Change in fatigue in acceptance and commitment therapy‐based treatment for chronic pain and its association with enhanced psychological flexibility

Abstract

Purpose Fatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic pain. Methods This study included 354 adults attending an interdisciplinary ACT‐oriented treatment for chronic pain. T‐tests and analyses of clinically meaningful change were used to investigate participant improvements in fatigue interference after the treatment. Pearson's correlations and hierarchical regressions were conducted to investigate associations between improvement in fatigue interference and improvements in PF processes. Finally, mixed effects models were used to explore associations between baseline fatigue interference and changes in treatment outcome measures. Results Participants improved in fatigue interference (d = 0.37), pain, some PF processes and daily functioning (d = 0.18–1.08). 39.7% of participants demonstrated clinically meaningfully improvements in fatigue interference. Changes in fatigue interference was associated with changes in pain, PF processes and daily functioning, |r| = 0.20–0.46. Change in fatigue interference was associated with change in pain acceptance independent of change in pain, β = −0.36, p < .001. However, baseline fatigue interference did not predict any treatment outcome. Overall, people with fatigue appeared to benefit from the ACT‐oriented interdisciplinary treatment for chronic pain, and relatively higher levels of fatigue did not appear to impede this benefit. Conclusion ACT‐based treatments may benefit people with chronic pain and fatigue. Future studies including experimental designs, and studies investigating other PF processes, are needed to better understand the utility of ACT for comorbid fatigue and pain. Significance This study investigates the association between fatigue interference and psychological flexibility processes in chronic pain, and the first one investigating fatigue interference as a predictor of functioning in chronic pain following Acceptance and Commitment Therapy (ACT)‐based treatment. Findings of the study provide preliminary evidence for the association between ACT and fatigue in people with chronic pain and support the potential benefit of ACT for people with comorbid chronic pain and fatigue.

Effect of Psychological Inflexibility on Depressive Symptoms and Sleep Disturbance among Japanese Young Women with Chronic Pain

“…Depressive symptoms were measured using the Japanese version [ 40 ] of the Patient Health Questionnaire-9 (PHQ-9) [ 43 ]. The PHQ-9 has been used to treat depressive symptoms in individuals and patients with chronic pain [ 17 , 22 , 24 , 26 , 30 ]. The Japanese version is strongly correlated with another scale designed to measure depressive symptoms [ 44 ].…”

“…In fact, accumulating evidence suggests that psychological inflexibility is associated with higher levels of depressive symptoms in individuals with chronic pain [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Additionally, ACT for chronic pain alleviates depressive symptoms by improving psychological inflexibility [ 22 , 25 , 26 , 27 , 28 , 29 , 30 ]. One study [ 31 ] found that psychological inflexibility predicted severe depressive symptoms in 144 patients with chronic pain, independent of the effect of their pain intensity, mindfulness, and pain-related acceptance.…”

Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

“…In studies of chronic pain, the independent variable is usually pain, and the dependent variables are pain interference, depression, anxiety, etc. [ 40 ], even when other aspects, such as fatigue, are already being considered [ 41 ]. However, fibromyalgia is a syndrome in which pain is not the only or the main symptom.…”

Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia

“…In recent years, a call for contextually sensitive approaches to behavioural determinants of functioning in chronic pain has been made (Yu et al., 2020). The development of the Activity Patterns Scale has been a first step in this direction (Esteve et al., 2016).…”

“…Specifically, this activity pattern was only significantly related to depressive levels when pain severity levels were at their highest (M = 10). In recent years, a call for contextually sensitive approaches to behavioural determinants of functioning in chronic pain has been made (Yu et al, 2020). The development of the Activity Patterns Scale has been a first step in this direction (Esteve et al, 2016).…”