade, I. A., Guiomar, R., Carvalho, S. A., Duarte, J., Lapa, T., Menezes, P., Nogueira, M. R., Patrão, B., Pinto-Gouveia, J., & Castilho, P. (2021) · The Journal of Pain · doi:10.1016/j.jpain.2021.04.003 · Cited by 117 · see citing works
Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review
Toivonen, K. I., Zernicke, K., & Carlson, L. E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7487 · Cited by 106 · see citing works
French, K., Golijani-Moghaddam, N., & Schröder, T. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.08.002 · Cited by 100 · see citing works
Yu, L., Norton, S., & McCracken, L. M. (2017) · The Journal of Pain · doi:10.1016/j.jpain.2017.01.005 · Cited by 88 · see citing works
Ma, T.-W., Yuen, A. S.-K., & Yang, Z. (2023) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000001096 · Cited by 88 · see citing works
Murillo, C., Vo, T., Vansteelandt, S., Harrison, L. E., Cagnie, B. J., Coppieters, I., Chys, M., Timmers, I., & Meeus, M. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102160 · Cited by 85 · see citing works
Lin, J., Klatt, L.-I., McCracken, L. M., & Baumeister, H. (2018) · PAIN · doi:10.1097/j.pain.0000000000001134 · Cited by 76 · see citing works
Rickardsson, J., Gentili, C., Holmström, L., Zetterqvist, V., Andersson, E., Persson, J., Lekander, M., Ljótsson, B., & Wicksell, R. K. (2021) · European Journal of Pain · doi:10.1002/ejp.1723 · Cited by 64 · see citing works
“PF has repeatedly been shown to be a potential treatment mechanism in ACT, with increased PF being associated with decreased pain interference and increased functioning (Cederberg et al., 2016; Lin et al., 2018; McCracken & Gutiérrez-Martínez, 2011; Stockton et al., 2018; Trompetter et al., 2015; Vowles et al., 2008,…”
BackgroundKratz, A. L., Ehde, D. M., Bombardier, C. H., Kalpakjian, C. Z., & Hanks, R. A. (2017) · The Journal of Pain · doi:10.1016/j.jpain.2016.11.006 · Cited by 65 · see citing works
van de Graaf, D. L., Trompetter, H. R., Smeets, T., & Mols, F. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100465 · Cited by 49 · see citing works
Self-citationPots, W. T. M., Trompetter, H. R., Schreurs, K. M. G., & Bohlmeijer, E. T. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-0841-6 · Cited by 46 · see citing works
Self-citationRisk and Resilience in Pediatric Pain
Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Yoon, I. A., Ross, A. C., Huestis, S. E., Griffin, A. T., & Simons, L. E. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000639 · Cited by 45 · see citing works
Goal Pursuit in Individuals with Chronic Pain: A Personal Project Analysis
Crombez, G., Lauwerier, E., Goubert, L., & Damme, S. V. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00966 · Cited by 43 · see citing works
Mallett, R., Coyle, C., Kuang, Y., & Gillanders, D. T. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.09.003 · Cited by 42 · see citing works
Carvalho, S. A., Skvarc, D., Barbosa, R., Tavares, T., Santos, D., & Trindade, I. A. (2022) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2643 · Cited by 40 · see citing works
Atkins, P. W. B., Ciarrochi, J., Gaudiano, B. A., Bricker, J. B., Donald, J. N., Rovner, G., Smout, M., Livheim, F., Lundgren, T., & Hayes, S. C. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.05.016 · Cited by 41 · see citing works
Yang, M. M. H., Riva-Cambrin, J. K., Cunningham, J., Jetté, N., Sajobi, T. T., Soroceanu, A., Lewkonia, P. D., Jacobs, W. B., & Casha, S. (2020) · Journal of Neurosurgery Spine · doi:10.3171/2020.5.spine20347 · Cited by 41 · see citing works
