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

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 treat...

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Bibliographic Details
Published in:	The journal of pain 2013-11, Vol.14 (11), p.1398-1406
Main Authors:	McCracken, Lance M, Sato, Ayana, Taylor, Gordon J
Format:	Article
Language:	eng
Subjects:	Acceptance and Commitment Therapy Adult Aged Aged, 80 and over Anesthesia & Perioperative Care chronic pain Chronic Pain - complications Chronic Pain - psychology Chronic Pain - therapy cognitive behavioral therapy Depression - complications Depression - psychology Depression - therapy Female Fibromyalgia - complications Fibromyalgia - psychology Fibromyalgia - therapy Humans Male Middle Aged Original Report Pain Medicine pilot Pilot Projects psychological flexibility randomized controlled trial Treatment Outcome
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Summary:	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.
ISSN:	1526-5900 1528-8447