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Randomized Controlled Trial
. 2013 Nov;14(11):1398-406.
doi: 10.1016/j.jpain.2013.06.011. Epub 2013 Sep 12.

A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results

Lance M McCracken  1 , Ayana Sato, Gordon J Taylor
Affiliations
Randomized Controlled Trial

A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results

Lance M McCracken et al. J Pain. 2013 Nov.

Abstract

Acceptance and commitment therapy (ACT) is a developing approach for chronic pain. The current study was designed to pilot test a brief, widely inclusive, local access format of ACT in a UK primary care setting. Seventy-three participants (68.5% women) were randomized to either ACT or treatment as usual (TAU). Many of the participants were aged 65 years or older (27.6%), were diagnosed with fibromyalgia (30.2%) and depression (40.3%), and had longstanding pain (median = 10 years). Standard clinical outcome measures included disability, depression, physical functioning, emotional functioning, and rated improvement. Process measures included pain-related and general psychological acceptance. The recruitment target was met within 6 months, and 72.9% of those allocated to ACT completed treatment. Immediately post treatment, relative to TAU, participants in ACT demonstrated lower depression and higher ratings of overall improvement. At a 3-month follow-up, again relative to TAU, those in ACT demonstrated lower disability, less depression, and significantly higher pain acceptance; d = .58, .59, and .64, respectively. Analyses based on intention-to-treat and on treatment "completers," perhaps predictably, revealed more sobering and more encouraging results, respectively. A larger trial of ACT delivered in primary care, in the format employed here, appears feasible with some recommended adjustments in the methods used here (Trial registration: ISRCTN49827391).

Perspective: This article presents a pilot randomized controlled trial of ACT for chronic pain in a primary care setting in the United Kingdom. Both positive clinical outcomes and ways to improve future trials are reported.

Keywords: Acceptance and commitment therapy; chronic pain; cognitive behavioral therapy; pilot; psychological flexibility; randomized controlled trial.

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Figures

Figure 1
Figure 1
CONSORT flow diagram. *One participant in the TAU condition was uncontactable at posttreatment but contactable at follow-up.
See this image and copyright information in PMC

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