Cited by 628Mindfulness and Compassion InterventionsMusculoskeletal pain and rehabilitationPsychotherapy Techniques and Applications

Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress.

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McCracken, Lance M., Vowles, Kevin E.·2014·American Psychologist

Abstract

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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Crossref · 10.1037/a0035623

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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)

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  • ACT 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 measured
  • Measurements 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 measured
  • Contextual 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 measured
  • The 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)

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Research works printed but not linked: 2

  1. [7]7. Burns, J. W., Kubilus, A., Bruehl, S., & Harden, R. N. (2003). Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? Journal of Consulting and Clinical Psychology, 66, 434-439.
  2. [25]25. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and Commitment Therapy: The process and practice of mindful change. New York: The Guildford Press. ACT and Mindfulness for Chronic Pain 25

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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
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
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

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