New generation psychological treatments in chronic pain

McCracken, Lance M; Yu, Lin; Vowles, Kevin E

doi:10.1136/bmj-2021-057212

Cited by 123Mindfulness and Compassion InterventionsMusculoskeletal pain and rehabilitationPain Management and Treatment

New generation psychological treatments in chronic pain

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McCracken, Lance M, Yu, Lin, Vowles, Kevin E·2022·BMJ

DOI 10.1136/bmj-2021-057212

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Abstract

Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called “third wave” CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.

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ACT may be particularly suitable for people with life-limiting illnesses and disabling long-term conditions such as MND, muscle disorders, brain injury and chronic pain.
“Acceptance and Commitment Therapy (ACT) may be particularly suitable for people with life-limiting illnesses and disabling long-term conditions such as MND, muscle disorders, brain injury and chronic pain [5, 23–25].”
From Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study (2023) · cites this paper as [25]
The Practical implications section reports that ACT benefits the average patient with chronic pain, and the included-studies table lists trials involving fibromyalgia and mild brain injury with chronic pain. But that section says the evidence is not strong or consistent enough to determine who is best suited to ACT. The paper does not establish particular suitability for the full range of life-limiting illnesses and conditions named, including MND. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Comorbidity between chronic pain and psychological distress generates a significant impact on the quality of life of patients with these conditions.
“it generates a significant impact on the quality of life of patients with these conditions (McCracken et al., 2022)”
From A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress (2023) · cites this paper as McCracken et al., 2022
The 'Prevalence and impact of chronic pain' section says chronic pain is associated with depression and anxiety and that people with chronic pain report lower quality of life. It does not establish that the comorbidity itself causes the quality-of-life impact. (LLM, conf=0.84)
Experimental — accuracy not yet measured
This indirect effect may be because third-wave psychotherapies commonly address some facets that overlap with the primary components of psychological flexibility.
“Thus, this indirect effect may be because”
From Efficacy of Videoconference Group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for Chronic Low Back Pain (CLBP) Plus Comorbid Depressive Symptoms: A Randomized Controlled Trial (IMPACT Study) (2023) · cites this paper as [40]
In “Generations of cognitive and behavioral treatment” (page not supplied), the paper identifies ACT as a third-wave therapy and says it targets psychological flexibility, including acceptance, awareness, and behavior-change processes. It does not establish that third-wave psychotherapies generally address overlapping facets, so the claim extends beyond the ACT-focused discussion. (LLM, conf=0.82)
Experimental — accuracy not yet measured
PPIs and ACT have been found to be effective in the treatment of chronic pain.
“PPIs and ACT have been found to be effective in the treatment of chronic pain [30-35], improving affect and functional ability after knee surgery [21], and quicker cessation of pain and opioid use in veterans after orthopedic surgery [36].”
From Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study (2024) · cites this paper as [32]
The Conclusion says ACT benefits people with chronic pain, particularly by improving pain interference, disability, depression, and quality of life; it also says evidence for pain reduction is lacking. The paper does not establish that PPIs are effective for chronic pain, so it supports only the ACT part of the attributed claim. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Acceptance and Commitment Therapy has been shown to be beneficial for improving quality of life and psychological wellbeing in other long-term health conditions, including muscle disorders and chronic pain.
“This approach has been shown to be beneficial for improving quality of life and psychological wellbeing in other long-term health conditions, including muscle disorders and chronic pain. 14,15”
From Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND): a multicentre, parallel, randomised controlled trial in the UK (2024) · cites this paper as [14]

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Randomized Controlled Trial of Adding Telephone Follow-Up to an Occupational Rehabilitation Program to Increase Work Participation
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One-Day Acceptance and Commitment Therapy Compared to Support for Depressed Migraine Patients: a Randomized Clinical Trial.
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An exploratory clinical trial on acceptance and commitment therapy as an adjunct to psychoeducational relaxation therapy for chronic pain.
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[8]8. ns=effect sizes for non-significant effects not reported; effect size (ES) signs are reversed from original manuscript in some cases to be consistent across all studies. Positive ES indicate superiority of ACT v control. CPAQ=chronic pain acceptance questionnaire; GACT=group ACT; ITT=intention to treat analyses; RPT=recommended pharmacological treatment; WL=waiting list. CLINICAL REVIEW by copyright. on 15 March 2022 at The HSC (Health Service Northern Ireland). Protected http://www.bmj.com/ BMJ: first published as 10.1136/bmj-2021-057212 on 28 February 2022. Downloaded from
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A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND): study protocol.
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Authors: McCracken, L. M., Yu, L., & Vowles, K. E.
Affiliations: Uppsala University (SE)
Middlesex University London (GB)
Queen's University Belfast (GB)
Corresponding author: McCracken, Lance M
ORCID: McCracken, Lance M
Yu, Lin
Vowles, Kevin E
Venue: BMJ
Publisher: BMJ
Published: 2022-02-28
Volume: 376
Pages: e057212
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj-2021-057212
OpenAlex: W4214510919
Semantic Scholar: a84aa15eb11de13d42f3a7a877f948ccb7611e7b
Cited by: 123
References: 86
Citations by year: 2026: 16 · 2025: 32 · 2024: 31 · 2023: 37 · 2022: 7
FWCI: 4.44
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations: BMJ (publishedVersion)
PubMed (publishedVersion)
Research Portal (Queen's University Belfast) (submittedVersion, cc-by)
Topics: Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: chronic pain, acceptance and commitment therapy, third-wave CBT, psychological flexibility, pain interference, disability, depression, quality of life, cost-effectiveness, change processes, psychological intervention
MeSH terms: Humans, Randomized Controlled Trials as Topic, Chronic Pain, Acceptance and Commitment Therapy

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