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,Lance Mccracken,Harald Baumeister,Jiaxi Lin

doi:10.3390/jcm8010024

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.

Highlights

Chronic pain (CP) is a disorder with a pooled prevalence rate of 31% [1] and it is constantly one of the top causes of years lived with disability [2]
The outcome at t1 was better for guided Internet-based ACT than for waitlist in participants with AAQ-II baseline scores
Unguided Internet-based ACT was superior to waitlist at follow-up in participants with less baseline psychological inflexibility, but not in participants with higher baseline psychological inflexibility

Summary

Introduction

Chronic pain (CP) is a disorder with a pooled prevalence rate of 31% [1] and it is constantly one of the top causes of years lived with disability [2]. Numerous psychological variables appear to contribute to the process of how pain leads to disability, including self-efficacy, emotional distress, and fear [3]. Psychological therapies have been shown to be effective to improve anxiety, depression, catastrophic thinking, disability, and sometimes pain [4]. A psychotherapy increasingly gaining interest in the treatment of CP is Acceptance and Commitment Therapy (ACT), a contextual form of Cognitive and Behavioral Therapy (CBT). In ACT, psychological flexibility and its opposite psychological inflexibility are central concepts [5].

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Results

Conclusion