| 1. |
- Al-Kaisy, Adnan, et al.
(author)
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Multicentre, double-blind, randomised, sham-controlled trial of 10 khz high-frequency spinal cord stimulation for chronic neuropathic low back pain (MODULATE-LBP) : a trial protocol
- 2020
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In: Trials. - : BMC. - 1745-6215. ; 21
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Journal article (peer-reviewed)abstract
- Introduction: Chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. Evidence demonstrates that high-frequency 10 kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in patients with failed back surgery syndrome (FBSS), but evidence of this effect is limited in individuals with CNLBP who have not had surgery. The aim of this multicentre randomised trial is to assess the clinical and cost-effectiveness of 10 kHz SCS for this population.Methods: This is a multicentre, double-blind, randomised, sham-controlled trial with a parallel economic evaluation. A total of 96 patients with CNLBP who have not had spinal surgery will be implanted with an epidural lead and a sham lead outside the epidural space without a screening trial. Patients will be randomised 1:1 to 10 kHz SCS plus usual care (intervention group) or to sham 10 kHz SCS plus usual care (control group) after receiving the full implant. The SCS devices will be programmed identically using a cathodal cascade. Participants will use their handheld programmer to alter the intensity of the stimulation as per routine practice. The primary outcome will be a 7-day daily pain diary. Secondary outcomes include the Oswestry Disability Index, complications, EQ-5D-5 L, and health and social care costs. Outcomes will be assessed at baseline (pre-randomisation) and at 1 month, 3 months and 6 months after device activation. The primary analyses will compare primary and secondary outcomes between groups at 6 months, while adjusting for baseline outcome scores. Incremental cost per quality-adjusted life year (QALY) will be calculated at 6 months and over the lifetime of the patient.Discussion: The outcomes of this trial will inform clinical practice and healthcare policy on the role of high-frequency 10 kHz SCS for use in patients with CNLBP who have not had surgery.
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| 2. |
- Anderson, Madeleine, et al.
(author)
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An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain
- 2024
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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 15
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Journal article (peer-reviewed)abstract
- Introduction: Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes.Materials and methods: Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431).Results: The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not.Discussion: The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.
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| 3. |
- Bartels, Sara Laureen, et al.
(author)
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Development, evaluation and implementation of a digital behavioural health treatment for chronic pain : study protocol of the multiphase DAHLIA project
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.METHODS AND ANALYSIS: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.ETHICS AND DISSEMINATION: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.TRIAL REGISTRATION NUMBER: NCT05066087.
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| 4. |
- Bartels, Sara Laureen, et al.
(author)
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Using Personas in the development of eHealth interventions for chronic pain : A scoping review and narrative synthesis
- 2023
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 32
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Research review (peer-reviewed)abstract
- Objectives: Behavioral eHealth interventions can enhance self-management and improve well-being in people with chronic pain. The development of these interventions calls for a user-centered approach to ensure that patient needs are appreciated. However, it may be challenging to involve patients; particularly during the early stages of the process. Fictional user profiles, known as Personas, can represent needs and guide designing eHealth interventions. This article provides a comprehensive overview of the use of Personas in the development of behavioral eHealth interventions for people with chronic pain with the aim to identify benefits and challenges. Methods: Bibliographic databases (Medline, Web of Science Core Collection, PsycInfo, CINAHL) and registries (PubMed Central, medaRxiv) were systematically searched. In a double-reviewing process, n = 6830 hits and n = 351 full-texts were screened and read. Ten peer-reviewed studies published between 2017 and 2022 were included in the narrative synthesis. Findings: Ten studies reported using "Pain Personas" in the development of eHealth interventions for such purposes as to gain a shared understanding of the user and to discuss solutions in team meetings, or for patients to identify with (if Personas are included in the intervention). Personas were based on qualitative and/or quantitative data. However, the procedure for creating Personas was only described in half of the included studies (n = 5). These five studies provided descriptive details of the Personas (i.e., picture, name, narrative of their pain behavior, technological skills, and motivation). Conclusions: Although Personas have been used by pain researchers in recent projects and were highlighted as an important ingredient in the development process, available design guidelines for the creation and use of Personas are not followed or communicated transparently. Benefits and challenges when using Personas in the development of eHealth interventions for people with chronic pain are discussed to support future eHealth efforts and to improve the quality of eHealth innovation in the field of pain.
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| 5. |
- Björkstrand, Frida Köhler, et al.
(author)
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Access to psychological treatment for chronic cancer-related pain in Sweden
- 2024
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In: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Journal article (peer-reviewed)abstract
- Objectives Cancer-related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least 3 months, affecting >40% of cancer survivors. Evidence-based treatments, including pain-focused cognitive behavioral therapy (CBT), are available, but it appears that cancer patients/survivors are often poorly informed about CRP or the potential benefits of CBT for such pain. This study examined current experience of Swedish cancer patients/survivors in relation to CRP. Methods Participants (N = 276; 83% female; mean age = 55.5 years, SD = 11.9) were recruited to an online survey via cancer websites in Sweden, and they provided information about their history of chronic CRP and whether they received information about or treatment for CRP from a healthcare professional. Results Participants had a history of breast (36%), gynecological (12%), lung (10%), colon (8%), and other forms of cancer (36%). A majority (74%) reported a history of chronic CRP and being prescribed analgesic medications (70%). Less than half (47%) received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these, only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (standard deviation 2.6). Conclusions Greater efforts are needed to raise awareness among cancer patients/survivors and healthcare providers about the risk of CRP and evidence-based interventions, including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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| 6. |
- Casey, Maire-Brid, et al.
(author)
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Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain : a randomised controlled trial
- 2022
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In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 163:6, s. 1158-1171
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Journal article (peer-reviewed)abstract
- A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference -0.18, 95% confidence interval -0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.
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| 7. |
- Casey, Máire-Bríd, et al.
(author)
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Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain : study protocol for a randomised controlled trial
- 2018
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In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19
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Journal article (peer-reviewed)abstract
- Background: Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy, which may be beneficial for people with chronic pain. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to chronic pain, there is a need for further research to test its effectiveness in clinical practice, particularly with regards to combining ACT with physical exercise.Methods/design: This prospective, two-armed, parallel-group, single-centre randomised controlled trial (RCT) will assess the effectiveness of a combined Exercise and ACT programme, in comparison to supervised exercise for chronic pain. One hundred and sixty patients, aged 18 years and over, who have been diagnosed with a chronic pain condition by a physician will be recruited to the trial. Participants will be individually randomised to one of two 8-week, group interventions. The combined group will take part in weekly psychology sessions based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group will attend weekly supervised exercise classes but will not take part in an ACT programme. The primary outcome will be pain interference at 12-week follow-up, measured using the Brief Pain Inventory-Interference Scale. Secondary outcomes will include self-reported pain severity, self-perception of change, patient satisfaction, quality of life, depression, anxiety and healthcare utilisation. Treatment process measures will include self-efficacy, pain catastrophising, fear avoidance, pain acceptance and committed action. Physical activity will be measured using Fitbit ZipTM activity trackers. Both groups will be followed up post intervention and again after 12 weeks. Estimates of treatment effects at follow-up will be based on an intention-to-treat framework, implemented using a linear mixed-effects model. Individual and focus group qualitative interviews will be undertaken with a purposeful sample of participants to explore patient experiences of both treatments.Discussion: To our knowledge, this will be the first RCT to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme.Trial registration: www.ClinicalTrials.gov, ID: NCT03050528. Registered on 13 February 2017.
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| 8. |
- Catella, Stephanie, et al.
