Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress.
Open accessAbstract
Over 30 years ago, treatments based broadly within cognitive behavioral therapy (CBT) began a rise in prominence that eventually culminated in their widespread adoption in chronic pain treatment settings. Research into CBT has proliferated and continues today, addressing questions very similar to those addressed at the start of this enterprise. However, just as it is designed to do, the process of conducting research and analyzing evidence reveals gaps in our understanding of and shortcomings within this treatment approach. A need for development seems clear. This article reviews the progress of CBT in the treatment of chronic pain and the challenges now faced by researchers and clinicians interested in meeting this need for development. It then focuses in greater detail on areas of development within CBT, namely acceptance and commitment therapy (ACT) and mindfulness-based approaches, areas that may hold potential for future progress. Three specific recommendations are offered here to achieve this progress.
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Systematic reviews that qualitatively assess the efficacy of ACT, MBSR and MBCT generally find beneficial effects in chronic pain conditions.
“Systematic reviews that qualitatively assess the efficacy of ACT, MBSR and MBCT generally find beneficial effects in chronic pain conditions (Lakhan & Schofield, 2013; McCracken & Vowles, 2014).”
From Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review (2016) · cites this paper as McCracken & Vowles, 2014
The ACT for Chronic Pain section reports positive chronic-pain trials and a meta-analysis finding acceptance- and mindfulness-based treatments at least as effective as traditional CBT. The Mindfulness section also describes symptom and emotional-functioning benefits. But the paper does not establish that qualitative systematic reviews generally found benefits for each of ACT, MBSR, and MBCT in chronic pain; its ACT systematic reviews covered mixed disorders, and the passages found do not address MBCT specifically. (LLM, conf=0.86)
Experimental — accuracy not yet measuredACT has shown effectiveness for functional and quality of life improvements when interventions directly targeting nociceptive pain achieve limited success.
“ACT has shown effectiveness for functional and quality of life improvements when interventions directly targeting nociceptive pain achieve limited success [30, 31].”
From Benchmark findings from a veteran electronic patient-reported outcomes evaluation from a chronic pain management telehealth program (2024) · cites this paper as [30]
The “ACT for Chronic Pain: Model, Process, and Evidence” section reports improved physical and social functioning and discusses life satisfaction as an outcome in an ACT trial. “The Success of CBT for Chronic Pain” also says functioning can improve even when pain remains unchanged. The paper does not establish that ACT was effective specifically when interventions targeting nociceptive pain had achieved limited success. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMeasurements of symptom acceptance have recently been preferred by researchers over intensity scales.
“measurements of symptom acceptance have recently been preferred by researchers over intensity scales (Kerns et al., 2011; McCracken and Morley, 2014; McCracken and Vowles, 2014; Du et al., 2021).”
From Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials (2024) · cites this paper as McCracken and Vowles, 2014
The Abstract emphasizes changing responses to symptoms rather than symptoms themselves, and the ACT for Chronic Pain section (p. 14) discusses studies using measures of pain acceptance. Neither passage says researchers have recently preferred acceptance measures over symptom-intensity scales; that comparative trend is unsupported. (LLM, conf=0.82)
Experimental — accuracy not yet measuredContextual behavioral therapies such as those based on acceptance, commitment, and mindfulness are considered an improvement over traditional cognitive-behavioral therapy for pain management.
“Contextual behavioral therapies -such as those based on acceptance, commitment, and mindfulness -are considered an improvement over the traditional cognitive-behavioral therapy model for pain management (McCracken & Vowles, 2014).”
From Acceptance and commitment therapy for chronic pain: a quasiexperimental study (2023) · cites this paper as McCracken & Vowles, 2014
The Abstract describes ACT and mindfulness-based approaches as areas that may hold potential for future progress in chronic pain treatment. The discussion on p. 21 calls ACT a potential route toward progress while acknowledging traditional CBT’s successes. The source does not establish that these approaches are already an improvement over traditional CBT for pain management. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe American Psychological Association considers acceptance and commitment therapy as an evidence-based treatment.
“The American Psychological Association (APA) considers ACT as an evidence-based treatment [87].”
From Effectiveness of acceptance and commitment therapy in central pain sensitization syndromes: A systematic review (2021) · cites this paper as [87]
In “ACT for Chronic Pain: Model, Process, and Evidence,” the paper says the APA Division of Clinical Psychology lists ACT as an empirically supported treatment with strong research support for general chronic pain. The citing sentence omits that condition, making the endorsement sound broader than the paper reports. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Acceptance and commitment therapy (ACT) is considered a third-wave of CBT and can be used alongside more traditional CBT.
“It is considered a third-wave of CBT and can be used alongside more traditional CBT [41–43].”
From A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK (2021) · cites this paper as [42]
In “ACT for Chronic Pain: Model, Process, and Evidence” (p. 10), the paper places ACT within the CBT family and describes it as extending that tradition. The same section says ACT adopts familiar methods, supporting some compatibility with traditional CBT, but the paper does not explicitly say ACT can be used alongside a separate traditional CBT treatment. (LLM, conf=0.81)
Experimental — accuracy not yet measuredResilience factors such as pain acceptance, positive affect, and adaptive pain beliefs relieve pain-related distress and improve functioning and social integration.
