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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]
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“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
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“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]
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“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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“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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“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].”
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“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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“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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Ma, T.-W., Yuen, A. S.-K., & Yang, Z. (2023) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000001096 · Cited by 88
Psychological Flexibility, Chronic Pain, and Health
McCracken, L. M. (2023) · Annual Review of Psychology · doi:10.1146/annurev-psych-020223-124335 · Cited by 89
Self-citationSanabria-Mazo, J. P., Colomer-Carbonell, A., Fernández-Vázquez, Ó., Noboa-Rocamora, G., Cardona-Ros, G., McCracken, L. M., Montes-Pérez, A., Castaño-Asins, J. R., Edo, S., Borràs, X., et al. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1200685 · Cited by 56
“…is more treatment-resistant than either condition alone (Mansfield et al., 2016) and it generates a significant impact on the quality of life of patients with these conditions (McCracken et al., 2022), it has been considered a growing target for treatment in recent years (McCracken, 2023).”
BackgroundSelf-citationSanabria-Mazo, J. P., Colomer-Carbonell, A., Borràs, X., Castaño-Asins, J. R., McCracken, L. M., Montero-Marin, J., Pérez-Aranda, A., Edo, S., Sanz, A., Feliu-Soler, A., et al. (2023) · The Journal of Pain · doi:10.1016/j.jpain.2023.04.008 · Cited by 40
Self-citationChronic pain, chronic stress and substance use: overlapping mechanisms and implications
Schaffer, J., Fogelman, N., Seo, D., & Sinha, R. (2023) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1145934 · Cited by 43
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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