(author)
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Self-guided digital acceptance and commitment therapy for fibromyalgia management : results of a randomized, active-controlled, phase II pilot clinical trial
- 2024
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In: Journal of behavioral medicine. - : Springer. - 0160-7715 .- 1573-3521. ; 47:1, s. 27-42
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Journal article (peer-reviewed)abstract
- Although empirically validated for fibromyalgia (FM), cognitive and behavioral therapies, including Acceptance and Commitment Therapy (ACT), are inaccessible to many patients. A self-guided, smartphone-based ACT program would significantly improve accessibility. The SMART-FM study assessed the feasibility of conducting a predominantly virtual clinical trial in an FM population in addition to evaluating preliminary evidence for the safety and efficacy of a digital ACT program for FM (FM-ACT). Sixty-seven patients with FM were randomized to 12 weeks of FM-ACT (n = 39) or digital symptom tracking (FM-ST; n = 28). The study population was 98.5% female, with an average age of 53 years and an average baseline FM symptom severity score of 8 out of 11. Endpoints included the Fibromyalgia Impact Questionnaire-Revised (FIQ-R) and the Patient Global Impression of Change (PGIC). The between-arm effect size for the change from baseline to Week 12 in FIQ-R total scores was d = 0.44 (least-squares mean difference, − 5.7; SE, 3.16; 95% CI, − 11.9 to 0.6; P = .074). At Week 12, 73.0% of FM-ACT participants reported improvement on the PGIC versus 22.2% of FM-ST participants (P < .001). FM-ACT demonstrated improved outcomes compared to FM-ST, with high engagement and low attrition in both arms. Retrospectively registered at ClinicalTrials.gov (NCT05005351) on August 13, 2021.
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| 9. |
- Chisari, Claudia, et al.
(author)
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A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes
- 2021
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In: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 22:12, s. 2863-2875
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Journal article (peer-reviewed)abstract
- Objective Psychosocial factors are related to pain and sex-related outcomes in provoked vulvodynia and possibly in mixed and spontaneous vulvodynia. However, a broader behavioral framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to vulvodynia, and their associations with vulvodynia outcomes. The study also explored potential differences across vulvodynia subtypes.Design An online cross-sectional study of 349 participants with vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out.Methods Participants completed self-report questionnaires, including questions on pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and for provoked and mixed/spontaneous vulvodynia subsamples.Results Perceived injustice, pain acceptance, and depression were “central” factors among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype.Conclusions Among the included variables, perceived injustice, pain acceptance, depression, and psychological flexibility appear to be important in vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.
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| 10. |
- Chisari, Claudia, et al.
(author)
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Acceptance and Commitment Therapy for women living with Vulvodynia : A single-case experimental design study of a treatment delivered online
- 2022
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In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 23, s. 15-30
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Journal article (peer-reviewed)abstract
- Introduction: Vulvodynia is a condition characterised by persistent vulval pain and includes particular impacts on sexual and emotional functioning. Acceptance and Commitment Therapy (ACT) has been successfully applied in persistent pain but has not been tested in this population. This single-case experimental design (SCED) study aimed to evaluate whether an online ACT programme improves clinical outcomes in women with Vulvodynia. We also evaluated whether the intervention led to changes in hypothesised processes of therapeutic change.Methods: This study applied a nonconcurrent multiple baseline SCED method to assess ACT in women with Vulvodynia. During baseline and treatment phases, participants completed daily self-report outcomes of pain severity and interference, sexual functioning and satisfaction, depression, and hypothesised process-variables: pain-acceptance, present-moment-awareness, committed-action, perceived injustice, and body-exposure anxiety during sexual activities. Full-length assessments of these variables were also completed before and after treatment. The intervention comprised a six-week online ACT programme, combined with a Vulvodynia-specific manual. Visual and statistical analyses were conducted.Results: Seven participants, mostly with mixed Vulvodynia, provided baseline and treatment phase data, and completed the intervention and diaries. Based on the visual inspection, and Tau and Tau-U values as effect sizes from the daily data, all participants showed moderate size improvements in two or more outcomes. However, participants had highly individual treatment effects. Limited improvement was found in depression. Pain acceptance, committed-action, and perceived injustice also demonstrated change for some participants.Discussion: The results suggest online ACT may improve pain and sexual outcomes for some women with Vulvodynia. Pain-acceptance, committed-action, and perceived injustice are highlighted as potential processes of change for some participants. In general, responses to treatment appear highly individual. Further application of the SCED approach to ACT for Vulvodynia is recommended.
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| 11. |
- Chisari, Claudia, et al.
(author)
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Psychosocial factors associated with pain and sexual function in women with Vulvodynia : A systematic review.
- 2021
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In: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 25:1, s. 39-50
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVE: Vulvodynia is a prevalent chronic vulval pain condition affecting 10%-28% of women, and significantly impacting their health and quality of life. It is currently poorly understood and biomedical treatments achieve only modest benefits for pain and sexual functioning. A wider psychosocial conceptualization of this condition may improve outcomes. There is currently no coherent understanding of how psychosocial factors may contribute to outcomes in Vulvodynia. The aim of this review is to identify and systematically review psychosocial factors associated with pain and sexual outcomes and to inform a psychosocial model of Vulvodynia.DATABASES AND DATA TREATMENT: Observational/experimental studies reporting on the association between psychosocial factors and pain/sexual outcomes in adult women with Vulvodynia were eligible. Two reviewers independently conducted eligibility screening, data extraction and quality assessment. Twenty-one studies were included, all focused on women with Provoked Vestibulodynia (PVD). Most of the studies were low-to-medium quality.RESULTS/CONCLUSION: A range of general/pain-related distress and avoidance processes, and sex/intimacy avoidance or engagement processes were significantly associated with pain, sexual functioning or sexual distress and sexual satisfaction, supporting the role of a psychosocial approach to PVD. Depression, anxiety, catastrophizing, pain-anxiety, pain acceptance, body-exposure anxiety, attention to sexual cues, partner hostility and solicitousness, self-efficacy and penetration cognitions are highlighted as potentially important treatment targets in PVD. Due to the limited data available, developing a psychosocial model was not possible. Directions for future research include examining the replicability and generalizability of the factors identified, exploring differences/similarities across Vulvodynia subsets and testing tailored theoretically based treatments.SIGNIFICANCE: The systematic review highlights the role of psychosocial factors associated with pain and sexual functioning in Vulvodynia. The review findings reveal that Vulvodynia presents both similar and unique cognitive, behavioural and interpersonal features compared to other chronic pain conditions. There may be important roles for negative sexual cues, body image-related factors during intercourse, partner factors, self-efficacy beliefs and penetration cognitions, in relation to pain and sexual functioning.
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| 12. |
- Chisari, Claudia, et al.
(author)
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The role of psychological flexibility, perceived injustice and body image in Vulvodynia : A longitudinal study
- 2022
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In: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 26:1, s. 103-113
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Journal article (peer-reviewed)abstract
- Background Women with Vulvodynia experience pain, related impacts on sex and daily functioning, and depression. While psychosocial factors are associated with outcomes in Vulvodynia, longitudinal data are limited, especially in mixed/spontaneous Vulvodynia. Broad psychological models such as psychological flexibility (PF) and content-specific factors, such as body-exposure anxiety (BEA) and avoidance during sexual activities and perceived injustice, have not been adequately investigated in Vulvodynia. The aim of this study was to explore whether these factors assessed at baseline predict pain severity, pain interference, sexual functioning and satisfaction and depression 3 months later.Methods A longitudinal study of 349 women with Vulvodynia was conducted. Participants completed online self-report measures of pain-related and sexual outcomes, depression, BEA, perceived injustice and facets of PF (present moment awareness, pain acceptance, committed action) at baseline and after 3 months, overlapping with the Coronavirus disease 2019 (COVID-19) pandemic.Results Seventy percent of women responded at both assessments (n = 244). There were significant decreases in pain severity, pain interference, present moment awareness, committed action and a significant increase in depression at 3 months. All the baseline psychosocial factors significantly correlated with at least one outcome at 3 months. When adjusting for baseline outcome and demographics, committed action significantly positively predicted depression at 3 months and pain acceptance significantly positively predicted pain interference at 3 months.Conclusions Among women with Vulvodynia, pain acceptance and committed action are prospectively associated with pain interference and depression. The reliability and generalizability of these results needs to be established given the overlap with the COVID-19 pandemic. Future studies should investigate whether targeting these factors enhances outcomes in Vulvodynia.Significance This longitudinal study explored the role of PF, perceived injustice and body image during sexual activities in predicting pain severity, pain interference, sexual functioning, sexual satisfaction and depression in women with Vulvodynia. The study findings reveal that two facets of PF (committed action and pain acceptance) predicted pain interference and depression over time. It may be important to incorporate these processes in treatments developed for Vulvodynia.