“A second dimension has focused on how “resilience factors”, such as pain acceptance, positive affect, and adaptive pain beliefs relieve pain-related distress and improve functioning and social integration.145–147”
From <p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p> (2020) · cites this paper as [147]
In “ACT for Chronic Pain: Model, Process, and Evidence” (p. 14), the paper reports that increased pain acceptance correlates with improvements in anxiety, depression, and disability; it also reports improved social functioning after ACT. It does not establish positive affect as a factor with these effects, and its discussion of pain beliefs (“Challenges in CBT for Chronic Pain,” p. 8) describes correlations rather than showing that adaptive beliefs cause relief or improved social integration. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe notion of enabling patients to manage their chronic pain through mindfulness meditation training (and therapies that incorporate mindfulness) is becoming increasingly popular.
“The notion of enabling patients to manage their chronic pain through such approaches as mindfulness meditation training (and therapies that incorporate mindfulness) is becoming increasingly popular (McCracken & Vowles, 2014, this issue).”
From Hypnotic approaches for chronic pain management: Clinical implications of recent research findings. (2014) · cites this paper as McCracken & Vowles, 2014
The “Mindfulness: Method, Process, and Outcome” section discusses mindfulness-based treatments for chronic pain and notes a relatively large number of outcome studies. This supports the claim that these approaches are used and studied, but our copy does not establish that they are becoming increasingly popular. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBehavioral interventions have a long history of success in treating chronic pain.
“Behavioral interventions have a long history of success for the treatment of chronic pain26.”
From Acceptance and Commitment Therapy for Prevention of Chronic Postsurgical Pain and Opioid Use in At-Risk Veterans: A Pilot Randomized Controlled Study. (2018) · cites this paper as [26]
Several studies provide data supporting the use of ACT for patients with chronic pain.
“Several studies provide data supporting the use of ACT for patients with chronic pain (Aytur et al., 2021;Hann & McCracken, 2014;McCracken & Vowles, 2014;Rickardsson et al., 2021;Yang & McCracken, 2014).”
From Acceptance and commitment therapy for chronic pain: a quasiexperimental study (2023) · cites this paper as McCracken & Vowles, 2014
ACT focuses on the enhancement of psychological flexibility, which enables individuals to pursue their values and goals despite pain.
“ACT mainly focuses on the enhancement of so-called ‘psychological flexibility’.”
Cognitive fusion is a significant predictor of psychological distress and QoL in a range of health conditions including multiple sclerosis, chronic pain and cancer.
“Studies indicate that cognitive fusion is a significant predictor of psychological distress and QoL in a range of health conditions including multiple sclerosis (Ferenbach, 2011), chronic pain (McCracken & Vowles, 2014) and cancer (Gillanders et al., 2015).”
From Psychosocial adjustment to Mild Cognitive Impairment: The role of illness perceptions, cognitive fusion and cognitive impairment. (2021) · cites this paper as McCracken & Vowles, 2014
For the chronic-pain portion attributed to McCracken and Vowles, the 'ACT for Chronic Pain: Model, Process, and Evidence' section describes cognitive defusion as a treatment process, while 'Challenges in CBT for Chronic Pain' says pain-related cognitions correlate with functioning. Neither passage reports that cognitive fusion significantly predicts psychological distress or quality of life in people with chronic pain (searched: cognitive fusion, predictor, psychological distress, quality of life). (LLM, conf=0.72)
Experimental — accuracy not yet measuredAn early evaluation of the acceptability of a complex intervention is imperative, as it can highlight aspects of the interventions that can be modified before a trial.
“An early evaluation of the acceptability of a complex intervention is imperative, as it can highlight aspects of the interventions that can be modified before a trial [32,33].”
From 'A Mindful ACT'- testing the feasibility and acceptability of a brief psychosocial intervention designed to accompany osteopathy treatment for people who live with persistent pain. (2021) · cites this paper as [32]
The 'Challenges in CBT for Chronic Pain' section discusses using treatment processes to guide and optimize methods, while 'ACT for Chronic Pain: Model, Process, and Evidence' mentions preliminary and pilot trials (p. 13). Neither passage addresses evaluating a complex intervention's acceptability early to identify modifications before a trial. A search for acceptability, feasibility, and pretrial feedback found no passage making that point. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAmong African-American samples, greater perceived daily racial discrimination is associated with higher rates of chronic pain and greater laboratory pain sensitivity.
“Multiple published studies have suggested that a greater degree of perceived daily racial discrimination is associated with elevated rates of chronic pain and enhanced sensitivity to pain in the laboratory among samples of African-American participants 252–254.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [254]
Several studies report a high value for ACT in the management of chronic pain when compared with standard pharmacological treatment alone.
“Several studies report a high value for ACT in the management of chronic pain when compared with standard pharmacological treatment alone [13-16].”
Both CBT and ACT interventions can improve a person's quality of life, pain acceptance, functioning, and self-efficacy while also having the potential to reduce pain, depressive symptoms, and distress.
