Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning

Abstract

Acceptance and Commitment Therapy (ACT) is based on the Psychological Flexibility (PF) model, which includes a therapeutic process, referred to as "self-as-context" (SAC). This study investigates whether ACT is associated with an effect on SAC and whether this effect is linked to treatment outcomes in people with chronic pain. 412 adults referred to a pain management center participated in the study. Participants completed measures of treatment processes (SAC, pain acceptance) and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon completion of treatment, and at nine-month follow-up.Paired sample t-tests and analyses of meaningful change were conducted to examine changes in processes and outcomes. Regression analyses with residualized change scores from process and outcome variables, and bivariate growth curve modeling were used to examine the association between change in SAC and change in outcomes. Participants significantly improved on all process and outcome variables at post-treatment (d=.38 to .98) and nine-month followup (d=.24 to .75). 42.0% to 67.5% participants showed meaningful improvements on each outcome at post-treatment and follow-up. Change in SAC was associated with change in outcomes (β=-.21 to -.31; r=-.16 to -.46). Results support a role for change in SAC in treatment as the PF model suggested. PerspectiveThis study shows the delivery of a treatment for chronic pain based on Acceptance and Commitment Therapy was associated with improved self-as-context (SAC) and improved M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTChange in Contextual Self 3 functioning for people with chronic pain, and increases in SAC were associated with improved functioning. These results can inform future treatment development.

The role of psychological flexibility in relation to suicidal thinking in chronic pain

“…Higher scores reflect a greater sense of self‐as‐context. The SEQ has good internal consistency, it correlates as one would expect with other components of PF and with measures of functioning in people with chronic pain (Yu et al., ), and is sensitive to treatment effects from ACT (Yu et al., ).…”

Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses

“…The psychological flexibility represents the ability to consciously stay in touch with the present moment, without setting up unnecessary defences, and to put in place a behavior adapted to the service of a set personal goal[18]. One of the components of the model is the committed action which is defined as a value-oriented behavior pattern, persistent in that it incorporates setbacks or discomfort[19, 20].…”

“…Another component is the contextual Self. This conceptualization of the Self is centered on the capacity of perspective-taking which entails distancing oneself from one’s thoughts[18]. Recent studies have shown favorable associations between these components, social, and physical functioning[21].…”

Psychological approaches to chronic pain management: where are we coming from and where might we go?

“…It is customarily regarded as having six facets: acceptance, cognitive defusion, present-focused awareness, a sense of self as perspective, and action qualities that are committed and values-directed (20,30). Accumulating evidence for the PF model is now quite considerable, including evidence for each of the facets listed here in their significant role in relation to the emotional, physical, and social functioning of people with chronic pain (31-33; see [34] for a recent short review).…”

“…More recently we have shown for the first time that change in what is called in ACT "self-ascontext," or perspective taking, combined with acceptance also correlates with improved functioning in ACT for chronic pain (34,46). Self-as-context is a process of experiencing a distinction (you are separate from) or a hierarchical arrangement (you are larger or greater than) between thoughts and feelings and the person who sees and acts on these experiences.…”