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| 13. |
- Clason van de Leur, Jakob, et al.
(author)
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Mediators during a multimodal intervention for stress-induced exhaustion disorder
- 2024
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In: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 53:3, s. 235-253
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Journal article (peer-reviewed)abstract
- Our understanding of the underlying psychological processes of development, maintenance, and treatments for stress-induced exhaustion disorder (ED) remains limited. Therefore, the current study aimed to explore whether sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility mediate change in exhaustion symptoms during a Multimodal intervention for ED based on Cognitive behavioral therapy principles. Participants (N = 913) were assessed at three time points, and mediation was explored using a two-criteria analytical model with linear mixed-effects models (criterion one) and random intercepts cross-lagged panel modeling (criterion 2). Criterion one for mediation was successfully met, as the findings indicated significant associations between time in treatment, with all suggested mediators, and exhaustion symptoms (significant ab-products). However, criterion two was not satisfied as changes in the mediators did not precede changes in exhaustion symptoms. Therefore, mediation could not be established. Instead, changes in the suggested mediators appeared to result from changes in exhaustion symptoms. Consequently, sleep concerns, pathological worry, perfectionistic concerns, and psychological flexibility appear to improve in conjunction with exhaustion symptoms during treatment, where improvement in exhaustion is indicated as the main driving factor, based on this exploratory analysis. The implications of these findings are contextualized within a broader framework of process-based therapy.
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| 14. |
- Clason van de Leur, Jakob, et al.
(author)
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Predictors and sub-groups in the treatment of stress-induced exhaustion disorder
- 2023
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In: Cognitive Behaviour Therapy. - : Taylor & Francis Group. - 1650-6073 .- 1651-2316. ; 52:4, s. 397-418
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Journal article (peer-reviewed)abstract
- Little is known about psychological interventions for stress-induced Exhaustion disorder (ED), and there is a need for more research to improve the outcomes obtained in treatments. The present study examines predictors of improvement, including sub-group responses, in a large sample of ED patients receiving a Multimodal intervention (MMI) based on Cognitive Behavior Therapy (N = 915). In step one, available variables were explored separately as predictors of improvement in ED symptoms. In step two, sub-groups were explored through Latent Class Analysis to reduce the heterogeneity observed in the larger group and to investigate whether combining the variables from step one predicted symptom improvement. Younger age, no previous sick leave due to ED, and scoring high on anxiety, depression, insomnia, perfectionism, and treatment credibility emerged as separate predictors of improvement. In the sub-group analyses, a sub-group including participants who were single and had a lower income showed less improvement. Overall, people with ED participating in MMI report symptom improvement regardless of characteristics before treatment. However, the present findings do have the potential to inform future treatments for ED, as they highlight perfectionism as a predictor of improvement and the importance of assessing treatment credibility during treatment.
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| 15. |
- Clason van de Leur, Jakob, et al.
(author)
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Psychological Treatment of Exhaustion Due to Persistent Non-Traumatic Stress : A Scoping Review
- 2024
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In: International Journal of Behavioral Medicine. - : Springer. - 1070-5503 .- 1532-7558. ; 31:2, s. 175-191
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Research review (peer-reviewed)abstract
- BackgroundExhaustion due to persistent non-traumatic stress (ENTS) is a significant health problem with substantial personal, social, and economic impact. While there are increasing studies of ENTS, there is no international agreement on how it should be diagnosed and treated. This scoping review aimed to map definitions, diagnoses, treatments, outcome measures, and outcomes in psychological treatment studies of ENTS. A further aim was to assess the quality of the treatments and map what change processes are described within ENTS interventions.MethodsA PRISMA-guided scoping review of psychological treatment studies delivered in a clinical setting for ENTS was conducted using the databases of PubMed, PsycINFO, and CINAHL.ResultsOf the 60 studies included, the majority (87%) stemmed from Europe. The most recurrent term for ENTS was burnout, and the diagnosis most often utilized was exhaustion disorder. Several treatments were reported, the most frequent being cognitive behavioral therapy (CBT) (68%). Statistically significant outcomes relevant to ENTS were reported in 65% (n = 39) of the studies, with effect sizes between 0.13 and 1.80. In addition, 28% of the treatments were rated as high quality. The most frequent change processes described were dysfunctional sleep, avoidance, behavioral activation, irrational thoughts and beliefs, worry, perceived competence/positive management, psychological flexibility, and recuperation.ConclusionsWhile several treatments based on CBT show promising results for ENTS, there do not seem to be any uniformly established methods, theoretical models, or change processes. Instead of adopting a monocausal, syndromal, and potentially bio-reductionist perspective on ENTS, a process-based approach to treatment is encouraged.
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| 16. |
- Contreras, Milena, et al.
(author)
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Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS) : a qualitative study of carer views and acceptability
- 2022
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1
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Journal article (peer-reviewed)abstract
- Purpose: To explore carers' views and acceptability of internet-delivered, therapist-guided, self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia (iACT4CARERS).Methods: A qualitative approach with semi-structured interviews was employed with family carers (N = 23) taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed and analysed using thematic analysis.Results: Four overarching themes were identified: 1) usefulness and relevance of the content of the sessions, 2) sense of connectedness, 3) the impact of the intervention on participants and 4) acceptability of the online delivery. Positive carer experiences and intervention acceptability were facilitated by learning helpful ACT skills, perceiving the content of the session as relatable to the carers' needs, feeling connected to other carers and the therapist during the intervention, noticing the benefits of the intervention and the user-friendliness of the online platform. Recommendations for a full-scale trial were identified, such as the inclusion of some "face-to-face" interactions (e.g., via video call) between carers and therapists to facilitate a bidirectional interaction and the provision of an additional aide-memoire to improve the learning experiences.Conclusion: Overall, the intervention was acceptable to the family carers. The proposed recommendations should be considered in a full-scale trial.
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| 17. |
- Contreras, Milena, et al.
(author)
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Therapists' perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS) : a qualitative study
- 2021
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In: The Cognitive Behaviour Therapist. - : Cambridge University Press. - 1754-470X. ; 14
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Journal article (peer-reviewed)abstract
- This study aimed to explore therapists' perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists' workload, (3) therapists' confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists' burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist-carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.
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| 18. |
- Davey, Amanda, et al.
(author)
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Psychological flexibility, self-compassion and daily functioning in chronic pain
- 2020
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In: Journal of Contextual Behavioral Science. - : Elsevier BV. - 2212-1447. ; 17, s. 79-85
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Journal article (peer-reviewed)abstract
- Psychological flexibility (PF) and self-compassion (SC) are both associated with positive outcomes for people living with chronic pain. Despite conceptual similarities they have mostly been studied independently. The present study aimed to determine the relationship between PF and SC, and investigate their roles in relation to pain interference, work and social adjustment, and depressive symptoms. 420 participants attending a speciality chronic pain service completed the Self-Compassion Scale Short Form along with measures of PF, pain, interference, functioning, and depression, prior to starting treatment. PF and SC variables were significantly correlated (r = 0.38 to 0.56) and demonstrated a degree of independence. Multiple regression models for all three pain outcomes explained 44% of the variance in pain interference, 36% in work and social adjustment, and 32% in depression. SC accounted for significant unique variance in each of the pain outcomes, however this was no longer significant when PF variables were added to the model for pain interference and work and social adjustment. In conclusion, PF and SC appear to include mostly related and some distinct elements in the context of chronic pain. PF processes may encompass the effects of SC on pain interference and work and social adjustment. However, SC appears to play an independent role in depression. Given the high comorbidity of depression, it may be beneficial to further study the potential for SC-based processes and methods to improve overall wellbeing for people with chronic pain.