“Both types of interventions can improve a person’s quality of life, pain acceptance, functioning, and self-efficacy while also having the potential to reduce pain, depressive symptoms, and distress [10-18].”
From A User-Centered Approach to an Evidence-Based Electronic Health Pain Management Intervention for People With Chronic Pain: Design and Development of EPIO (2020) · cites this paper as [15]
Acceptance and Commitment Therapy has a strong scientific basis for improving chronic pain outcomes.
“Another form of CBT is Acceptance and Commitment Therapy (“ACT”), [13] which has a strong scientific basis for improving chronic pain outcomes [14–17].”
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“Systematic reviews that qualitatively assess the efficacy of ACT, MBSR and MBCT generally find beneficial effects in chronic pain conditions (Lakhan & Schofield, 2013; McCracken & Vowles, 2014).”
BackgroundEvaluating psychosocial contributions to chronic pain outcomes
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“The notion of enabling patients to manage their chronic pain through such approaches as mindfulness meditation training (and therapies that incorporate mindfulness) is becoming increasingly popular (McCracken & Vowles, 2014, this issue).”
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“, 2012), chronic pain (McCracken and Vowles, 2014; Veehof et al., 2016), and substance use disorders (Chiesa and Serretti, 2014).”
BackgroundA Meta-Analysis of Mindfulness-Based Therapies for Insomnia and Sleep Disturbance
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“Several studies report a high value for ACT in the management of chronic pain when compared with standard pharmacological treatment alone [13-16].”
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“The American Psychological Association (APA) considers ACT as an evidence-based treatment [87].”
BackgroundChanges of valued behaviors and functioning during an Acceptance and Commitment Therapy Intervention
Wersebe, H., Lieb, R., Meyer, A. H., Hoyer, J., Wittchen, H.-U., & Gloster, A. T. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2016.11.005 · Cited by 43 · see citing works
Scott, W., Daly, A., Yu, L., & McCracken, L. M. (2016) · Pain Medicine · doi:10.1093/pm/pnw073 · Cited by 45 · see citing works
Self-citationInteroception, mindfulness and touch: A meta-review of functional MRI studies
Casals-Gutiérrez, S., & Abbey, H. (2019) · International journal of osteopathic medicine · doi:10.1016/j.ijosm.2019.10.006 · Cited by 44 · see citing works
Graham, C. D., Simmons, Z., Stuart, S. R., & Rose, M. R. (2015) · Muscle & Nerve · doi:10.1002/mus.24487 · Cited by 43 · see citing works
Carnes, D., Mars, T., Plunkett, A., Nanke, L., & Abbey, H. (2017) · International Journal of Osteopathic Medicine · doi:10.1016/j.ijosm.2017.03.005 · Cited by 42 · see citing works
Bennett, M., Meulders, A., Baeyens, F., & Vlaeyen, J. W. S. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00520 · Cited by 42 · see citing works
The Impact of Perceived Injustice on Pain-related Outcomes
Carrière, J. S., Sturgeon, J. A., Yakobov, E., Kao, M. J., Mackey, S., & Darnall, B. D. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000602 · Cited by 42 · see citing works
Vowles, K. E., Witkiewitz, K., Levell, J., Sowden, G., & Ashworth, J. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000159 · Cited by 41 · see citing works
Self-citationJacobs, C. M., Guildford, B. J., Travers, W., Davies, M., & McCracken, L. M. (2015) · British Journal of Pain · doi:10.1177/2049463715600460 · Cited by 42 · see citing works
Self-citationPredicting factors of outcome in multidisciplinary treatment of chronic neuropathic pain
Shaygan, M., Böger, A., & Kröner‐Herwig, B. (2018) · Journal of Pain Research · doi:10.2147/jpr.s175817 · Cited by 41 · see citing works
- Authors
- McCracken, L. M., & Vowles, K. E.
- Affiliations
- King's College London (GB)
- University of New Mexico (US)
- Venue
- American Psychologist
- Published
- 2014
- Volume
- 69
- Issue
- 2
- Pages
- 178-187
- ISSN
- 0003-066X (ISSN-L)
- 1935-990X
- OpenAlex
- W2091828452
- Semantic Scholar
- 3841c62426b1eb3ad98fb79319e28c085dd5e0b0
- Cited by
- 627
- References
- 94
- Citations by year
- 2026: 38 · 2025: 54 · 2024: 53 · 2023: 31 · 2022: 44 · 2021: 68 · 2020: 55 · 2019: 61 · 2018: 64 · 2017: 49 · 2016: 54 · 2015: 40 · 2014: 15
- FWCI
- 62.15
- Type
- journal article
- Language
- en
- Open access
- green
- pure.qub.ac.uk
- Licence
- other-oa
- Locations
- American Psychologist (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion, other-oa)
- 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 › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- acceptance and commitment therapy, chronic pain, cognitive behavioral therapy, pain management, treatment development
- MeSH terms
- Humans, Models, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Chronic Pain, Mindfulness, Acceptance and Commitment Therapy
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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