Current status of acceptance and commitment therapy for chronic pain: a narrative review

Abstract

It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.

Effect of Acceptance and Commitment Therapy on the Quality of Life in Infertile Women During Treatment: A Randomized Control Trial

“…The research on the effect of ACT as a therapy for mood disorders confirmed it as an effective treatment for mood, anxiety, and other psychological disorders such as pain and eating disorder (15,16). The ACT is used for treating anger (17), chronic pain, drug abuse, and many other problems as well (18,19). Further, it is an effective therapy for decreasing infertility stress, psychological distress, and infertility-related depression (20), as well as a promising treatment for patients who have failed in vitro fertilization.…”

Acceptance as an Emotion Regulation Strategy in Experimental Psychological Research: What We Know and How We Can Improve That Knowledge

“…Many different forms of acceptance-based programs were developed and tested for effectiveness. They were shown to be successful in stress and pain reduction as well as decreasing anxiety and depression symptoms (Segal et al, 2002;Hayes et al, 2006;Veehof et al, 2011;Twohig and Levin, 2017;Feliu-Soler et al, 2018). Other studies showed the role of mindfulness and acceptance for the severity of psychotic symptoms (Cramer et al, 2016;Jansen et al, 2019), eating disorders (Prefit et al, 2019), compulsive sexual behavior (Lew-Starowicz et al, 2019), addictive behaviors (Bowen et al, 2011), suicidal ideation and self-harm (Tighe et al, 2018) as well as other psychopathological symptom clusters (Aldao et al, 2010).…”

The Bed Nucleus of the Stria Terminalis as a Brain Correlate of Psychological Inflexibility in Fibromyalgia

“…Similarly, higher PF has also been found to be associated with less pain intensity and interference, less anxiety and depressive symptomatology, and improved physical and mental functioning in patients with FM [17,23,24]. Furthermore, PF (and its individual components) have also been reported to mediate clinical changes in acceptance-and mindfulness-based interventions delivered to patients with chronic pain [22,25] and FM [26][27][28].…”

“…Although PF has been established as a relevant transdiagnostic mechanism and as a key variable in explaining the effects of third-wave cognitive behavioral interventions on health, studies assessing the brain structures underpinning this set of cognitive processes are lacking [25]. The main objective of the present study was to explore the brain structural correlates of PF, as measured by the Psychological Inflexibility in Pain Scale (PIPS) [24] in patients with FM.…”