Translating e-pain research into patient care
McGuire, B. E., Henderson, E. M., & McGrath, P. J. (2017) · Pain · doi:10.1097/j.pain.0000000000000686 · Cited by 39 · see citing works
Preliminary investigation of self-as-context in people with fibromyalgia
Yu, L., Norton, S., Almarzooqi, S., & McCracken, L. M. (2017) · British Journal of Pain · doi:10.1177/2049463717708962 · Cited by 35 · see citing works
Fang, S., & Ding, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1069748 · Cited by 34 · see citing works
Rosser, B. A., Fisher, E., Janjua, S., Eccleston, C., Keogh, E., & Duggan, G. B. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013863.pub2 · Cited by 31 · see citing works
Frinking, E., Jans-Beken, L., Janssens, M., Peeters, S. C. T., Lataster, J., Jacobs, N., & Reijnders, J. S. A. M. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1673309 · Cited by 31 · see citing works
Lin, J., Scott, W., Carpenter, L., Norton, S., Domhardt, M., Baumeister, H., & McCracken, L. M. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1044-2 · Cited by 30 · see citing works
Measuring ACT in context: Challenges and future directions
Ong, C. W., Sheehan, K. G., & Haaga, D. A. F. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.04.005 · Cited by 28 · see citing works
Miller-Matero, L. R., Hecht, L. M., Miller, M. K., Autio, K., Pester, B., Tobin, E. T., Patel, S. R., Braciszewski, J. M., Maye, M. P., & Ahmedani, B. K. (2020) · Pain Medicine · doi:10.1093/pm/pnaa444 · Cited by 28 · see citing works
Yu, L., Scott, W., & McCracken, L. M. (2019) · European Journal of Pain · doi:10.1002/ejp.1480 · Cited by 28 · see citing works
Loss of adaptive mechanisms during aging.
Rc, A. (1979) · PubMed · Cited by 25 · see citing works
Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial
Morcillo-Muñoz, Y., Sánchez-Guarnido, A. J., Calzón-Fernández, S., & Baena-Parejo, I. (2022) · Journal of Medical Internet Research · doi:10.2196/36114 · Cited by 25 · see citing works
The Role of Cognitive Content and Cognitive Processes in Chronic Pain
Jensen, M. P., Thorn, B. E., Carmody, J., Keefe, F. J., & Burns, J. W. (2017) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000559 · Cited by 22 · see citing works
Kratz, A., Murphy, J. F., Kalpakjian, C., & Chen, P. (2017) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000550 · Cited by 19 · see citing works
Sharma, S., Thibault, P., Abbott, J. H., & Jensen, M. (2018) · Journal of Pain Research · doi:10.2147/jpr.s153061 · Cited by 23 · see citing works
Mechanisms of change in acceptance and commitment therapy for primary headaches
Vasiliou, V. S., Karademas, E. C., Christou, Y., Papacostas, S., & Karekla, M. (2022) · European Journal of Pain · doi:10.1002/ejp.1851 · Cited by 21 · see citing works
Hegarty, R. S. M., Fletcher, B. D., Conner, T. S., Stebbings, S., & Treharne, G. J. (2020) · Musculoskeletal Care · doi:10.1002/msc.1464 · Cited by 18 · see citing works
Harrison, A. M., Scott, W., Johns, L., Morris, E. M. J., & McCracken, L. M. (2016) · Pain Medicine · doi:10.1093/pm/pnw310 · Cited by 18 · see citing works
Braun, L., Terhorst, Y., Titzler, I., Freund, J., Thielecke, J., Ebert, D. D., & Baumeister, H. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113858 · Cited by 17 · see citing works
“Specifically, psychological wellbeing [103] and psychological flexibility [25,29] were identified as moderators for ACT-based online therapy.”
