The DOI matches its Crossref record; 86 of the 86 references it cites were found in a registry or an index.
New generation psychological treatments in chronic pain
Open accessAbstract
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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“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]
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
“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
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
“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]
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
“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]
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In the citing paper
“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”
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“ACT is supported in evidence as treatment for chronic pain.”
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In the citing paper
“This is in line with research in patients with chronic pain showing beneficial effects of ACT and PPIs compared with a control group on pain intensity and emotional functioning [65,66], in the treatment of chronic pain [30-35], in improving affect and functional ability after knee surgery [21], and in quicker cessation of pain and opioid use in veterans after orthopedic surgery [36].”
The cited source says what the claim attributes to it.
In the citing paper
“ACT is an acceptance-based behaviour therapy [16] with a strong evidence base for improving outcomes (such as functioning, quality of life and mood) in chronic pain [17], and a growing evidence base in chronic disease and mental health contexts [18].”
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In the citing paper
“Considering a dropout rate of 30% [48,49,50,51], it will be necessary to include 51 subjects in each study arm.”
From Effectiveness of Acceptance and Commitment Therapy (ACT) for the Management of Postsurgical Pain: Study Protocol of a Randomized Controlled Trial (SPINE-ACT Study) (2023) · cites this paper as [51]
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Citations
Cites
Vos, T., Lim, S. S., Abbafati, C., Abbas, K. M., Abbasi, M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30925-9 · Cited by 19,358
Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006) · European Journal of Pain · doi:10.1016/j.ejpain.2005.06.009 · Cited by 5,486
Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., et al. (2019) · Pain · doi:10.1097/j.pain.0000000000001384 · Cited by 3,478
The biopsychosocial approach to chronic pain: Scientific advances and future directions.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.4.581 · Cited by 3,392
Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & for the Clinical Guidelines Committee of the American College of Physicians* (2017) · Annals of Internal Medicine · doi:10.7326/m16-2367 · Cited by 3,234
Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016
Dahlhamer, J., Lucas, J., Zelaya, Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6736a2 · Cited by 2,598
Mediators and Mechanisms of Change in Psychotherapy Research
Kazdin, A. E. (2007) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.3.022806.091432 · Cited by 2,504
Chronic pain: a review of its epidemiology and associated factors in population-based studies
Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019) · British Journal of Anaesthesia · doi:10.1016/j.bja.2019.03.023 · Cited by 1,728
Wu, A., MARCH, L. M., Zheng, X.-Q., Huang, J., Wang, X., Zhao, J., Blyth, F., Smith, E. U. R., Buchbinder, R., & Hoy, D. G. (2020) · Annals of Translational Medicine · doi:10.21037/atm.2020.02.175 · Cited by 1,689
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Eccleston, C., & Morley, S. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub3 · Cited by 1,634
Research works printed but not linked: 7
- Hayes SC. Acceptance and commitment therapy and the new behavior therapies: mindfulness, acceptance, and relationship. In: Hayes SC, Follette VM, Linehan MM, eds. Mindfulness and acceptance: Expanding the cognitive-behavioral tradition. Guildford Press 2004.1-29.
- Fordyce WE . Behavioral methods for chronic pain and illness. CV Mosby, 1976.
- Hayes S Strosahl K Wilson K . Acceptance and commitment therapy: The process and practice of mindful change. 2nd ed. Guilford Press, 2012.
- Hayes SC Strosahl KD Wilson KG . Acceptance and Commitment Therapy: The process and practice of mindful change. 2nd ed. Guilford Press, 2012.
- Lin, 2017, An internet-based intervention for chronic pain: A three-arm randomized controlled study of the effectiveness of guided and unguided acceptance and commitment therapy, Dtsch Arztebl Int, 114, 681
- 10.1097/AJP.0000000000000203 · DOI · Paper page
- 10.3389/fnhum.2021.587018 · DOI · Paper page
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Eather, C.-E., Sullivan, C. M., Sterling, M. M., Armfield, N. R., Liimatainen, J., Chandra, S. S., & Elphinston, R. A. (2026) · Pain · doi:10.1097/j.pain.0000000000003959
Zhdanova, I. V., & Shakhova, O. H. (2026) · Psychiatry Neurology and Medical Psychology · doi:10.26565/2312-5675-2026-33-09
Zhang, Y., Zhao, Y., Cheng, Y., Liu, L., Wang, Z., & Wu, B. (2026) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2026.102060
Eshraghi, P., Drake, D., Iddon, J., & Dickson, J. M. (2026) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph23060708
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Alvarez, M., Herrera, S., Cruz, D., & Castro, A. (2026) · International Journal of Social and Psychological Aspects of Healthcare · doi:10.51847/skztcezvaw
Kadri, K., Keating, C., Anderson, M., Novelli, D., McBride, E., & Scott, W. (2026) · British Journal of Pain · doi:10.1177/20494637261497966
Metadata
- 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
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2022-02-28
- Volume
- 376
- Pages
- e057212
- ISSN
- 1756-1833 (ISSN-L)
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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