Baseline psychological inflexibility moderates the outcome pain interference in a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain
Open accessAbstract
This study re-investigated data of a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain (ACTonPain). Baseline psychological inflexibility was examined as a moderator of the outcome pain interference. In the ACTonPain trial, participants with chronic pain were randomized to one of three conditions: guided Internet-based ACT (n = 100), unguided Internet-based ACT (n = 101), and waitlist (n = 101). Moderation analyses were performed with the SPSS macro PROCESS. Pain interference according to the Multidimensional Pain Inventory (MPI) was the primary outcome in this trial, and the potential moderator psychological inflexibility was measured with the Acceptance and Action Questionnaire (AAQ-II). Psychological inflexibility at baseline moderated the outcome between guided Internet-based ACT and waitlist 9-weeks as well as 6-months after randomization. (both p < 0.05). Between unguided Internet-based ACT and waitlist, psychological inflexibility moderated the outcome 6-months after randomization (p < 0.05). Internet-based ACT was superior to waitlist for participants with less psychological inflexibility at baseline, but Internet-based ACT became increasingly comparable to waitlist at higher AAQ-II baseline values. Future research should investigate whether the results can be replicated in more individualized and tailored face-to-face settings.
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People with chronic pain are more likely to benefit from an ACT-based pain intervention in case of initially lower psychological flexibility.
“As one example, it has been shown that people with chronic pain are more likely to benefit from an Acceptance and Commitment Therapy (ACT) based pain intervention in case of initially lower psychological flexibility (Probst et al., 2018), and psychological flexibility has been verified as mechanism of change (Lin et al., 2018).”
From Special issue on digital health interventions in chronic medical conditions: Editorial (2022) · cites this paper as Probst et al., 2018
The Discussion says the opposite: people with chronic pain needed a certain amount of psychological flexibility at baseline to benefit from Internet-based ACT. It recommends ACT over no treatment for those who were psychologically flexible at baseline, but not for those with higher psychological inflexibility. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredPsychological flexibility is a mediator of change in ACT for reducing pain-associated disability.
“Psychological flexibility has been proposed as a mediator of change, specifically in ACT, for reducing pain-associated disability [25,29].”
From Lessons Learned from an Attempted Pragmatic Randomized Controlled Trial for Improvement of Chronic Pain-Associated Disability in Green Professions: Long-Term Effectiveness of a Guided Online-Based Acceptance and Commitment Therapy (PACT-A) (2022) · cites this paper as [29]
The Introduction identifies psychological flexibility as central to ACT, and the Treatment section says the modules aim to increase it. The Discussion says increases in flexibility are associated with improved outcomes, but this paper tests baseline inflexibility as a moderator of pain interference, not flexibility as a mediator of reduced pain-associated disability. No page numbers are provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe other five articles were excluded because they comprised the same samples as the selected five.
“The other five were excluded because they comprised the same samples as the selected five”
From Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis (2021) · cites this paper as [38]
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- Authors
- Probst, T., Baumeister, H., McCracken, L. M., & Lin, J.
- Affiliations
- Universität für Weiterbildung Krems (AT)
- Universität Ulm (DE)
- King's College London (GB)
- University of Freiburg (DE)
- Corresponding author
- Probst, Thomas
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2018-12-25
- Volume
- 8
- Issue
- 1
- Pages
- 24
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC6352262
- OpenAlex
- W2906503559
- Cited by
- 38
- References
- 25
- Citations by year
- 2026: 1 · 2024: 5 · 2023: 8 · 2022: 9 · 2021: 7 · 2020: 5 · 2019: 3
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- OPen Access Repositorium der Universität Ulm (OPARU) (Ulm University) (submittedVersion, other-oa)
- Universität Ulm, Kommunikations- und Informationszentrum (kiz) (cc-by)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- psychological inflexibility, acceptance and commitment therapy, online therapy, chronic pain, pain interference, moderators, Acceptance and Action Questionnaire, Multidimensional Pain Inventory
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