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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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In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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 Pain and Evil: From Local Nociception to Misery Following Social Harm (2020) · cites this paper as [147]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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
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In the citing paper
“ACT mainly focuses on the enhancement of so-called ‘psychological flexibility’.”
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In the citing paper
“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
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“Several studies report a high value for ACT in the management of chronic pain when compared with standard pharmacological treatment alone [13-16].”
In the citing paper
“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]
In the citing paper
“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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The role of psychosocial processes in the development and maintenance of chronic pain
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016) · The Journal of Pain · doi:10.1016/j.jpain.2016.01.001 · Cited by 954
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2015.1098724 · Cited by 737
“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
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
Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., et al. (2022) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.2669 · Cited by 331
Hann, K. E. J., & McCracken, L. M. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.10.001 · Cited by 259
Self-citation
Metadata
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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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.
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