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| 19. |
- Duarte, Joana, et al.
(author)
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The contribution of psychological flexibility to functioning in people living with cancer-related pain
- 2023
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In: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 27:3, s. 413-423
-
Journal article (peer-reviewed)abstract
- BackgroundStudies of individuals with non-cancer-related chronic pain find that higher levels of psychological flexibility (PF) are associated with less distress, better functioning, and a better response to treatment. People diagnosed with cancer are at a significantly increased risk of developing chronic cancer-related pain, the presence of which is associated with poorer health outcomes. Little is known about whether PF is applicable to cancer pain. The current study investigates the relationship between chronic cancer-related pain, distress and functioning, and three theoretical processes proposed by the PF model: pain acceptance, present-moment focus, and committed action. MethodsAdults (n = 246) with a cancer diagnosis (current or previous), and living in Sweden, completed an online survey involving standardized measures of cancer-related pain (intensity and impairment), depression, fatigue, PF and social stigma. ResultsModerate to strong correlations were found between PF and all variables. In regression analyses, PF, and particularly pain acceptance, accounted for a large and significant proportion of the observed variance in depression, pain-related and overall functioning, after controlling for cancer status, pain intensity and social stigma. ConclusionConsistent with studies of non-cancer-related pain, higher levels of PF were strongly associated with lower levels of distress and better functioning in individuals with cancer-related pain. Further studies are needed to further explore these relationships and to determine whether psychosocial treatments targeting PF may be of benefit to people with chronic cancer-related pain. SignificanceThis study explores the relationship between cancer-related pain (intensity and impairment), depression, fatigue, overall functioning, social stigma and PF. The findings suggest that higher levels of PF are associated with lower levels of distress and improved functioning in chronic cancer-related pain, after controlling for cancer status (current, in remission), pain intensity and social stigma.
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| 20. |
- Dures, Emma, et al.
(author)
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Brief intervention to reduce fatigue impact in patients with inflammatory arthritis : design and outcomes of a single-arm feasibility study
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:7
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Journal article (peer-reviewed)abstract
- Objectives Patients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive-behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis (FREE-IA) study tested the feasibility of RHP training, intervention delivery and outcome collection ahead of a potential trial of clinical and cost-effectiveness. Methods In this single-arm feasibility study, eligible patients were >= 18 years, had a clinician-confirmed diagnosis of an inflammatory arthritis and scored >= 6/10 on the Bristol Rheumatoid Arthritis Fatigue (BRAF) Numerical Rating Scale (NRS) Fatigue Effect. Following training, RHPs delivered two to four sessions to participants. Baseline data were collected before the first session (T0) and outcomes at 6 weeks (T1) and 6 months (T2). The proposed primary outcome was fatigue impact (BRAF NRS Fatigue Effect). Secondary outcomes included fatigue severity and coping, disease impact and disability, and measures of therapeutic mechanism (self-efficacy and confidence to manage health). Results Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 (9.4%) and 27 (19.6%) missing primary and secondary outcome responses, respectively. Results indicated improvements in all measures except disability, at either T1 or T2, or both. Conclusions This study showed it was feasible to deliver the intervention, including training RHPs, and recruit and follow-up participants with high retention. While there was no control group, observed within-group improvements suggest potential promise of the intervention and support for a definitive trial to test effectiveness.
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| 21. |
- Edwards, Victoria, et al.
(author)
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Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease : a nested qualitative study within the ACTMus randomized controlled trial
- 2023
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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 14
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Journal article (peer-reviewed)abstract
- Introduction: In adults, muscle disease (MD) is typically a chronic long-term condition that can lead to a reduced quality of life (QoL). Previous research suggests that a psychological intervention, in particular Acceptance and Commitment Therapy (ACT), may help improve QoL for individuals living with chronic conditions such as MD.Methods: This nested qualitative study was incorporated within a randomized controlled trial which evaluated a guided self-help ACT intervention for people living with MD to explore their experiences of the intervention. Semi-structured interviews (n = 20) were conducted with those who had received ACT. Data were analyzed via thematic analysis.Results: There were four overarching themes. (1) Views on whether therapy sessions would help with a medical condition: participants' expectations regarding ACT varied. Some participants were skeptical about mindfulness. (2) I was able to look at things in a different way: participants described increased meaningful activity, greater awareness of thoughts and emotions and acceptance or adaptation to mobility problems. Some described improvement in the quality of relationships and a sense of feeling free. (3) Treating the body and the mind together: following the intervention participants noted that a holistic approach to healthcare is beneficial. (4) Intervention delivery: The remote delivery was generally seen as helpful for practical reasons and allowed participants to speak openly. Participants voiced a need for follow-up sessions.Discussion: Overall, the intervention was experienced as acceptable. Suggested improvements included de-emphasizing the role of mindfulness and adding follow-up sessions.
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| 22. |
- Feliu-Soler, A, et al.
(author)
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Acceptance and Commitment Therapy (ACT) for chronic pain: : a narrative review
- 2018
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In: Journal of Pain Research. - 1178-7090. ; 11, s. 2145-2159
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Journal article (peer-reviewed)abstract
- It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.
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| 23. |
- Feliu-Soler, Albert, et al.
(author)
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Economic Impact of Third-Wave Cognitive Behavioral Therapies : A Systematic Review and Quality Assessment of Economic Evaluations in Randomized Controlled Trials
- 2018
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In: Behavior Therapy. - : Elsevier BV. - 0005-7894 .- 1878-1888. ; 49:1, s. 124-147
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Journal article (peer-reviewed)abstract
- The term third-wave cognitive behavioral therapy (CBT) encompasses new forms of CBT that both extend and innovate within CBT. Most third-wave therapies have been subject to randomized controlled trials (RCTs) focused on clinical effectiveness; however, the number and quality of economic evaluations in these RCTs has been unknown and may be few. Evidence about efficiency of these therapies may help support decisions on efficient allocation of resources in health policies. The main aim of this study was to systematically review the economic impact of third-wave therapies in the treatment of patients with physical or mental conditions. We conducted a systematic literature search in PubMed, PsycINFO, EMBASE, and CINALH to identify economic evaluations of third-wave therapies. Quality and Risk of Bias (RoB) assessment of economic evaluations was also made using the Drummond 35-item checklist and the Cochrane Collaboration's tool for assessing risk of bias, respectively. Eleven RCTs were included in this systematic review. Mindfulness-Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and extended Behaviour Activation (eBA) showed acceptable cost-effectiveness and cost-utility ratios. No study employed a time horizon of more than 3 years. Quality and RoB assessments highlight some limitations that temper the findings. There is some evidence that MBCT, MBSR, ACT, DBT, and eBA are efficient from a societal or a third-party payer perspective. No economic analysis was found for many third-wave therapies. Therefore, more economic evaluations with high methodological quality are needed.
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| 24. |
- Galea Holmes, Melissa N., et al.
(author)
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Physiotherapy informed by Acceptance and Commitment Therapy for chronic low back pain : A mixed-methods treatment fidelity evaluation
- 2022
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In: British Journal of Health Psychology. - : John Wiley & Sons. - 1359-107X .- 2044-8287. ; 27:3, s. 935-955
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Journal article (peer-reviewed)abstract
- Objectives A randomized controlled trial of a new type of Physiotherapy informed by Acceptance and Commitment Therapy (PACT), found that it improved functioning in people with chronic low back pain compared to usual physiotherapy care. Fidelity evaluation is necessary to understand trial processes and outcomes. This study evaluated PACT treatment fidelity including delivery, receipt, and enactment. Design A mixed-methods study nested within a randomized controlled trial was conducted. Methods A total of 72 (20% of total) PACT treatment audio files were independently assessed by two raters, according to a novel framework developed to measure PACT treatment content adherence, therapeutic alliance, ACT competence, and treatment enactment. Interview transcripts from 19 trial participants randomized to PACT were analysed thematically for evidence of treatment receipt and enactment. Results PACT physiotherapists delivered treatment as intended with high content adherence and satisfactory therapeutic alliance, but ACT competence was low. Qualitative findings indicated participant receipt of 11/17 and enactment of 3/17 components; 89% (n = 17) and 47% (n = 9) of participants reported treatment receipt and enactment of at least one component, respectively. Conclusions This mixed-methods study of PACT treatment demonstrated high fidelity reflecting treatment content delivery and receipt, and therapeutic alliance. There was some evidence of treatment enactment in participants with chronic low back pain. Low ACT competence could be addressed through additional support and adaptations to therapeutic processes for delivery by physiotherapists.
