General psychological acceptance and chronic pain: There is more to accept than the pain itself
Abstract
An increasing body of research demonstrates that acceptance of pain is significantly associated with the quality of daily functioning in people with chronic pain. The aim of the present study was to examine acceptance more broadly in relation to a wider range of undesirable experiences these people may encounter, such as other physical symptoms, experiences of emotional distress, or distressing thoughts. One hundred forty‐four, consecutive, adult patients attending interdisciplinary treatment for chronic pain participated in this study. They completed the Acceptance and Action Questionnaire‐II (AAQ‐II [Bond F, Hayes SC, Baer RA, Carpenter KM, Orcutt HK, Waltz T, Zettle RD. Preliminary psychometric properties of the Acceptance Action Questionnaire‐II: a revised measure of psychological flexibility and acceptance, submitted for publication]), measuring their general psychological acceptance. They also completed measures of emotional, physical, and psychosocial functioning, pain acceptance, and mindfulness. The AAQ‐II achieved satisfactory internal consistency, α = .89, and factor analysis revealed a unitary factor structure. Primary results showed that general psychological acceptance significantly correlated with depression, r = −.69, pain‐related anxiety, r = −.59, physical disability, r = −.42, and psychosocial disability, r = −.65, all p < .001. Hierarchical regression analyses showed that general psychological acceptance added a significant increment of explained variance to the prediction of patient functioning, independent of patient background characteristics, pain, acceptance of pain, and mindfulness. These results suggest that, when people with chronic pain are willing to have undesirable psychological experiences without attempting to control them, they may function better and suffer less. General acceptance may have a unique role to play in the disability and suffering of chronic pain beyond similar processes such as acceptance of pain or mindfulness.
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Both general and illness-specific psychological flexibility have correlations with psychological distress, with general measures explaining additional variance independent of illness-specific measures.
“Both general and illness-specific psychological flexibility have correlations with psychological distress, with general measures explaining additional variance independent of illness-specific measures (McCracken & Zhao-O'Brien, 2010).”
From Better living with illness: A transdiagnostic acceptance and commitment therapy group intervention for chronic physical illness (2016) · cites this paper as McCracken & Zhao-O'Brien, 2010
The AAQ-II had a unitary factor structure in a sample of people seeking treatment for chronic pain.
“Exploratory factor analysis (EFA) demonstrated that the AAQ-II had a unitary factor structure in this population as well.”
From Further evaluation of the psychometric properties of the acceptance and action questionnaire-II (2012) · cites this paper as McCracken & Zhao-O'Brien, 2010
The AAQ-II showed good internal consistency (Cronbach's alpha = .89) and construct validity in a chronic pain sample.
“The AAQ-II showed good internal consistency (Cronbach's 𝛂 = .89) and construct validity as it was associated with pain-related anxiety, depression, and mindfulness.”
From Further evaluation of the psychometric properties of the acceptance and action questionnaire-II (2012) · cites this paper as McCracken & Zhao-O'Brien, 2010
McCracken and Zhao-O'Brien (2010) found that the AAQ-II added significant variance to the prediction of quality of daily patient functioning above and beyond acceptance of pain and general mindfulness.
“McCracken and ZhaoO'Brien (2010) found that the AAQ-II added significant variance to the prediction of the quality of daily patient functioning above and beyond acceptance of pain and general mindfulness.”
From Further evaluation of the psychometric properties of the acceptance and action questionnaire-II (2012) · cites this paper as McCracken & Zhao-O'Brien, 2010
This finding corroborates earlier research that showed that the AAQ-II had incremental validity beyond mindfulness in predicting chronic pain (McCracken & Zhao-O'Brien, 2010).
“This finding corroborates earlier research that showed that the AAQ-II had incremental validity beyond mindfulness in predicting chronic pain (McCracken & Zhao-O'Brien, 2010).”
From Further evaluation of the psychometric properties of the acceptance and action questionnaire-II (2012) · cites this paper as McCracken & Zhao-O'Brien, 2010
In McCracken and Zhao-O'Brien (2010), a unitary factor structure was found.
“Furthermore, in McCracken and Zhao-O'Brien (2010), a unitary factor structure was found as well.”
From Further evaluation of the psychometric properties of the acceptance and action questionnaire-II (2012) · cites this paper as McCracken & Zhao-O'Brien, 2010
The Dutch version of the AAQ-II has shown good psychometric properties, also in adults with psychological distress.
“The Dutch version of the AAQ-II has shown good psychometric properties [38] also in adults with psychological distress [39].”
From A web-based self-help intervention for partners of cancer patients based on Acceptance and Commitment Therapy: a protocol of a randomized controlled trial. (2015) · cites this paper as [38]
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- Authors
- McCracken, L. M., & Zhao‐O'Brien, J.
- Affiliations
- Royal National Hospital for Rheumatic Diseases (GB)
- Corresponding author
- McCracken, Lance M.
- ORCID
- McCracken, Lance M.
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2010-02
- Volume
- 14
- Issue
- 2
- Pages
- 170-175
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2107861151
- Cited by
- 203
- References
- 28
- Citations by year
- 2026: 1 · 2025: 8 · 2024: 6 · 2023: 12 · 2022: 13 · 2021: 15 · 2020: 7 · 2019: 10 · 2018: 10 · 2017: 8 · 2016: 23 · 2015: 19 · 2014: 18 · 2013: 19 · 2012: 8
- FWCI
- 12.36
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- chronic pain, Acceptance and Action Questionnaire-II, psychological flexibility, pain acceptance, mindfulness, depression, pain-related anxiety, physical disability, psychosocial disability, daily functioning, multidisciplinary pain management, psychometric validation
- MeSH terms
- Adaptation, Psychological, Adult, Anxiety, Attention, Awareness, Chronic Disease, Major Depressive Disorder, Disability Evaluation, Factor Analysis, Statistical, Female, Humans, Male, Middle Aged, Motor Activity, Neuropsychological Tests, Pain, Surveys and Questionnaires, Regression Analysis, Social Behavior, Socioeconomic Factors, Reproducibility of Results, Sickness Impact Profile
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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