Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial

Abstract

Although several studies have illustrated the effectiveness of cognitive behavior therapy (CBT) on adult pain patients, there are few randomized controlled trials on children and adolescents. There is particularly a need for studies on pediatric patients who are severely disabled by longstanding pain syndromes. Acceptance and Commitment Therapy, as an extension of traditional CBT, focuses on improving functioning and quality of life by increasing the patient's ability to act effectively in concordance with personal values also in the presence of pain and distress. Following a pilot study, we sought to evaluate the effectiveness of an ACT-oriented intervention based on exposure and acceptance strategies and to compare this with a multidisciplinary treatment approach including amitriptyline (n=32). The ACT condition underwent a relatively brief treatment protocol of approximately 10 weekly sessions. Assessments were made before and immediately after treatment, as well as at 3.5 and 6.5 months follow-up. Prolonged treatment in the MDT group complicated comparisons between groups at follow-up assessments. Results showed substantial and sustained improvements for the ACT group. When follow-up assessments were included, ACT performed significantly better than MDT on perceived functional ability in relation to pain, pain intensity and to pain-related discomfort (intent-to-treat analyses). At post-treatment, significant differences in favor of the ACT condition were also seen in fear of re/injury or kinesiophobia, pain interference and in quality of life. Thus, results from the present study support previous findings and suggest the effectiveness of this ACT-oriented intervention for pediatric longstanding pain syndromes.

Long Term Follow up in Children with Anxiety Disorders Treated with Acceptance and Commitment Therapy or Cognitive Behavioral Therapy: Outcomes and Predictors

“…This is in keeping with the findings of other studies that reported treatment gains to be more evident a few months post treatment [21][22][23]. Although the proportion of participants diagnosis free at 2YFU was not statistically different, a larger sample size may have increased the power to detect significant findings, as there was a trend towards a greater proportion of CBT participants being diagnosis free.…”

“…Several studies have shown maintenance of gains one year post treatment [15][16][17]; and including youth 2-3 years [3], 3.5 years [18], 6 years [19] and 7.4 years [20] following treatment cessation. Assessing outcomes over the long term may be particularly indicated among children treated with ACT as studies of ACT for children with a spectrum of presenting problems have found that treatment gains were either not fully evident at posttreatment (or initial follow-up), or that greater improvements for ACT were obtained some months after therapy cessation [21][22][23]. This underscores the need for the inclusion of longer follow-up time points in research.…”

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…There are now six published RCTs of ACT related to chronic pain in adults, 7,14,75,88,90,91, and one in young people. 92 There are other trials that are pseudo-randomized, partly controlled, or pilot studies, 36,58,87 a partial reanalysis of treatment outcome focused on older adults, 54 and several larger scale effectiveness studies, 52,84 including a large treatment cohort that showed good outcomes at three years post treatment. 86 There are also two small RCTs of ACT for headache.…”

Effectiveness of Acceptance and Commitment-Based Therapy (ACT Rehab) on Quality of Life, Severity and Duration of Pain; in Women With Chronic Low Back Pain

“…The results of the study of Veehof et al (2011) suggest that ACT interventions improve health and reduce mental pressures by changing psychological flexibility and paying conscious attention to the symptoms of anxiety [29]. Wicksell et al (2009) reported that flexibility throughout the interventions reduces symptoms of depression and anxiety [31]. Moreover, this study shows that ACT affects anxiety-related disorders [15,16].…”