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| 25. |
- Gallego, Ana, et al.
(author)
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Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia
- 2024
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In: Digital Health. - : Sage Publications. - 2055-2076. ; 10
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Journal article (peer-reviewed)abstract
- Objective: Fibromyalgia (FM) is a prevalent pain syndrome with significant healthcare and societal costs. The aim of the SMART-FM-SP study is to determine the effectiveness, cost-utility, and physiological effects in patients with FM of a digital intervention (STANZA (R)) currently marketed in the United States, which delivers smartphone-based, fully self-guided Acceptance and Commitment Therapy (Digital ACT) for treating FM-related symptoms.Methods: A single-site, parallel-group, superiority, randomized controlled trial (RCT) will be conducted, including a total of 360 adults diagnosed with FM. Individuals will be randomly allocated (1:1:1) to treatment as usual (TAU), to TAU plus 12 weeks of treatment with Digital ACT, or to TAU plus 12 weeks of treatment with digital symptom tracking (i.e. FibroST). Participants will be assessed at baseline, post-treatment, and 6-month follow-up. An intention-to-treat analysis using linear mixed models will be computed to analyze the effects of Digital ACT on functional impairment (primary outcome), as measured by the Fibromyalgia Impact Questionnaire Revised at 6 months from the inception of the treatment. Secondary outcomes include impression of change, symptoms of distress, pain catastrophising, quality of life, cost-utility, and selected biomarkers (cortisol and cortisone, immune-inflammatory markers, and FKBP5 gene polymorphisms). The role of ACT-related processes of change will be tested with path analyses.Conclusions: This study is the first RCT that tests Digital ACT for Spanish patients with FM. Results will be important not only for patients and clinicians, but also for policy makers by examining the cost-utility of the app in a public healthcare context.
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| 26. |
- Gilpin, Helen, et al.
(author)
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A theoretically guided approach to identifying predictors of treatment outcome in contextual CBT for chronic pain
- 2019
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In: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 23:2, s. 354-366
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Journal article (peer-reviewed)abstract
- BACKGROUND:Psychological treatments are known to be effective for chronic pain, but little is understood about which patients are most likely to benefit from which ones.METHODS:The study reported here included 609 people who attended a residential, interdisciplinary, pain management programme based on Acceptance and Commitment Therapy between January 2012 and August 2014. A flexible and theoretically guided approach to model building based on fractional polynomials was used to identify potential predictors of outcome in domains of emotional, physical and social functioning and pain intensity. Variables considered for inclusion were baseline demographic variables along with measures reflecting processes of psychological flexibility, including acceptance, cognitive defusion and committed action.RESULTS:Employment status, level of distress, decentring (a process like cognitive defusion) and acceptance significantly contributed to the model above and beyond the effects of other baseline variables. The unique effects of these were small but may be clinically relevant.CONCLUSIONS:Future research should continue to investigate moderators of treatment outcome and to explicitly link these to treatment mechanisms. Taking a flexible, theoretically driven approach to modelling continuous outcomes may be valuable in furthering our understanding of which patients might respond best to which treatments.SIGNIFICANCE:Further research is needed to better understand who benefits most from psychological treatments for chronic pain. This study suggests that a flexible, multivariate and theoretical approach to identifying predictors of outcome may be valuable in furthering research in this area.
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| 27. |
- Godfrey, Emma, et al.
(author)
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Physical Therapy Informed by Acceptance and Commitment Therapy (PACT) Versus Usual Care Physical Therapy for Adults With Chronic Low Back Pain : A Randomized Controlled Trial
- 2020
-
In: Journal of Pain. - : Elsevier BV. - 1526-5900 .- 1528-8447. ; 21:1-2, s. 71-81
-
Journal article (peer-reviewed)abstract
- Chronic low back pain (CLBP) is a major cause of global disability and improving management is essential. Acceptance and commitment therapy (ACT) is a promising treatment for chronic pain but has not been modified for physical therapy. This randomized controlled trial (RCT) compared physical therapy informed by ACT (PACT) against standard care physical therapy for patients with CLBP. Patients with CLBP (duration ≥12 weeks, mean 3 years) were recruited from physical therapy clinics in 4 UK public hospitals. The Roland-Morris Disability Questionnaire (RMDQ) at 3 months' post-randomization was the primary outcome. Two hundred forty-eight participants (59% female, mean age = 48) were recruited and 219 (88.3%) completed measures at 3 and/or 12 months' follow-up. At 3 months, PACT participants reported better outcomes for disability (RMDQ mean difference = 1.07, p = .037, 95% CI = -2.08 to -.07, d = .2), Patient Specific Functioning (p = .008), SF12 physical health (p = .032), and treatment credibility (p < .001). At 12 months' follow-up, there were no significant differences between groups. PACT was acceptable to patients and clinicians and feasible to deliver. Physical therapists incorporated psychological principles successfully and treatment was delivered with high (≥80%) fidelity. Our results may inform the management of CLBP, with potential benefits for patients, health care providers, and society. PERSPECTIVE: Psychologically informed physical therapy has great potential but there are challenges in implementation. The training and support included in the PACT trial enabled the intervention to be delivered as planned. This successfully reduced disability in the short but not long term. Findings could inform physical therapists' treatment of CLBP.
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| 28. |
- González-Deleito, Carmen Muñoz, et al.
(author)
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Ultra-brief acceptance & commitment therapy for inpatients with psychosis - a single-case experimental design investigating processes of change
- 2024
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In: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 53:3, s. 267-285
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Journal article (peer-reviewed)abstract
- People with primary psychosis are among the most seen in inpatient psychiatry. Treatment guidelines recommend both pharmacological and psychological treatments. However, psychological treatments are not routinely offered in many settings. There is also a lack of research on psychological treatments for this vulnerable population in the inpatient setting. The first aim of the current study was to examine treatment effects of a brief form of Acceptance and Commitment Therapy on outcomes valued by the treatment recipients. The second aim was to explore hypothetical processes of change in relation to outcomes over time. Three people with primary psychosis were treated for two to four sessions. A replicated single-case experimental design with multiple baselines across subjects (Clinical Trials registration number ID NCT04704973) was employed to examine treatment effects. The Personal Questionnaire (PQ) was used as primary outcome, symptom believability and preoccupation as proposed processes of change. Data were analyzed using visual inspection, calculation of Tau-U values, and cross-lagged correlation. All participants improved significantly on PQ and the symptom preoccupation measure. Two improved significantly on the symptom believability measure. Cross-lagged correlation analyses showed no clear mediation. Change in proposed processes of change and primary outcome predominantly happened concomitantly, although patterns of results reflected individual differences.
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| 29. |
- Gould, Rebecca, et al.
(author)
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Acceptance and Commitment Therapy for people living with motor neuron disease : an uncontrolled feasibility study
- 2023
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In: Pilot and Feasibility Studies. - : Springer Nature. - 2055-5784. ; 9
-
Journal article (peer-reviewed)abstract
- Background: Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND.Methods: PlwMND aged >= 18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (>= 80% of the target sample [N = 28] recruited) and initial engagement with the intervention (>= 70% completing >= 2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months.Results: Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended >= 2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status.Conclusions: There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway.
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| 30. |
- Gould, Rebecca L., et al.