BackgroundKhanjani, M. S., Kazemi, J., Younesi, J., Dadkhah, A., Biglarian, A., & Ebrahimi Barmi, B. (2021) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.105378 · Cited by 17 · see citing works
Trompetter, H. R., Mols, F., & Westerhof, G. J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02443 · Cited by 16 · see citing works
Self-citationAre people with chronic pain more diverse than we think? An investigation of ergodicity
Sundström, F., Lavefjord, A., Buhrman, M., & McCracken, L. M. (2025) · Pain · doi:10.1097/j.pain.0000000000003573 · Cited by 16 · see citing works
Arbinaga, F. (2023) · Journal of Science in Sport and Exercise · doi:10.1007/s42978-023-00234-z · Cited by 15 · see citing works
Mechanisms of change in an Internet-Based ACT study for depression in China
Zhao, C., Ren, Z., Jiang, G., & Zhang, L. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.03.004 · Cited by 14 · see citing works
Harrison, A. M., McCracken, L. M., Jones, K., Norton, S., & Moss-Morris, R. E. (2016) · Disability and Rehabilitation · doi:10.1080/09638288.2016.1209580 · Cited by 14 · see citing works
Grunberg, V. A., Mace, R. A., Bannon, S. M., Greenberg, J., Bakhshaie, J., & Vranceanu, A.-M. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.069 · Cited by 13 · see citing works
Sairanen, E., Lappalainen, R. I., Lappalainen, P., & Hiltunen, A. J. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.11.010 · Cited by 15 · see citing works
Rhodes, A., Marks, D., Block-Lerner, J., & Lomauro, T. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-020-09729-1 · Cited by 13 · see citing works
Bendelin, N., Gerdle, B. U. C., Blom, M., Södermark, M., & Andersson, G. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10245872 · Cited by 12 · see citing works
Psychological Interventions for Persistent Orofacial Pain
Barker, S., Urbanek, M., & Penlington, C. (2018) · Primary Dental Journal · doi:10.1177/205016841800700408 · Cited by 12 · see citing works
Management protocols of chronic Orofacial Pain: A Systematic Review
Priyank, H., Prasad, R. S., Shivakumar, S., Abdul, N. S., Pathak, A., Cervino, G., Cicciù, M., & Minervini, G. (2023) · The Saudi Dental Journal · doi:10.1016/j.sdentj.2023.04.003 · Cited by 11 · see citing works
Rhodes, A., Martin, S., Guarna, J., Vowles, K., & Allen, T. (2020) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2020.07.009 · Cited by 10 · see citing works
Torabian, S., Hemmati Sabet, V., & Meschi, F. (2019) · International Clinical Neuroscience Journal · doi:10.15171/icnj.2019.10 · Cited by 10 · see citing works
Taub, R., Agmon‐Levin, N., Frumer, L., Samuel-Magal, I., Glick, I., & Horesh, D. (2024) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2024.101860 · Cited by 10 · see citing works
Bendelin, N., Gerdle, B., & Andersson, G. (2018) · Journal of Pain Research · doi:10.2147/jpr.s157939 · Cited by 10 · see citing works
Rovner, G., Johansson, F., & Gillanders, D. T. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.07.006 · Cited by 10 · see citing works
Yu, L., McCracken, L. M., & Scott, W. (2022) · European Journal of Pain · doi:10.1002/ejp.1972 · Cited by 9 · see citing works
Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia
Luque-Reca, O., Gillanders, D., Catala, P., & Peñacoba, C. (2023) · Current Psychology · doi:10.1007/s12144-021-02214-4 · Cited by 8 · see citing works
Predictors of illness acceptance in women with endometriosis
Andysz, A., & Merecz‐Kot, D. (2020) · Health Psychology Report · doi:10.5114/hpr.2020.97914 · Cited by 9 · see citing works
Reilly, E. D., Kelly, M. M., Grigorian, H. L., Waring, M. E., Quigley, K. S., Hogan, T. P., Heapy, A. A., Drebing, C. E., Volonte, M., Kathawalla, U., et al. (2024) · JMIR Formative Research · doi:10.2196/56437 · Cited by 9 · see citing works
Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation
Smith, P. J., & Cendales, L. C. (2019) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000712 · Cited by 10 · see citing works
Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia
Vallejo, M. Á., Vallejo-Slocker, L., Offenbächer, M., Hirsch, J. K., Toussaint, L. L., Kohls, N., Sirois, F. M., & Rivera, J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147300 · Cited by 9 · see citing works
Examining psychological flexibility in unaccompanied refugee minors: A network analysis
Freymann, J., Morroni, D., Kleinbub, J. R., & Karekla, M. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100808 · Cited by 7 · see citing works
Internet-based treatment for vulvodynia (EMBLA) – Study protocol for a randomised controlled study
Hess Engström, A., Kullinger, M., Jawad, I., Hesselman, S., Buhrman, M., Högberg, U., & Skalkidou, A. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100396 · Cited by 7 · see citing works
“There are also promising results for ACT delivered via the internet (Buhrman et al., 2013; Buhrman et al., 2015; Carlbring et al., 2018; Lin et al., 2017; Trompetter et al., 2015a, 2015b), but knowledge about if it is suitable for vulvar pain is lacking.”
