Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec 25;8(1):24.
doi: 10.3390/jcm8010024.

Baseline Psychological Inflexibility Moderates the Outcome Pain Interference in a Randomized Controlled Trial on Internet-based Acceptance and Commitment Therapy for Chronic Pain

Thomas Probst  1 , Harald Baumeister  2 , Lance M McCracken  3   4 , Jiaxi Lin  5
Affiliations

Baseline Psychological Inflexibility Moderates the Outcome Pain Interference in a Randomized Controlled Trial on Internet-based Acceptance and Commitment Therapy for Chronic Pain

Thomas Probst et al. J Clin Med. .

Abstract

This study re-investigated data of a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain (ACTonPain). Baseline psychological inflexibility was examined as a moderator of the outcome pain interference. In the ACTonPain trial, participants with chronic pain were randomized to one of three conditions: guided Internet-based ACT (n = 100), unguided Internet-based ACT (n = 101), and waitlist (n = 101). Moderation analyses were performed with the SPSS macro PROCESS. Pain interference according to the Multidimensional Pain Inventory (MPI) was the primary outcome in this trial, and the potential moderator psychological inflexibility was measured with the Acceptance and Action Questionnaire (AAQ-II). Psychological inflexibility at baseline moderated the outcome between guided Internet-based ACT and waitlist 9-weeks as well as 6-months after randomization. (both p < 0.05). Between unguided Internet-based ACT and waitlist, psychological inflexibility moderated the outcome 6-months after randomization (p < 0.05). Internet-based ACT was superior to waitlist for participants with less psychological inflexibility at baseline, but Internet-based ACT became increasingly comparable to waitlist at higher AAQ-II baseline values. Future research should investigate whether the results can be replicated in more individualized and tailored face-to-face settings.

Keywords: acceptance and commitment therapy; chronic pain; psychological inflexibility.

PubMed Disclaimer

Conflict of interest statement

H. Baumeister reports that he is a psychological psychotherapist and consultant of the German chamber for psychotherapists in the last years. Moreover, he gives (paid) lectures and workshops on Internet- and mobile-based interventions. The remaining authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Visualizations of the results testing baseline psychological inflexibility as a moderator of the treatment outcome pain interference between waitlist and guided Internet-based ACT. The outcome (Y-axis) is displayed for three different levels (sample mean ± 1 standard deviation) of psychological inflexibility (X-axis). Note: AAQ-II = Acceptance and Action Questionnaire; iACT = Internet-based Acceptance and Commitment Therapy; MPI = Pain interference scale of the Multidimensional Pain Inventory; t0 = baseline; t1 = 9-weeks after randomization; t2 = 6-months after randomization.
Figure 2
Figure 2
Visualizations of the results testing baseline psychological inflexibility as a moderator of the treatment outcome pain interference between waitlist and unguided Internet-based ACT. The outcome (Y-axis) is displayed for three different levels (sample mean ± 1 standard deviation) of psychological inflexibility (X-axis). Note: AAQ-II = Acceptance and Action Questionnaire; iACT = Internet-based Acceptance and Commitment Therapy; MPI = Pain interference scale of the Multidimensional Pain Inventory; t0 = baseline; t1 = 9-weeks after randomization; t2 = 6-months after randomization.
Figure 3
Figure 3
Visualizations of the results testing baseline psychological inflexibility as a moderator of the treatment outcome pain interference between unguided and guided Internet-based ACT. The outcome (Y-axis) is displayed for three different levels (sample mean ± 1 standard deviation) of psychological inflexibility (X-axis). Note: AAQ-II = Acceptance and Action Questionnaire; iACT = Internet-based Acceptance and Commitment Therapy; MPI = Pain interference scale of the Multidimensional Pain Inventory; t0 = baseline; t1 = 9-weeks after randomization; t2 = 6-months after randomization.
See this image and copyright information in PMC

References

    1. Steingrímsdóttir Ó.A., Landmark T., Macfarlane G.J., Nielsen C.S. Defining chronic pain in epidemiological studies: A systematic review and meta-analysis. Pain. 2017;158:2092–2107. doi: 10.1097/j.pain.0000000000001009. - DOI - PubMed
    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 328 Diseases and Injuries for 195 Countries, 1990–2016: A Systematic Analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–1259. doi: 10.1016/S0140-6736(17)32154-2. - DOI - PMC - PubMed
    1. Lee H., Hübscher M., Moseley G.L., Kamper S.J., Traeger A.C., Mansell G., McAuley J.H. How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain. 2015;156:988–997. doi: 10.1097/j.pain.0000000000000146. - DOI - PubMed
    1. Williams A.C., Eccleston C., Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst. Rev. 2012;11:CD007407. doi: 10.1002/14651858.CD007407.pub3. - DOI - PMC - PubMed
    1. Hayes S.C., Luoma J.B., Bond F.W., Masuda A., Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav. Res. Ther. 2006;44:1–25. doi: 10.1016/j.brat.2005.06.006. - DOI - PubMed

LinkOut - more resources