(author)
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A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND) : study protocol
- 2022
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In: BMC Neurology. - : Springer Nature. - 1471-2377. ; 22
-
Journal article (peer-reviewed)abstract
- Background: Motor neuron disease (MND) is a rapidly progressive, fatal neurodegenerative disease that predominantly affects motor neurons from the motor cortex to the spinal cord and causes progressive wasting and weakening of bulbar, limb, abdominal and thoracic muscles. Prognosis is poor and median survival is 2-3 years following symptom onset. Psychological distress is relatively common in people living with MND. However, formal psychotherapy is not routinely part of standard care within MND Care Centres/clinics in the UK, and clear evidence-based guidance on improving the psychological health of people living with MND is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT) may be particularly suitable for people living with MND and may help improve their psychological health.Aims: To assess the clinical and cost-effectiveness of ACT modified for MND plus usual multidisciplinary care (UC) in comparison to UC alone for improving psychological health in people living with MND.Methods: The COMMEND trial is a multi-centre, assessor-blind, parallel, two-arm RCT with a 10-month internal pilot phase. 188 individuals aged >= 18 years with a diagnosis of definite, laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis, and additionally the progressive muscular atrophy and primary lateral sclerosis variants, will be recruited from approximately 14 UK-based MND Care Centres/clinics and via self-referral. Participants will be randomly allocated to receive up to eight 1:1 sessions of ACT plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and at 6- and 9-months post-randomisation. The primary outcome will be quality of life at six months. Secondary outcomes will include depression, anxiety, psychological flexibility, health-related quality of life, adverse events, ALS functioning, survival at nine months, satisfaction with therapy, resource use and quality-adjusted life years. Primary analyses will be by intention to treat and data will be analysed using multi-level modelling.Discussion: This trial will provide definitive evidence on the clinical and cost-effectiveness of ACT plus UC in comparison to UC alone for improving psychological health in people living with MND.
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| 31. |
- Gould, Rebecca L., et al.
(author)
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Acceptance and Commitment Therapy plus usual care for improving quality of life in people with motor neuron disease (COMMEND) : a multicentre, parallel, randomised controlled trial in the UK
- 2024
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 403:10442, s. 2381-2394
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Journal article (peer-reviewed)abstract
- Background: Motor neuron disease is a progressive, fatal neurodegenerative disease for which there is no cure. Acceptance and Commitment Therapy (ACT) is a psychological therapy incorporating acceptance, mindfulness, and behaviour change techniques. We aimed to evaluate the effectiveness of ACT plus usual care, compared with usual care alone, for improving quality of life in people with motor neuron disease.Methods: We conducted a parallel, multicentre, two -arm randomised controlled trial in 16 UK motor neuron disease care centres or clinics. Eligible participants were aged 18 years or older with a diagnosis of definite or laboratory -supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis; progressive muscular atrophy; or primary lateral sclerosis; which met the World Federation of Neurology's El Escorial diagnostic criteria. Participants were randomly assigned (1:1) to receive up to eight sessions of ACT adapted for people with motor neuron disease plus usual care or usual care alone by a web -based system, stratified by site. Participants were followed up at 6 months and 9 months post -randomisation. Outcome assessors and trial statisticians were masked to treatment allocation. The primary outcome was quality of life using the McGill Quality of Life Questionnaire -Revised (MQOL-R) at 6 months post -randomisation. Primary analyses were multi -level modelling and modified intention to treat among participants with available data. This trial was pre -registered with the ISRCTN Registry (ISRCTN12655391).Findings: Between Sept 18, 2019, and Aug 31, 2022, 435 people with motor neuron disease were approached for the study, of whom 206 (47%) were assessed for eligibility, and 191 were recruited. 97 (51%) participants were randomly assigned to ACT plus usual care and 94 (49%) were assigned to usual care alone. 80 (42%) of 191 participants were female and 111 (58%) were male, and the mean age was 63⋅1 years (SD 11⋅0). 155 (81%) participants had primary outcome data at 6 months post -randomisation. After controlling for baseline scores, age, sex, and therapist clustering, ACT plus usual care was superior to usual care alone for quality of life at 6 months (adjusted mean difference on the MQOL-R of 0⋅66 [95% CI 0⋅22-1⋅10]; d=0⋅46 [0⋅16-0⋅77]; p=0⋅0031). Moderate effect sizes were clinically meaningful. 75 adverse events were reported, 38 of which were serious, but no adverse events were deemed to be associated with the intervention.Interpretation: ACT plus usual care is clinically effective for maintaining or improving quality of life in people with motor neuron disease. As further evidence emerges confirming these findings, health-care providers should consider how access to ACT, adapted for the specific needs of people with motor neuron disease, could be provided within motor neuron disease clinical services.
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| 32. |
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| 33. |
- Hayes, Steven C., et al.
(author)
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Report of the ACBS Task Force on the strategies and tactics of contextual behavioral science research
- 2021
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In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 20, s. 172-183
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Journal article (peer-reviewed)abstract
- Throughout its history the strategy and tactics of contextual behavioral science (CBS) research have had distinctive features as compared to traditional behavioral science approaches. Continued progress in CBS research can be facilitated by greater clarity about how its strategy and tactics can be brought to bear on current challenges. The present white paper is the result of a 2 1/2-year long process designed to foster consensus among representative producers and consumers of CBS research about the best strategic pathway forward. The Task Force agreed that CBS research should be multilevel, process-based, multidimensional, prosocial, and pragmatic, and provided 33 recommendations to the CBS community arranged across these characteristics. In effect, this report provides a detailed research agenda designed to maximize the impact of CBS as a field. Scientists and practitioners are encouraged to mount this ambitious agenda.
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| 34. |
- Hoffmann, Alice Ahnlund, et al.
(author)
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Psychometric evaluation of the Pain Vigilance and Awareness Questionnaire (PVAQ) in fibromyalgia : Confirmatory factor analysis and the development of a Swedish 8-item version
- 2024
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In: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 28:3, s. 396-407
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Journal article (peer-reviewed)abstract
- Background:Excessive attention to pain, or hypervigilance, is associated with negative outcomes in chronic pain conditions such as fibromyalgia. The Pain Vigilance and Awareness Questionnaire (PVAQ) is a self-report questionnaire to measure attention to pain. This study aimed to evaluate the psychometric properties of a Swedish version of the PVAQ.Methods:Psychometric evaluation on cross-sectional data derived from a clinical trial for fibromyalgia (N = 274). We evaluated item characteristics, factor structure in a confirmatory factor analytic framework, internal consistency, and construct validity in terms of correlations with other clinical variables.Results:Though confirmatory factor analysis did not result in a satisfactory solution for the full 16-item scale, acceptable two-factor solutions could be based on either nine or eight items (the PVAQ-9 and PVAQ-8). Internal consistency for both the PVAQ-9 and PVAQ-8 were good to excellent, and associations with pain catastrophizing, anxiety, depression, disability, and overall fibromyalgia impact were largely supportive of construct validity. An unexpected result was that, contrary to previous findings, no version of the PVAQ correlated consistently with pain intensity.Conclusions:The Swedish PVAQ-9 and PVAQ-8 appear to have acceptable psychometric properties when administered online to individuals with fibromyalgia. The PVAQ-8 may be preferable due to being shorter and including an equal number of items per factor. Replication is warranted.Significance:This study evaluated the psychometric properties of a Swedish translation of the PVAQ in individuals with fibromyalgia. No convincing factor structure was found for the 16-item version. We could, however, confirm the factor structure of an established 9-item version (the PVAQ-9), and recommend further use of a new 8-item version (the PVAQ-8). In summary, the PVAQ exhibited more convincing psychometric properties when the number of items was roughly cut in half.
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| 35. |
- Hollyfield, Shakira, et al.
(author)
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An Observational Study of Outcomes Associated With Virtual Pain Management Programs Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic
- 2023
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In: The Clinical Journal of Pain. - : Wolters Kluwer. - 0749-8047 .- 1536-5409. ; 39:10, s. 524-536
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Journal article (peer-reviewed)abstract
- Objective: In response to COVID-19, virtual, group-based interdisciplinary pain management programs (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low-intensity and pre-neuromodulation PMPs based on acceptance and commitment therapy as part of routine care during the pandemic.Methods: Depending on patients’ needs, participants completed a virtual high-intensity or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 to 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide a historical benchmark of performance.Results: The virtual high-intensity PMP (n=294) showed significant improvements in all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low-intensity PMP (n=90). The improvements associated with prepandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic.Discussion: These data provide preliminary support for the potential benefits of high, but not low, intensity virtual acceptance and commitment therapy-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
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| 36. |
- Holmes, Melissa N. Galea, et al.
