A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy–based bibliotherapy intervention among adults living with chronic pain

Abstract

Background: Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims: The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods: This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results: Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46-0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion: These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain. RÉSUMÉ Contexte: La douleur chronique a des répercussions importantes sur le fonctionnement physique et psychologique des personnes atteintes. Il est maintenant reconnu que la thérapie d'acceptation et d'engagement (ACT) est une intervention efficace pour la prise en charge de la douleur chronique; cependant, plusieurs barrières limitent son accessibilité. Objectifs: La présente étude avait pour but d'évaluer l'efficacité d'une intervention psychologique autoadministrée de huit semaines sous forme de bibliothérapie avec contact thérapeutique minimal, basée sur l'ACT dans la gestion de la douleur chronique. Méthodes: Cet essai contrôlé et randomisé comprenait trois temps de mesure (prétest, posttest et trois mois suivant l'intervention) (Code d'identification ClinicalTrials.gov :NCT03924687). Un total de 140 adultes souffrant de douleur chronique a été assigné aléatoirement dans une condition ACT de type self-help (bibliothérapie) et une condition liste d'attente. Résultats: Un modèle d'analyse de variance (ANOVA) à deux facteurs à mesures répétées a démontré des différences statistiquement significatives entre le prétest et le posttest sur l'incapacité liée à la douleur (variable principale), la dépression (variable secondaire), l'acceptation et l'inflexibilité psychologique associées à la douleur (d = 0,46 à 0,88) en faveur de la condition ACT de type self-help. Au suivi de trois mois, ces différences se sont maintenues et près de 54 % des participants...

Acceptance and commitment therapy for patients with chronic pain: A systematic review and meta-analysis on psychological outcomes and quality of life

“…Specifically, all but one of the studies demonstrated random sequence generation [48]. On allocation concealment, one study was assessed as "high risk of bias" [55], eight studies were assessed as "unclear risk of bias" [42,43,45,46,48,50,53,54]. For performance bias, all studies were considered "low risk of bias."…”

“…Moreover, no evidence of serious bias was found. For detection bias, six studies did not explicitly indicate whether they blinded the interviewers and were therefore assessed as "some concerns" [47,54,56,57,59,60]. In terms of attrition bias, twenty studies were rated as "low risk of bias" [28, 29, 46, 47, 49-51, 53, 55-57, 60].…”

Acceptance-based telephone support around the time of transition to secondary progressive multiple sclerosis: A feasibility randomised controlled trial

“…A recent review recommended the use of ACT self-help as an intervention, especially when combined with clinician guidance (French et al, 2017). ACT bibliotherapy has shown promise in a case-series evaluation of those with MS (Harrison et al, 2017) and a robust trial in chronic pain (Veillette et al, 2019). A review examining the efficacy of psychotherapy delivered over the telephone in MS showed moderate benefits in physical and mental health domains, with the authors recommending further studies of better quality (Proctor, Moghaddam, Vogt, et al, 2018).…”

A qualitative feasibility and acceptability study of an acceptance and commitment-based bibliotherapy intervention for people with cancer

“…One such intervention type is bibliotherapy, or the therapeutic use of books and other reading materials ( Bilich et al, 2008 ; Howie, 1988 ) which can be used to address psychological and physical health concerns ( Hedman et al, 2016 ). Among them, bibliotherapy has been used to provide support for internalizing type problems, such as depression and anxiety ( Lorenzo-Luaces et al, 2023 ), and managing a number of long-term conditions including: chronic pain ( Thorsell et al, 2011 ; Veillette et al, 2019 ), appearance related concern ( Muftin and Thompson, 2013 ; Powell et al, 2023 ), distress associated with multiple sclerosis ( Proctor et al, 2018 ) and in post-stroke management ( Gladwyn-Khan and Morris, 2023 ).…”

“…ACT’s efficacy in cancer has been reported in face-to-face therapy studies ( Arch and Mitchell, 2016 ; Brown et al, 2020 ; Gentili et al, 2019 ; Gonzalez-Fernandez et al, 2018 ; Li et al, 2021a , 2021b ; Low et al, 2016 ). Further ACT bibliotherapy’s potential is seen in other conditions, including irritable bowel syndrome (IBS) ( Gillanders et al, 2017 ), skin and appearance-related conditions ( Powell et al, 2023 ), multiple sclerosis ( Proctor et al, 2018 ) and chronic pain ( Veillette et al, 2019 ) with similar effects observed in non-clinical populations, too ( Jeffcoat and Hayes, 2012 ; Ritzert et al, 2016 ). However, to our knowledge there is no existing research that has examined the acceptability of ACT for individuals with cancer delivered in the form of bibliotherapy.…”