A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy-based bibliotherapy intervention among adults living with chronic pain
Open accessAbstract
Background Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility.Aims The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain.Methods This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition.Results Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46–0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health.Conclusion These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain.
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For detection bias, six included studies did not explicitly indicate whether they blinded the interviewers and were assessed as some concerns.
“For detection bias, six studies did not explicitly indicate whether they blinded the interviewers and were therefore assessed as”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [54]
The Methods CONSORT checklist (item 11a; page not specified) marks reporting of who was blinded, including outcome assessors, as “n/a.” This supports the narrower point that this trial does not explicitly report assessor blinding. As a single trial, it does not establish that six studies omitted interviewer-blinding details or that they were assessed as having “some concerns.” (LLM, conf=0.82)
Experimental — accuracy not yet measuredOn allocation concealment, one included study was assessed as high risk of bias and eight studies were assessed as unclear risk of bias.
“On allocation concealment, one study was assessed as”
From Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life (2024) · cites this paper as [54]
The Methods CONSORT checklist (page not specified) marks the trial’s allocation-concealment mechanism as “n/a.” A search for allocation-concealment risk assessments found no passage classifying one study as high risk and eight as unclear risk. (LLM, conf=0.76)
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Cites
Statistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gotzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010) · BMJ · doi:10.1136/bmj.c869 · Cited by 8,883 · see citing works
(1999) · Cited by 5,934 · see citing works
Pain assessment: global use of the Brief Pain Inventory.
Cs, C., & Km, R. (1994) · PubMed · Cited by 5,178 · see citing works
Kabat-Zinn, J. (1982) · General Hospital Psychiatry · doi:10.1016/0163-8343(82)90026-3 · Cited by 4,255 · see citing works
Core outcome measures for chronic pain clinical trials: IMMPACT recommendations
Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., Kerns, R. D., Stucki, G., Allen, R. R., Bellamy, N., et al. (2005) · Pain · doi:10.1016/j.pain.2004.09.012 · Cited by 3,732 · see citing works
Core outcome domains for chronic pain clinical trials: IMMPACT recommendations
Turk, D. C., Dworkin, R. H., Allen, R. R., Bellamy, N., Brandenburg, N., Carr, D. B., Cleeland, C., Dionne, R., Farrar, J. T., Galer, B. S., et al. (2003) · Pain · doi:10.1016/j.pain.2003.08.001 · Cited by 3,510 · see citing works
Dworkin, R. H., Turk, D. C., Wyrwich, K. W., Beaton, D., Cleeland, C. S., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Kerns, R. D., Ader, D. N., et al. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2007.09.005 · Cited by 3,471 · cited 1× · see citing works
“Furthermore, the IMMPACT expert consensus deems that a reduction of more than 1 point (scale of 0 to 10) for the different items of the BPI Interference subscale represents a clinically significant change.(50) This study found a mean reduction of 1.”
BackgroundIntention-to-treat concept: A review
Gupta, S. (2011) · Perspectives in Clinical Research · doi:10.4103/2229-3485.83221 · Cited by 1,921 · see citing works
Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.03.004 · Cited by 1,858 · see citing works
Acceptance and commitment therapy.
Hayes, S. C., & Lillis, J. (2012) · American Psychological Association eBooks · doi:10.1037/17335-000 · Cited by 1,543 · see citing works
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101 · see citing works
Short Form of Depression Inventory: Cross-Validation
Beck, A. T., Rial, W. Y., & Rickels, K. (1974) · Psychological Reports · doi:10.1177/003329417403403s01 · Cited by 807 · see citing works
Assessing the clinical significance of change scores recorded on subjective outcome measures
Hurst, H., & Bolton, J. E. (2004) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2003.11.003 · Cited by 715 · see citing works
Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain
McCracken, L. M. (1998) · Pain · doi:10.1016/s0304-3959(97)00146-2 · Cited by 685 · see citing works
Clinical Effectiveness and Cost-Effectiveness of Treatments for Patients With Chronic Pain
Turk, D. C. (2002) · Clinical Journal of Pain · doi:10.1097/00002508-200211000-00003 · Cited by 642 · see citing works
Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress.