(author)
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Experiences of training and delivery of Physical therapy informed by Acceptance and Commitment Therapy (PACT) : a longitudinal qualitative study
- 2021
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In: Physiotherapy. - : Elsevier. - 0031-9406 .- 1873-1465. ; 112, s. 41-48
-
Journal article (peer-reviewed)abstract
- Objectives Physiotherapy informed by Acceptance and Commitment Therapy (PACT) is a novel intervention that is related to improved disability and functioning in people with chronic lowback pain. This study explored physiotherapists experiences over time of the PACT training programme and intervention delivery. Design A longitudinal qualitative study using semi-structured, in-depth, individual interviews at three time points was conducted. Methods A phenomenological approach underpinned the methods. Interviews followed topic-guides developed a priori. Transcribed interviews were coded inductively to generate themes. Data were member checked by participants and validated by two researchers. Participants Eight clinical physiotherapists from three secondary care centres in the United Kingdom (n = 5 female; age, 24 to 44 years; duration of practice, 3 to 14 years) were included. Results Five themes emerged from the data. Experiential learning techniques were challenging but valued because they bridged theoretical principles and concepts with practice. Ongoing individual and group supervision was beneficial, but required tailoring and tapering. PACT delivery extended physiotherapy skills and practice, including techniques that acknowledged and addressed patient treatment expectations. With experience, participants desired greater flexibility and autonomy to tailor PACT delivery. Conclusions PACT training and delivery were acceptable to physiotherapists. Existing skills were developed and additional, applicable approaches were provided that addressed psychosocial and behavioural aspects of chronic low back pain. (c) 2021 Chartered Society of Physiotherapy.
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| 37. |
- Karayannis, Nicholas Vasilis., et al.
(author)
-
Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology
- 2023
-
In: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 23:3, s. 464-475
-
Journal article (peer-reviewed)abstract
- Objectives: Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference.Methods: Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth modelling to analyze scores assessed within 180 days of patient care.Results: Psychological inflexibility (PIPS-12) and pain acceptance (CPAQ-8) measured at baseline predicted PI outcomes (n=86). PIPS-12 showed a direct relationship with pain interference (PI), where higher PIPS-12 scores predicted significantly higher PI mean scores on average across the study period (ρ=0.422, r2=0.382) but also predicted significantly greater decreases in PI across time (ρ=−0.489, r2=0.123). Higher CPAQ-8 scores predicted significantly lower PI mean scores on average across the study period (ρ=−0.478, r2=0.453) but also significantly smaller decreases in PI across time (ρ=0.495, r2=0.076). Awareness (FFMQ-SF) and engagement (CAQ-8) were not predictive of PI outcomes.Conclusions: Patients who entered pain psychology treatment with lower pain acceptance and higher psychological inflexibility showed the largest reductions in pain interference across time. These results contribute towards a novel prognostic understanding of the predictive roles of an enhancing dimension and limiting dimension of psychological flexibility.
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| 38. |
- Karekla, Maria, et al.
(author)
-
The Role of Psychologists in Healthcare During the COVID-19 Pandemic Lessons Learned and Recommendations for the Future
- 2021
-
In: EUROPEAN JOURNAL OF PSYCHOLOGY OPEN. - : Hogrefe & Huber Publishers. - 2673-8627. ; 80:1-2, s. 5-17
-
Journal article (peer-reviewed)abstract
- Introduction: The COVID-19 pandemic has impacted individuals, communities, and whole populations. Experts across many different fields contributed their time and efforts in different ways to respond to the pandemic. Psychologists working in healthcare provided support and led many initiatives, both regionally and nationally. However, it is unknown how this has differed across Europe and its full range of activities and contributions. Aim: The current study is a survey of European member associations of EFPA, carried out to understand the current contributions and the impact those psychology contributions have had on the COVID-19 pandemic response, to share lessons learned, and to propose a roadmap for the future. Results: Overall, our study highlights how psychological expertise was integrated into many countries' policy/decision-making, action-planning, caregiving, and the promotion of health and well-being to health professionals and the general public. Even in places where psychologists were not directly integrated into governmental systems, they played an important role in responding to this pandemic by providing their services and empirical knowledge. Discussion: Many psychologists possess the skills and tools to adapt their practice to the digital provision of services and to provide a continuity of care during the pandemic. Research carried out by psychologists has contributed important and new knowledge on pandemic effects, consequences, and interventions; yet, more research financial support is needed. We make recommendations for augmenting psychologists' contributions in the future. In a global health crisis, where the main possible treatment is a preventive approach concentrated on sustainable behavior change, psychologists should be included every step of the way - they can make a difference.
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| 39. |
- Kilic, Aysenur, et al.
(author)
-
A 12-month longitudinal study examining the shared and unique contributions of self-compassion and psychological inflexibility to distress and quality of life in people with Type 2 Diabetes
- 2022
-
In: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 155
-
Journal article (peer-reviewed)abstract
- Objectives: Self-compassion and psychological flexibility appear to benefit wellbeing and quality of life (QoL) in the general population and in people with long-term conditions like Type 2 Diabetes (T2D). However, both variables share similarities and their unique roles in relation to distress and QoL in people with diabetes over time are not clear.Design: This was a longitudinal study with online assessments of self-compassion, psychological inflexibility, distress (depression, anxiety, diabetes-distress), and QoL at baseline (T1) and six (T2) and 12 months (T3). Methods: In total, 173 UK adults with T2D completed baseline questionnaires; T2 and T3 follow-ups were completed by 82 and 52 participants, respectively. Correlations were conducted to understand the relationships between variables at each time point. Hierarchical regressions were conducted to understand the unique predictive role of baseline self-compassion and psychological inflexibility in relation to distress and QoL at T2 and T3, controlling for age and baseline distress and QoL.Results: There were large significant negative correlations between self-compassion and psychological inflexibility (r >-0.50), and both had significant large correlations with distress (r >-0.50) but not QoL across time points. Regressions indicated that psychological inflexibility uniquely predicted depression (T2) and anxiety symptoms (T2 and T3) and QoL (T3). Self-compassion did not uniquely predict any of the outcomes.Conclusions: Psychological inflexibility may play an important role in distress in T2D, but prospective studies with larger samples are needed to replicate these findings. Given the overlap between psychological inflexibility and self-compassion, treatments targeting either variable may be useful.
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| 40. |
- Kilic, Aysenur, et al.
(author)
-
A Systematic Review of the Effectiveness of Self-Compassion-Related Interventions for Individuals With Chronic Physical Health Conditions
- 2021
-
In: Behavior Therapy. - : Elsevier. - 0005-7894 .- 1878-1888. ; 52:3, s. 607-625
-
Research review (peer-reviewed)abstract
- Self-compassion, defined as a mindful way of coping with pain and suffering by showing kindness, care, and concern towards the self, may improve psychological adjustment in people living with a chronic physical health condition (CPHC). Various studies illustrate that self-compassion is associated with positive outcomes in general. The aim of this systematic review is to establish the effect of compassion-related therapies on self-compassion specifically in people with CPHCs. Secondary aims are to (a) establish the effect on other psychological and physiological outcomes and (b) explore the relative effectiveness of different therapy types among those identified. Cochrane, Embase, Medline, Psy-cINFO, and CINAHL databases were searched using & ldquo;compassion & rdquo; AND & ldquo;chronic disease & rdquo; AND & ldquo;psychological outcomes & rdquo; and their synonyms, from 2004 to March 2019. Eligible studies had an experimental design using a self-compassion scale with an adult population. Risk of bias (RoB)& nbsp;was assessed using the Cochrane RoB tool. Effect sizes were calculated for study outcomes. Fifteen studies, including a total of 1,190 participants, 7 different CPHCs, and 11 types of therapies, were included in the review. Nearly all included therapies significantly increased self-compassion with medi-um to large effect sizes, and reported positive outcomes, such as decreased depression. None of the therapy types appeared clearly superior to the others. Findings from this review show that included therapies increased self-compassion and im -proved various outcomes, which may represent clinically significant benefits for patients. However, there is a need to further understand how self-compassion exerts its benefits and determine the best methods to increase self-compassion.
