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Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Barnonkologisk forskning/Ljungman)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
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2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 1, 21-29 p.Article in journal (Refereed) Published
Abstract [en]

Background Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design. Purpose The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain. Method A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, preassessment to 6-month follow-up (n=53) and pre-assessment to 12-month follow-up (n=32), were used. Results Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life. Conclusion This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.

Place, publisher, year, edition, pages
2016. Vol. 23, no 1, 21-29 p.
Keyword [en]
Acceptance, Acceptance and commitment therapy, Chronic pain, Mediation analysis, Physical functioning, Satisfaction with life
National Category
Medical and Health Sciences Applied Psychology
Identifiers
URN: urn:nbn:se:uu:diva-256448DOI: 10.1007/s12529-015-9494-yISI: 000370243400003PubMedID: 26041582OAI: oai:DiVA.org:uu-256448DiVA: diva2:825430
Available from: 2015-06-23 Created: 2015-06-23 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Acceptance for persons suffering from pain: Evaluation of acceptance-based interventions for adults with chronic pain and children with cancer experiencing acute pain
Open this publication in new window or tab >>Acceptance for persons suffering from pain: Evaluation of acceptance-based interventions for adults with chronic pain and children with cancer experiencing acute pain
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

It is increasingly clear that pain and emotions are closely interconnected. Pain does not only cause psychological distress, but psychological distress also amplifies pain through neurological mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts increased pain tolerance and decreased pain intensity and discomfort in experimentally induced pain and improved physical and psychosocial functioning for persons with chronic pain.

The overall aim of this thesis was to evaluate acceptance-based interventions for persons suffering from pain.

In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with life, physical functioning and pain intensity for the ACT group. Both the ACT and the control group improved regarding depression and anxiety. In Study II the mediating effect of acceptance for treatment change was evaluated, using data from Study I (n=64). The results showed indirect effects of treatment via acceptance for physical functioning but not for satisfaction with life. In Studies III and IV, instruments to measure psychological flexibility in relation to pain were developed for children with cancer, and their parents respectively, using factor analysis. The results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure exercise. All participants reported reduced discomfort of pain, and three of the participants reported reduced pain intensity.

The results suggest that a manualised ACT-based self-help intervention is a valuable addition to the treatment repertoire for persons with chronic pain and that acceptance may mediate the effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in the context of acute pain in children with cancer are now available, although further validation is needed. Lastly, the results indicate that an acceptance-based intervention may help children undergoing cancer treatment to cope with pain.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 64 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1340
Keyword
acute pain, chronic pain, acceptance, psychological flexibility, acceptance and commitment therapy, children and adolescents, cancer
National Category
Applied Psychology Other Medical Sciences not elsewhere specified
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-322401 (URN)978-91-513-0001-6 (ISBN)
Public defence
2017-09-08, Sal IX, Gamla universitetshuset, Biskopsgatan 3, 753 10 Uppsala, Uppsala, 09:00 (English)
Opponent
Supervisors
Funder
Swedish Childhood Cancer Foundation, FTJH11/002 och PR2013/0058Swedish Cancer Society, CAN2013/749
Available from: 2017-08-18 Created: 2017-05-22 Last updated: 2017-09-08
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Thorsell-Cederberg, JennyCernvall, MartinDahl, JoAnnevon Essen, LouiseLjungman, Gustaf

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