McCracken, L. M., & Vowles, K. E. (2014) · American Psychologist · doi:10.1037/a0035623 · Cited by 627 · see citing works
Acceptance and Commitment Therapy (ACT) for Chronic Pain: A Systematic Review and Meta-Analyses
Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & McMillan, D. (2017) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000425 · Cited by 611 · see citing works
Dropout from Internet‐based treatment for psychological disorders
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010) · British Journal of Clinical Psychology · doi:10.1348/014466509x472138 · Cited by 597 · see citing works
Coping or acceptance? What to do about chronic pain
McCracken, L. M., & Eccleston, C. (2003) · Pain · doi:10.1016/s0304-3959(03)00202-1 · Cited by 591 · see citing works
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100100 · Cited by 565 · see citing works
Newman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.008 · Cited by 480 · see citing works
Behavioral activation interventions for well-being: A meta-analysis
Mazzucchelli, T. G., Kane, R. T., & Rees, C. S. (2010) · The Journal of Positive Psychology · doi:10.1080/17439760903569154 · Cited by 319 · see citing works
Fish, R. A., McGuire, B., Hogan, M., Morrison, T. G., & Stewart, I. (2010) · Pain · doi:10.1016/j.pain.2009.12.016 · Cited by 306 · see citing works
Macea, D. D., Gajos, K., Daglia Calil, Y. A., & Fregni, F. (2010) · The Journal of Pain · doi:10.1016/j.jpain.2010.06.005 · Cited by 289 · see citing works
Intensity of Chronic Pain — The Wrong Metric?
Ballantyne, J. C., & Sullivan, M. D. (2015) · New England Journal of Medicine · doi:10.1056/nejmp1507136 · Cited by 284 · see citing works
Buhrman, M., Skoglund, A., Husell, J., Bergström, K., Gordh, T., Hursti, T., Bendelin, N., Furmark, T., & Andersson, G. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.02.010 · Cited by 281 · see citing works
Psychological therapies (Internet-delivered) for the management of chronic pain in adults
Eccleston, C., Fisher, E., Craig, L., Duggan, G. B., Rosser, B. A., & Keogh, E. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010152.pub2 · Cited by 271 · see citing works
Hann, K. E. J., & McCracken, L. M. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.10.001 · Cited by 259 · see citing works
Trompetter, H. R., Bohlmeijer, E. T., Veehof, M. M., & Schreurs, K. M. G. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9579-0 · Cited by 255 · see citing works
Vowles, K. E., McCracken, L. M., McLeod, C., & Eccleston, C. (2008) · Pain · doi:10.1016/j.pain.2008.08.012 · Cited by 226 · see citing works
Psychological approaches to chronic pain management: evidence and challenges
Eccleston, C., Morley, S. J., & Williams, A. C. D. (2013) · British Journal of Anaesthesia · doi:10.1093/bja/aet207 · Cited by 223 · see citing works
Internet interventions for chronic pain including headache: a systematic review
Buhrman, M., Gordh, T., & Andersson, G. (2016) · Internet Interventions · doi:10.1016/j.invent.2015.12.001 · Cited by 223 · see citing works
Dear, B. F., Titov, N., Perry, K. N., Johnston, L., Wootton, B. M., Terides, M. D., Rapee, R. M., & Hudson, J. L. (2013) · Pain · doi:10.1016/j.pain.2013.03.005 · Cited by 182 · see citing works
Wicksell, R. K., Lekander, M., Sorjonen, K., & Olsson, G. L. (2010) · European Journal of Pain · doi:10.1016/j.ejpain.2009.11.015 · Cited by 176 · see citing works
Kristjánsdóttir, Ó. B., Fors, E. A., Eide, E., Finset, A., Stensrud, T. L., van Dulmen, S., Wigers, S. H., & Eide, H. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2249 · Cited by 176 · see citing works
Self-help interventions for anxiety disorders: An overview
Cuijpers, P., & Schuurmans, J. (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0034-6 · Cited by 161 · see citing works
Nordgren, L. B., Hedman, E., Etienne, J., Bodin, J., Kadowaki, Å., Eriksson, S., Lindkvist, E., Andersson, G., & Carlbring, P. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.05.007 · Cited by 145 · see citing works
Ferguson, L., & Scheman, J. (2009) · Journal of Pain · doi:10.1016/j.jpain.2009.01.258 · Cited by 143 · see citing works
The Effectiveness of an Acceptance and Commitment Therapy Self-help Intervention for Chronic Pain.