Backgroundde la Vega, R., Serrano‐Ibáñez, E. R., Ruiz-Párraga, G. T., Palermo, T. M., Wicksell, R. K., Fernández-Jiménez, E., Oliva, S., Roldán, S., Monfort, L., Peláez, M. J., et al. (2023) · Digital Health · doi:10.1177/20552076231219490 · Cited by 7 · see citing works
Primer Encuentro Ibérico+ de Psicología del Deporte. Barcelona, febrero de 2024
Peris-Delcampo, D., Teques, P., & Palmi, J. (2023) · Revista de Psicología Aplicada al Deporte y el Ejercicio Físico · doi:10.5093/rpadef2023a7 · Cited by 7 · see citing works
Gandy, M., Karin, E., Jones, M. P., McDonald, S., Sharpe, L., Titov, N., & Dear, B. F. (2018) · European Journal of Pain · doi:10.1002/ejp.1239 · Cited by 6 · see citing works
Technological Interventions for Pain Management
Suso-Ribera, C., Castilla, D., Martínez-Borba, V., Jaén, I., Botella, C., Baños, R. M., & García-Palacios, A. (2022) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00009-1 · Cited by 6 · see citing works
Engström, A. H., Bohm‐Starke, N., Buhrman, M., Högberg, U., Skalkidou, A., & Lagenskiöld, S. (2023) · Scientific Reports · doi:10.1038/s41598-023-33406-6 · Cited by 6 · see citing works
Hedman‐Lagerlöf, M., Buhrman, M., Hedman‐Lagerlöf, E., Ljótsson, B., & Axelsson, E. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104546 · Cited by 6 · see citing works
Vugts, M. A. P., Joosen, M. C. W., Mert, A., Zedlitz, A. M. E. E., & Vrijhoef, H. J. (2017) · BMJ Open · doi:10.1136/bmjopen-2017-016394 · Cited by 5 · see citing works
Catastrophizing and chronic pain: a modern view on the problem
Lovchev, I. M., Shmidt, D. A., Sorokina, D. A., & Churyukanov, M. V. (2023) · Russian Journal of Pain · doi:10.17116/pain20232101160 · Cited by 6 · see citing works
Mechanisms of change in an online acceptance and commitment therapy intervention for insomnia
Hämäläinen, T., Lappalainen, P., Langrial, S. U., Lappalainen, R. I., & Kiuru, N. H. (2025) · Scientific Reports · doi:10.1038/s41598-025-87018-3 · Cited by 5 · see citing works
Spinoni, M., Gesto, C. D., Porpora, M. G., & Grano, C. (2025) · European Journal of Pain · doi:10.1002/ejp.70198 · Cited by 5 · see citing works
Bell, L. V., Cornish, P., Flusk, D., Garland, S. N., & Rash, J. A. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-033350 · Cited by 5 · see citing works
Wallace-Boyd, K., Boggiss, A. L., Ellett, S., Booth, R., Slykerman, R., & Serlachius, A. S. (2023) · Cogent Psychology · doi:10.1080/23311908.2023.2208916 · Cited by 3 · see citing works
“Previous studies have found a mediating relationship between psychological flexibility and improved psychological outcomes in ACT interventions (Lin et al., 2018; Trompetter et al., 2015).”
BackgroundGhatreh Samani, M., Najafi, M., & Rahimian Bouger, I. (2019) · Journal of Shahrekord University of Medical Sciences · doi:10.34172/jsums.2019.47 · Cited by 3 · see citing works
Arbinaga, F., Rodríguez, J. D., Fernández, J. N. G., Moreno, E., & Ceballos, I. D. (2025) · International Sport Coaching Journal · doi:10.1123/iscj.2025-0001 · Cited by 3 · see citing works
Ellis, J. D., Chipoletti, A. E., Tsang, S., Nordeck, C. D., Goodell, E. M. A., Mun, C. J., Martel, M. O., Bergeria, C. L., Dunn, K. E., Vandrey, R. G., et al. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112843 · Cited by 3 · see citing works
Miller-Matero, L. R., Chohan, S., Gavrilova, L., Hecht, L. M., Autio, K., Tobin, E. T., & Ahmedani, B. K. (2022) · Substance Use & Misuse · doi:10.1080/10826084.2022.2096239 · Cited by 3 · see citing works
King, A. C., Zahrai, A., Bisson, E. J., Shergill, Y., Andreev, P., Bosma, R. L., MacNeil, A., Radhakrishnan, A., Rash, J. A., Wilson, R. A., et al. (2024) · Digital Health · doi:10.1177/20552076241288748 · Cited by 3 · see citing works
Khani, M. M., Ebrahimi, M. E., Sahebi, A., & Assistant Professor, W. G. I. (2019) · Pajouhan Scientific Journal · doi:10.21859/psj.17.2.15 · Cited by 3 · see citing works
