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- Kemani, Mike K., et al.
(författare)
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Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain : a Randomized Controlled Trial
- 2015
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 31:11, s. 1004-1016
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain.Materials and Methods: On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance.Results: Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up.Discussion: More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.
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| 2. |
- Södermark, Martin, et al.
(författare)
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What Works? Processes of Change in a Transdiagnostic Exposure Treatment for Patients with Chronic Pain and Emotional Problems
- 2020
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 36:9, s. 648-657
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We recently developed a transdiagnostic exposure treatment ("the hybrid treatment") for chronic pain patients with concurrent emotional difficulties. This paper investigates the hypothesized treatment processes, specifically: a) if changes on pain-related dysregulation (catastrophizing, fear-avoidance and non-acceptance of pain) and general emotion dysregulation (difficulties to regulate a broad spectrum of emotional responses) mediate effects on outcomes; and b) if mediation is more pronounced for patients who score higher on these processes pre-treatment.METHODS: Structural equation modeling for longitudinal data using the full intention-to-treat sample was used to test whether proposed variables mediated the effect of the hybrid treatment (n=58) compared to a guided internet delivered pain management treatment based on cognitive-behavioral principles (iCBT; n=57) on pain interference and depressive symptoms at 9-months follow up. To make full use of the multiple process-measures collected in the trial, we modeled mediators as two continuous latent variables: pain-related dysregulation and general emotion dysregulation.RESULTS: Reduced pain-related dysregulation mediated the effects of treatment on both outcomes, whereas reduced general emotion dysregulation mediated the effects on depressive symptoms only. In the hybrid treatment, the mediated effect was more pronounced for participants who scored higher on pain-related dysregulation pre-treatment relative to those who scored lower.DISCUSSION: Our findings provide initial support for the transdiagnostic theoretical underpinnings of the hybrid treatment model. Using a hybrid treatment approach that centers on teaching patients emotion regulation skills before commencing broad exposure, successfully influenced both pain-related dysregulation and general emotion dysregulation, which in turn was associated with better treatment outcomes. It appears central to address these processes in pain patients with comorbid emotional problems, especially among patients scoring high on measures regarding catastrophizing, fear-avoidance and non-acceptance of pain.
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