Acceptance and Commitment Therapy for Longstanding Chronic Pain in a Community-Based Outpatient Group Setting

Abstract

Chronic pain affects millions of adults each year and has serious costs both economically and on psychosocial well-being. Acceptance-based behavioral treatments have been developed that improve quality of life and reduce disability, but additional attention to processes of change responsible for good outcomes is needed. While many interventions are effective in the context of comprehensive interdisciplinary treatment centers, such settings have limited reach. Treatments applicable to smaller, community-based settings are also needed. The current study examined the impact of an outpatient Acceptance and Commitment Therapy group intervention on adults (N=28) recruited from the community with heterogeneous longstanding chronic pain as compared to a wait-list control group. Results showed no between-group differences on process or outcome measures. Within-subjects analyses examining change from baseline at mid-treatment, post-treatment, and 4-month follow up indicated trending improvements in pain-related disability and depression outcomes, with changes in disability at post and follow up in line with clinically meaningful change, while quality of life and pain severity did not improve. ACT processes of pain-related avoidance and success at living leisure and relationship values improved at post and follow up with medium to large effect sizes, while mindfulness and coping strategy use did not improve. Limitations include small sample size, high attrition, and low participant engagement. Despite the fact that changes observed cannot be directly attributed to the intervention, important information was gleaned about the feasibility of adapting interventions to community settings and recommendations for next steps in such endeavors are discussed.