Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT)

Abstract

Objective: The purpose of this study was to examine the effectiveness of Acceptance and Commitment Therapy (ACT) for older adults with chronic pain. Secondarily, we examined the associations between changes on processes of psychological flexibility and treatment outcome variables.Subjects: Participants were 60 adults with chronic pain aged 65 and older selected from a larger consecutive sample of 928 adults of any age. All participants had longstanding pain that was associated with significant distress and disability.Methods: Participants completed measures of pain, functioning, and depression, and processes of psychological flexibility at baseline, immediately post-treatment, and at a nine month follow-up. Treatment consisted of a two or four week residential program based on principles of ACT delivered by an interdisciplinary team. Treatment was designed to increase daily functioning by enhancing key processes of psychological flexibility, including openness, awareness, and committed action.Results: Participants showed significant improvements in functioning and mental health at posttreatment. Participants also showed significant increases in pain acceptance and committed action from pre-to post-treatment. Small effect sizes were observed for most treatment outcome and process variables in the pre-treatment to follow-up intervals; however, these improvements were not statistically significant. In secondary analyses, changes in facets of psychological flexibility were significantly associated with improvements in social functioning and mental health.Chronic pain in older adults 3Conclusion: This study supports the potential effectiveness of ACT for chronic pain among older adults. Future research is needed to determine how to maximize the impact of this treatment, particularly through greater impact on psychological flexibility.

Acceptance and Commitment Therapy Improves Psychological Flexibility of Students with Thalassemia Major: A Randomized Controlled Trial

“…The results of this study indicate that ACT training increases the cognitive flexibility of patients with thalassemia. This finding is consistent with the results of the previous studies (McCracken & Gutiérrez-Martínez, 2011;McCracken & Morley, 2014;Scott et al, 2017). In McCracken and Gutiérrez-Martínez (2011) study, ACT was performed on 168 patients suffered from chronic pain.…”

“…Another study on the role of cognitive flexibility as the basic mechanism for change in the ACT shows that cognitive flexibility leads to the optimization of treatment effect (Gandy et al, 2018). Also, another study shows that the positive changes in the cognitive flexibility of adults are significantly associated with improving social performance and their psychological health (Scott et al, 2017).…”

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

“…Psychological inflexibility for pain was assessed using the Japanese version [ 40 ] of the Acceptance and Action Questionnaire-Ⅱ (AAQ-II) [ 41 ]. The AAQ-II has been applied across diverse samples [ 42 ], including patients and individuals with chronic pain [ 19 , 20 , 21 , 22 , 23 , 24 ]. Additionally, the reliability and validity of the AAQ-II for chronic pain have already been established in previous studies [ 31 ].…”

“…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.…”

“…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. The finding that psychological inflexibility plays a unique role in depressive symptoms beyond the effect of pain intensity has been replicated [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Moreover, another study [ 20 ] on patients with chronic pain conducted an ACT-based treatment for chronic pain and found that psychological inflexibility, pain intensity, and depressive symptoms at the three-month follow-up was reduced by the treatment, and that the change in score of psychological inflexibility at pre-treatment and follow-up was associated with that of depressive symptoms even when controlling for the effects of pain intensity and mindfulness.…”