A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain

Abstract

While much of the literature provides positive support for psychological interventions for chronic pain, 2 recent meta-analyses indicate small to moderate benefits only. This inconsistency in findings suggests that there are other treatment-related variables to consider. One possible consideration pertains to treatment format, as psychological models form the basis for both unidisciplinary psychology and integrated interdisciplinary treatments for chronic pain. Therefore, a comparative meta-analysis of unidisciplinary and interdisciplinary treatments was performed to determine whether there were differences in treatment effect size (ES) at post-treatment and follow-ups of up to 1 year. One specific treatment model, Acceptance and Commitment Therapy (ACT), was investigated as it was felt that this literature was extensive enough to perform the planned analysis, while also being circumscribed enough in size to make it feasible. In total, 29 articles met inclusion criteria, 13 reported outcomes for unidisciplinary ACT, and 15 for interdisciplinary ACT. At both post-treatment and follow-up, interdisciplinary ACT had a greater ES for physical disability, psychosocial impact, and depression compared to unidisciplinary ACT. No differences in ES were observed for pain intensity, pain-related anxiety, or pain acceptance. Findings remained the same when study heterogeneity was considered. There was a significant difference observed between treatment format and treatment duration-on average, unidisciplinary interventions were of shorter duration than interdisciplinary interventions. Moderation analyses examining the relation between total treatment duration and ES generally indicated a moderate positive relation between treatment length and ES. This relation was strong for psychosocial impact. Perspective: A comparative meta-analysis examined the relative ES of unidisciplinary (ie, clinical psychology only) and interdisciplinary ACT for chronic pain in 29 studies. The ES for interdisciplinary ACT was larger than unidisciplinary ACT for physical disability, psychosocial impact, and depression. No differences were present for pain intensity, anxiety, and acceptance.

Initial evaluation of the Chronic Pain Acceptance Questionnaire – 2

“…McCracken Reneman et al, 2010;Thompson & McCracken, 2011;Vowles, Pielech, Edwards, McEntee, & Bailey, 2019;Vowles & Thompson, 2011). The treatment approach most often associated with the CPAQ and pain acceptance is Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012).…”

“…Finally, while issues of construct validity are hugely important to examine, the literature on the CPAQ has consistently supported its psychometric properties, relations with other key aspects of pain‐related physical and emotional functioning, sensitivity to intervention and relevance as a treatment mechanism (e.g. see reviews and meta‐analyses of: McCracken & Vowles, 2014; Reneman et al., 2010; Thompson & McCracken, 2011; Vowles, Pielech, Edwards, McEntee, & Bailey, 2019; Vowles & Thompson, 2011).…”

Where is my arm? Investigating the link between complex regional pain syndrome and poor localisation of the affected limb

“… Notes: 1 Except for Depression or Anxiety disorders, due to the large incidence of these conditions within the population living with persistent pain ( e.g . Vowles et al, 2020 ). 2 According to recommended criteria for research ( Bruehl et al, 1999 ).…”

Recomendaciones clínicas para la rehabilitación de personas con fibromialgia. Una revisión narrativa.

“…Por otro lado, la psicología de la salud o médica con la subespecialidad del dolor que evalúa e interviene en los factores psicológicos que influyen en el dolor. En la FM, los efectos del tratamiento farmacológico son cuestionables y se recomienda tratamientos no farmacológicos, por lo cual toda persona con FM debería ser tratada psicológicamente de manera sincrónica junto con los demás abordajes terapéuticos (121). El abordaje de la FM debe ser interdisciplinario, ya que genera un efecto mayor en la discapacidad física, impacto psicosocial y depresión (121,122).…”

“…En la FM, los efectos del tratamiento farmacológico son cuestionables y se recomienda tratamientos no farmacológicos, por lo cual toda persona con FM debería ser tratada psicológicamente de manera sincrónica junto con los demás abordajes terapéuticos (121). El abordaje de la FM debe ser interdisciplinario, ya que genera un efecto mayor en la discapacidad física, impacto psicosocial y depresión (121,122). Además, las intervenciones unimodales han demostrado ser insuficientes, por lo que debería primar el multicomponente o multimodalidad en cada abordaje (78,122).…”