Johnston, M., Foster, M., Shennan, J., Starkey, N. J., & Johnson, A. (2010) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181cf59ce · Cited by 142 · cited 3× · see citing works
“The study by Johnston et al.(14) recruited a very small sample (N = 14), and the treatment effects over the long term were not examined.”
BackgroundThorsell, J., Finnes, A., Dahl, J., Lundgren, T., Gybrant, M., Gordh, T., & Buhrman, M. (2011) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e318219a933 · Cited by 136 · cited 2× · see citing works
“For example, the study conducted by Thorsell et al.15 included many telephone contacts with a clinician, making it harder to evaluate effects specifically related to reading the book.”
MethodThe reliability and validity of pain interference measures in persons with cerebral palsy
Tyler, E. J., Jensen, M. P., Engel, J. M., & Schwartz, L. M. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2002.27466 · Cited by 136 · see citing works
Hogg, M. N., Gibson, S., Helou, A., DeGabriele, J., & Farrell, M. J. (2012) · Medical Journal of Australia · doi:10.5694/mja12.10140 · Cited by 133 · see citing works
Geisser, M. E., Clauw, D. J., Strand, V., Gendreau, M. R., Palmer, R. H., & Williams, D. A. (2010) · Pain · doi:10.1016/j.pain.2010.02.043 · Cited by 127 · see citing works
Farrand, P., & Woodford, J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.11.001 · Cited by 125 · see citing works
An Internet-Based Intervention for Chronic Pain
Lin, J., Paganini, S., Sander, L., Lüking, M., Ebert, D. D., Buhrman, M., Andersson, G., & Baumeister, H. (2017) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2017.0681 · Cited by 110 · see citing works
French, K., Golijani-Moghaddam, N., & Schröder, T. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.08.002 · Cited by 100 · see citing works
Poundja, J., Fikretoglu, D., Guay, S., & Brunet, A. (2007) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2006.09.031 · Cited by 99 · see citing works
Andersson, E., Ljótsson, B., Smit, F., Paxling, B., Hedman, E., Lindefors, N., Andersson, G., & Rück, C. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-215 · Cited by 77 · see citing works
Clinical assessment of behavioral coping responses: Preliminary results from a brief inventory
McCracken, L. M., Eccleston, C., & Bell, L. (2005) · European Journal of Pain · doi:10.1016/j.ejpain.2004.04.005 · Cited by 62 · cited 10× · see citing works
“The purpose of this randomized controlled trial was to assess the effectiveness of an 8-week, ACT-based, self-administered bibliotherapy intervention program with minimal therapeutic support in the management of CP.”
BackgroundInfluentialDel Re, A. C., Maisel, N. C., Blodgett, J. C., & Finney, J. W. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003464 · Cited by 62 · see citing works
New Developments in the Psychological Management of Chronic Pain
Morley, S., & Williams, A. C. D. C. (2015) · The Canadian Journal of Psychiatry · doi:10.1177/070674371506000403 · Cited by 46 · see citing works
Disease Management for Chronic Pain: Barriers of Program Implementation With Primary Care Physicians
Jamison, R. N., Gintner, L., Rogers, J. F., & Fairchild, D. G. (2002) · Pain Medicine · doi:10.1046/j.1526-4637.2002.02022.x · Cited by 36 · see citing works
A Case Study of Overselling Psychotherapy: An ACT Intervention for Diabetes Management
O’Donohue, W., Snipes, C., & Soto, C. G. (2015) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-015-9308-1 · Cited by 23 · see citing works
Rosen, G. M., & Lilienfeld, S. O. (2015) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-015-9319-y · Cited by 23 · see citing works
Page, S., & Page, S. (1974) · Psychological Reports · doi:10.2466/pr0.1974.34.2.630 · Cited by 8 · see citing works
Gregg, J. A., & Hayes, S. C. (2015) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-015-9312-5 · Cited by 6 · see citing works
Flagged first, then by citations
3 of the 60 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- [44]Martel M-E, Dionne F, Gauchet A, Zouikri-Roland Y, Decker E, Trouillet R, Wicksell R, Monestès J-L Psychological inflexibility for pain: translation and validation for a French-speaking population. Poster presented at: the ACBS Annual World Conference; 2015; Berlin, Germany.