Langroudi, R. R., Ghiasian, M., Roozbehani, M., & Shamsaei, F. (2020) · Avicenna Journal of Nursing and Midwifery Care · doi:10.30699/ajnmc.28.3.251 · Cited by 3 · see citing works
Rezaei, F., & Ramaghani, N. A. H. (2018) · Practice in Clinical Psychology · doi:10.29252/nirp.jpcp.6.2.63 · Cited by 3 · see citing works
Arbinaga, F., Pedro, E. M. S., & Sierra, M. I. M. (2025) · PeerJ · doi:10.7717/peerj.19790 · Cited by 4 · see citing works
Arbinaga, F., Sierra, M. I. M., Casillas-García, R., Durán-Andrada, J., & Moreno-San-Pedro, E. (2025) · Acta Gymnica · doi:10.5507/ag.2025.010 · Cited by 2 · see citing works
Navigating the psychosocial landscape of Ehlers–Danlos syndrome: an autobiographic case study
Locke, J. D., & Eastman, J. T. (2025) · Discover Mental Health · doi:10.1007/s44192-025-00268-5 · Cited by 2 · see citing works
Psychological approaches to chronic pain management: where are we coming from and where might we go?
McCracken, L. M. (2017) · Revista de la Sociedad Española del Dolor · doi:10.20986/resed.2017.3606/2017 · Cited by 2 · see citing works
Arbinaga, F., Vargas, G. A., & Moreno, E. (2025) · Perceptual and Motor Skills · doi:10.1177/00315125251365290 · Cited by 1 · see citing works
Network analysis suggests working memory as a key target for facilitating subjective well-being
Xu, E. P., Stange, J. P., & Linke, J. O. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120139 · Cited by 1 · see citing works
Hughes, A. M., Tyson, G., Moss-Morris, R. E., McGuinness, S., Fawson, S., Chalder, T., & Hirsch, C. R. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104917 · Cited by 1 · see citing works
Kazdan, J., Ladha, K. S., & Husain, M. I. (2026) · Pharmacology Research & Perspectives · doi:10.1002/prp2.70238 · Cited by 1 · see citing works
Psychological Interventions for Persistent Orofacial Pain
Barker, S., Urbanek, M., & Penlington, C. (2022) · BDJ clinician's guides · doi:10.1007/978-3-030-86634-1_5 · Cited by 1 · see citing works
Acceptance and commitment therapy
Schreurs, K. M. G., Baalen, B. V., & Heuts, P. H. T. G. (2019) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2230-5_18 · Cited by 1 · see citing works
Self-citationChronic Pain: Perspective on the Second Wave
Adams, L. M., & Turk, D. C. (2022) · Springer eBooks · doi:10.1007/978-3-031-11677-3_29 · Cited by 1 · see citing works
Tatta, J. (2022) · Internet Journal of Allied Health Sciences and Practice · doi:10.46743/1540-580x/2022.2061 · Cited by 1 · see citing works
- Authors
- Trompetter, H. R., Bohlmeijer, E. T., Fox, J.-P., & Schreurs, K. M. G.
- Affiliations
- University of Twente (NL)
- Roessingh Research and Development (NL)
- Corresponding author
- Trompetter, Hester R.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 74
- Pages
- 50-59
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1789908247
- Cited by
- 112
- References
- 58
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 6 · 2023: 10 · 2022: 11 · 2021: 13 · 2020: 11 · 2019: 12 · 2018: 8 · 2017: 12 · 2016: 8
- FWCI
- 11.57
- Type
- journal article
- Language
- en
- Open access
- green
- research.utwente.nl
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- University of Twente Research Information (acceptedVersion, other-oa)
- University of Twente Research Information (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- psychological flexibility, pain catastrophizing, acceptance and commitment therapy, online therapy, chronic pain, mechanisms of change, pain interference, psychological distress, pain intensity, expressive writing, mediation analysis
- MeSH terms
- Adult, Depression, Female, Humans, Male, Middle Aged, Netherlands, Pain Measurement, Surveys and Questionnaires, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet, Catastrophization, Chronic Pain, Acceptance and Commitment Therapy
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