Introducing a Physical Therapist-Led Acceptance and Commitment Therapy Training for Pain: A Clinical Perspective

Abstract

Purpose: Mounting evidence supports the use of cognitive and behavioral techniques as part of physical therapist practice. These methods are used within a physical therapist’s multimodal treatment approach for the management of pain and to facilitate health behavior change. There is a multitude of evidence-based cognitive behavioral techniques to choose from including newer approaches based on Acceptance and Commitment Therapy. Yet few studies have examined physical therapists’ perceptions to learning and implementing ACT into clinical practice. The purpose of this manuscript is to present a clinical perspective of physical therapists learning about and incorporating Acceptance and Commitment Therapy in clinical practice. Methods: An 8-week online physical therapist-led ACT for chronic pain training was completed by 65 physical therapists. A post-training evaluation was developed and then scored by 46 participants. The evaluation included 15-questions with regard to the self-reported perceptions of learning foundational ACT skills necessary to implement into physical therapy practice, a deeper understanding of psychological factors involved in musculoskeletal pain, confidence in managing musculoskeletal pain, utility in physical therapist practice, and the recognition of a new or different approach to treating musculoskeletal pain. Results: Participants’ self-reported perceptions were highly positive with 73% reporting the training furthered their understanding of psychological factors in chronic musculoskeletal pain and 100% reported learning the foundational ACT skills necessary to implement it into physical therapy practice. In addition, 7 sub-themes regarding the ACT training emerged from a qualitative content analysis and included the following: 1) The training filled a knowledge gap in understanding of how to assess and treat psychological factors related to pain, 2) A mixture of prerecorded video training, reading, experiential exercises, and self-reflection via the ACTPTE were critical to reinforce learning, 3) Coaching and supervision calls were a useful part of the training and helped to translate course knowledge and implement into clinical practice, 4) Having an opportunity to practice in a group setting with like-minded peers was a critical component of confidence building, 5) Ongoing communication, networking, and mentorship via the online forum and coaching calls allowed participants to complete the course material on-time, stay connected, and share stories and experiences about implementing the material in practice, 6) The ACT stance of not changing pain or related psychological content (example: not changing thoughts, pain related beliefs, reconceptualizing pain) may run counter to other psychologically-informed approaches found in physical therapy practice and took some time for practitioners to process and integrate, 7) Some practitioners expressed that ACT helped them cope with work-related stress and burnout and to drop the struggle of fixing or curing every patient with pain. Conclusions: ACT delivered via an online training was acceptable to physical therapists and supervision calls were necessary for confidence building and implementation into practice. The ACT model was perceived as adaptable to the practice of physical therapy as well as the complex clinical and psychosocial presentation of many chronic pain conditions. Future investigations should explore brief training interventions, treatment fidelity, long-term outcomes, the development and validation of a scale to measure knowledge, concepts and skills conceptualizing psychological flexibility within physical therapist practice.