Cited by
Sorted by citations
Lai, L., Liu, Y., McCracken, L. M., Li, Y., & Ren, Z. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104308 · Cited by 60 · see citing works
Ye, L., Li, Y., Deng, Q., Zhao, X., Zhong, L., & Yang, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301226 · Cited by 43 · see citing works
Psychological Approaches for Migraine Management
Sturgeon, J. A., Ehde, D. M., Darnall, B. D., Barad, M. J., Clauw, D. J., & Jensen, M. P. (2023) · Anesthesiology Clinics · doi:10.1016/j.anclin.2023.02.002 · Cited by 13 · see citing works
Keenan, E., Morris, R. C., Vasiliou, V. S., & Thompson, A. R. (2023) · Journal of Health Psychology · doi:10.1177/13591053231216017 · Cited by 9 · see citing works
Wells, E. M., Velasquez, D., Hutchinson, A., & Gunn, K. M. (2023) · Journal of the Australian Library and Information Association · doi:10.1080/24750158.2023.2231231 · Cited by 7 · see citing works
Meek, C., Moghaddam, N. G., Evangelou, N., Oates, L. L., Topcu, G., Allen, C. M., & das Nair, R. (2021) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2021.07.001 · Cited by 6 · see citing works
Martel, M.-E., Dionne, F., Pagé, M. G., & Choinière, M. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100760 · Cited by 3 · see citing works
Self-citationYuan, R., & Li, M. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1625041 · Cited by 1 · see citing works
Sanabria‐Mazo, J. P., Rodríguez‐Freire, C., Royuela-Colomer, E., Ponce‐López, P., Alonso‐Coello, P., Barrios, V., Navarrete, J., Pérez‐Aranda, A., McCracken, L. M., & Luciano, J. V. (2026) · European Journal of Pain · doi:10.1002/ejp.70342 · Cited by 1 · see citing works
Gheibee, A., Tajeri, B., Kooshki, S., & Gharamaleki, N. S. (2021) · Iranian Journal of Rehabilitation Research
Dewi, I. P., Syabariyah, S., Fatmawati, A., Sanusi, S., & Pratiwi, D. R. (2022) · Jurnal EMPATI (Edukasi Masyarakat Pengabdian dan Bakti) · doi:10.26753/empati.v3i3.867
Salikka, T., Kylmä, J., & Fröjd, S. A. (2026) · European Journal of Pain · doi:10.1002/ejp.70235
Rutzick, S., Aufox, S. A., Borto, E., Lawrence, E. E., Scott, K., Shepherd, R. F., Rasmussen, C., & Young, J. L. (2026) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-026-04355-w
- Authors
- Veillette, J., Martel, M.-E., & Dionne, F.
- Affiliations
- Réseau québécois de recherche sur la douleur (CA)
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
- Corresponding author
- Dionne, Frédérick
- ORCID
- Dionne, Frédérick
- Venue
- Canadian Journal of Pain
- Publisher
- Informa UK Limited
- Published
- 2019-01
- Volume
- 3
- Issue
- 1
- Pages
- 209-225
- ISSN
- 2474-0527 (ISSN-L)
- PMC
- PMC8730660
- OpenAlex
- W2981015414
- Cited by
- 13
- References
- 60
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 2
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Canadian Journal of Pain (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fonds de recherche québécois société et culture (2016-NP-189887)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- acceptance and commitment therapy, bibliotherapy, chronic pain, self-help intervention, pain-related disability, depression, pain acceptance, psychological inflexibility, community-dwelling adults
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