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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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“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]
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“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
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“Psychological flexibility has been proposed as a mediator of change, specifically in ACT, for reducing pain-associated disability [25,29].”
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“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]
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“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 citing paper
“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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Citations
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
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117
(1998) · The Journal of Clinical Psychiatry · Cited by 19,139
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
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
Introduction to mediation, moderation, and conditional process analysis :
Hayes, A. F., & names (2015) · Cited by 7,004
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
Analysis of Incomplete Multivariate Data
Schafer, J. L. (1997) · doi:10.1201/9781439821862 · Cited by 6,012
Analysis of Incomplete Multivariate Data
Booth, D. E., & Schafer, J. L. (2000) · Technometrics · doi:10.2307/1271466 · Cited by 5,627
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
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
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
Preacher, K. J., & Kelley, K. (2011) · Psychological Methods · doi:10.1037/a0022658 · Cited by 3,060
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
Eysenbach, G. (2005) · Journal of Medical Internet Research · doi:10.2196/jmir.7.1.e11 · Cited by 2,524
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
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
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
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
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
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
Self-citationUnderstanding how and why psychotherapy leads to change
Kazdin, A. E. (2009) · Psychotherapy Research · doi:10.1080/10503300802448899 · Cited by 728
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
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
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
Turner, J. A., Holtzman, S., & Mancl, L. (2007) · Pain · doi:10.1016/j.pain.2006.09.005 · Cited by 530
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
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
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
Arbisi, P. A., & Ben‐Porath, Y. S. (1995) · Psychological Assessment · doi:10.1037/1040-3590.7.4.424 · Cited by 304
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 285
McCracken, L. M., & Gutiérrez-Martínez, O. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.02.004 · Cited by 283
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
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
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
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
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
Fledderus, M., Bohlmeijer, E. T., Pieterse, M. E., & Schreurs, K. M. G. (2012) · Psychological Medicine · doi:10.1017/s0033291711001206 · Cited by 209
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
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
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
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
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
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
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
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
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
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
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
(1996) · Cited by 105
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
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
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
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
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
Self-citationLeven met pijn. Praktijkboek voor behandelaars.
Schreurs, K. M. G., & Hulsbergen, M. L. (2011) · University of Twente Research Information · Cited by 7
Self-citation
Cited by
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Hayes, A. F., & Rockwood, N. J. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.11.001 · Cited by 2,350
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
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
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 188
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
Metadata
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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