Processes of change in treatment for chronic pain: the contributions of pain, acceptance, and catastrophizing
Abstract
Cognitive‐behavioral therapy has a substantial evidence base with regard to its effectiveness for individuals with chronic pain. Historically, although there has been some investigation in to the processes by which treatment succeeds or fails, few data are available regarding the unique contributions of processes from distinct cognitive behavioral approaches and how these processes may interact to affect patient functioning. The present investigation sought to evaluate three proposed process variables that have garnered empirical support within chronic pain settings, namely: pain intensity, catastrophizing, and acceptance. Participants were 252 consecutive patients who completed treatment on an interdisciplinary pain management unit. Using multiple regression, the contributions of changes in process variables to changes in treatment outcomes were assessed. In general, changes in both acceptance and catastrophizing accounted for significant variance independent of, and larger than, that accounted for by change in pain intensity. Changes in acceptance and catastrophizing accounted for roughly equivalent amounts of variance when entered immediately following changes in pain, and when entered following one another. The potential impact of these results is discussed in relation to the particular treatment delivered. Issues relating to change at the level of frequency or content of psychological experiences are considered relative to change in the functions of these experiences.
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Individuals who catastrophize have a worse prognosis for any treatment.
“Individuals who catastrophize develop a very negative view of their pain, think about it often, and feel unable to control it, so they have a worse prognosis for any treatment [15].”
An experiment has demonstrated that physical impairment is decreased by acceptance strategies but increased by control strategies.
“In supporting this view, an experiment has demonstrated that physical impairment is decreased by acceptance strategies but increased by control strategies [34].”
From Effectiveness of a multidisciplinary rehabilitation program in real-world patients with chronic back pain: A pilot cohort data analysis (2021) · cites this paper as [34]
Acceptance of pain is an important process in the adaptation to chronic pain.
“Acceptance of pain has been found to be an important process in the adaptation to chronic pain”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [56]
In the chronic pain context, ACT aims at improving functioning rather than reducing pain, targeting experiential avoidance and promoting emotional acceptance and valued action.
“In the chronic pain context, ACT aims at improving functioning rather than reducing pain - experiential avoidance is targeted and emotional acceptance and valued action are promoted, even in the context of experiencing pain and other unwanted experiences”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [56]
Changes in pain acceptance and values-based action through the three-year follow-up accounted for significant variance in changes in overall functioning over the same interval.
“Results of treatment process analyses are similar to those from previous studies (McCracken, Vowles, & Eccleston, 2005; Vowles, McCracken, & Eccleston, 2007; Vowles & McCracken, 2008) in that changes in pain acceptance and values-based action through the three year follow-up accounted for significant variance in changes in overall functioning over the same interval.”
From Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process (2011) · cites this paper as Vowles, McCracken, & Eccleston, 2007
Patients with persistent pain show reductions in gray matter in the dorsolateral prefrontal cortex and insula.
“There are reductions in gray matter in the dorsolateral prefrontal cortex and insula among patients with persistent pain 381–383.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [381]
Acceptance and commitment therapy has been found to reduce catastrophizing and disability in chronic pain patients.
“ACT has been found to reduce catastrophizing and disability in chronic pain patients [35-37].”
Catastrophizing tends to discourage patients from committing to their valued behavior and it has consistently been found to predict distress and disability.
“Catastrophizing tends to discourage patients from committing to their valued behavior and it has consistently been found to predict distress and disability [6,26,27].”
The average total CPAQ score in this fibromyalgia group (mean 40.9, SD 18.5) was lower than other samples, where the mean is usually around 50.
“In this case, the average total score for CPAQ in this fibromyalgia group (mean 40.9 with SD of 18.5) was lower than other samples, where usually the mean is around 50 [12,13,16,17].”
From Veaselaircdhation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia (2010) · cites this paper as [12]
Previous research shows pain acceptance and willingness to act in its presence are associated with lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime, and better work status.
“Previous research studies [5,9,12,13] show that acceptance of pain and willingness to act in its presence are associated with reports of lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily uptime and better work status.”
From Veaselaircdhation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia (2010) · cites this paper as [12]
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“This finding adds to those of Vowles et al. (2009) and Wetherell et al.”
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- Authors
- Vowles, K. E., McCracken, L. M., & Eccleston, C.
- Affiliations
- Royal National Hospital for Rheumatic Diseases (GB)
- Corresponding author
- Vowles, Kevin E.
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2007-10
- Volume
- 11
- Issue
- 7
- Pages
- 779-787
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W1976512343
- Cited by
- 253
- References
- 42
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 12 · 2021: 10 · 2020: 13 · 2019: 19 · 2018: 16 · 2017: 8 · 2016: 19 · 2015: 17 · 2014: 18 · 2013: 17 · 2012: 15
- FWCI
- 9.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, cognitive behavioral therapy, pain intensity, pain acceptance, pain catastrophizing, multidisciplinary pain management, treatment outcomes, cognitive processes
- MeSH terms
- Adaptation, Psychological, Adult, Chronic Disease, Depression, Female, Humans, Male, Middle Aged, Pain, Surveys and Questionnaires, Regression Analysis, Cognitive Behavioral Therapy, Pain Management
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