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| 41. |
- Kilic, Aysenur, et al.
(author)
-
An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes : A feasibility randomised-controlled trial
- 2023
-
In: Internet Interventions. - : Elsevier. - 2214-7829. ; 33
-
Journal article (peer-reviewed)abstract
- Background and purposeThis study explored the feasibility and acceptability of conducting a larger trial of a self-guided, online self-compassion and acceptance and commitment therapy (ACT) focused treatment among people with type 2 diabetes (T2D) to decrease psychological distress.Materials and methodsThis study was a two-arm, parallel, feasibility randomised controlled trial with nested qualitative methods. UK adults with T2D were randomly (1:1) allocated to a five-week online self-compassion and ACT treatment or waitlist control. Information regarding recruitment, trial retention, and treatment completion was collected, and post-treatment semi-structured interviews were conducted to assess feasibility and acceptability. Self-report measures of psychological distress (depression, anxiety, diabetes distress) and potential treatment processes (self-compassion and psychological flexibility) were completed as secondary feasibility outcomes.ResultsFifty-five (60.44 %) out of 91 people who accessed the study link were eligible to participate. Of these, 33 eligible participants (60 %) were randomly assigned to treatment (n = 19) or control arms (waitlist; n = 14). While treatment completion was 47.37 %, trial retention rates were 39.39 % (5-week follow-up) and 21.2 % (9-week follow-up). Secondary feasibility outcomes of treatment effect estimates are difficult to interpret in light of low treatment completion and trial retention rates.ConclusionA larger trial of the self-guided, online self-compassion treatment to decrease psychological distress in people with T2D may be beneficial, but it has limited feasibility in its current form. Further efforts are needed to improve treatment acceptability of online self-compassion and ACT focused treatment and trial procedures.
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| 42. |
- Kilic, Aysenur, et al.
(author)
-
Using Virtual Technology for Fear of Medical Procedures : A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions
- 2021
-
In: Annals of Behavioral Medicine. - : Oxford University Press. - 0883-6612 .- 1532-4796. ; 55:11, s. 1062-1079
-
Research review (peer-reviewed)abstract
- BackgroundInnovations in virtual reality (VR) technologies have improved the adaptability of its use in therapeutic settings, and VR has shown to be a promising treatment for fear of medical procedures, with research increasing in this area in recent years.PurposeThis review aims to collate evidence for the impact of VR on fear of medical procedures.MethodsCENTRAL (Cochrane), MEDLINE, EMBASE, and PsychINFO databases were searched up to October 2020. A mix of experimental and case-control studies were included for review, which evaluated the effectiveness of VR for fear, anxiety, and pain of medical procedures for people with needle phobia, dental phobia, claustrophobia of medical scans, and burn wound care anxiety. Risk of bias (RoB) was assessed by Cochrane and ROBINS-I tools.ResultsTwenty-eight studies were selected. Some studies included mixed participant groups of young people adults. The interventions varied, with VR used for distraction, hypnosis, or exposure. These were shown to be effective for reducing fear of medical procedures. However, effectiveness for blood-injection-injury phobias and burn wound care patients was unclear.ConclusionsEvidence on the effectiveness of VR suggests that it does decrease fear of medical procedures in some situations. However, the RoB assessment illustrated a poor quality of studies across those included in this review, limiting the ability to draw firm general conclusions from the study findings. There is a need for further research exploring the use of VR technologies in the management of anxiety in physical health care settings.
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| 43. |
- Kioskli, Kitty, et al.
(author)
-
Might psychological flexibility processes and Acceptance and Commitment Therapy (ACT) apply in adults with painful diabetic neuropathy? : A cross-sectional survey
- 2019
-
In: Journal of Contextual Behavioral Science. - : ELSEVIER. - 2212-1447. ; 13, s. 66-73
-
Journal article (peer-reviewed)abstract
- Painful diabetic neuropathy (PDN) is a distressing and disabling condition. There is, surprisingly, relatively lithe research into the role of psychological variables related to PDN. The aim of this study was to investigate the association between psychological flexibility, daily functioning, and distress in people with PDN. This cross-sectional study included 225 participants who were recruited from hospital services and online. In correlation analyses, acceptance of pain was shown to be negatively correlated with pain intensity (r = -0.21, p < 0.01), pain distress (r = -0.25, p < 0.01), functional impairment (r = -0.38, p < 0.01), depression severity (r = -0.41, p < 0.01), and depression impact (r = -0.41, p < 0.01). Cognitive fusion correlated positively with pain intensity (r = 0.14, p < 0.05), functional impairment (r = 0.24, p < 0.01), depression severity (r = 0.44, p < 0.01), and depression impact (r = 0.20, p < 0.01). Committed action also correlated negatively with functional impairment (r = -0.22, p < 0.01), depression severity (r = -0.43, p < 0.01), and depression impact (r = -0.21, p < 0.01). In regression analyses, the four variables representing psychological flexibility accounted for significant variance in all the equations except in the case of pain distress. However, in some cases the variance accounted for was less than that accounted for by pain intensity. For example, in the equation for functional impairment, pain intensity accounted for 32.2% of variance, while psychological flexibility accounted for 6.8% of variance. These results suggest that psychological flexibility may play a smaller role, relative to pain intensity, in the context of PDN as compared to the larger populations of chronic, mostly musculoskeletal, pain. The reliability and generalisability of these results need to be established.
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| 44. |
- Kioskli, Kitty, et al.
(author)
-
Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom : A Single-Arm Feasibility Trial
- 2020
-
In: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 21:11, s. 2777-2788
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified.METHODS: Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility.RESULTS: Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance.CONCLUSIONS: This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
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| 45. |
- Kioskli, Kitty, et al.
(author)
-
Psychosocial Factors in Painful Diabetic Neuropathy : A Systematic Review of Treatment Trials and Survey Studies
- 2019
-
In: Pain medicine (Malden, Mass.). - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 20:9, s. 1756-1773
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: Diabetes mellitus is associated with a number of complications that can adversely impact patients' quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies.METHODS: Electronic databases, related reviews, and associated reference lists were searched. Summaries of participants' data relating to the efficacy of psychological treatments and/or to associations between psychosocial factors and outcomes in painful diabetic neuropathy were extracted from the included studies. The methodological quality of included studies was assessed using two standardized quality assessment tools.RESULTS: From 2,921 potentially relevant titles identified, 27 studies were included in this systematic review. The evidence suggests that depression, anxiety, sleep, and quality of life are the most studied variables in relation to pain outcomes in painful diabetic neuropathy and are consistently associated with pain intensity. The magnitude of the associations ranged from small to large.CONCLUSIONS: Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.
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| 46. |
- Kishita, Naoko, et al.
(author)
-
Carers' and therapists' views of internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS) : a qualitative study in the context of ethnic minority families
- 2024
-
In: The Cognitive Behaviour Therapist. - : Cambridge University Press. - 1754-470X. ; 17
-
Journal article (peer-reviewed)abstract
- This study aimed to explore the views of family carers of people living with dementia from ethnic minority groups and their therapists on internet-delivered, self-help acceptance and commitment therapy for family carers (iACT4CARERS), enhanced with additional therapist guidance. To achieve this, a qualitative approach with semi-structured interviews was employed with ethnic minority carers who completed Enhanced iACT4CARERS (n=9) and therapists who supported them throughout the programme (n=5). The interviews were audio-recorded, transcribed and analysed using framework analysis. Four over-arching themes were identified: (1) Value of the programme to ethnic minority carers, (2) Barriers for ethnic minority carers, (3) Sense of connectedness through written feedback, and (4) Sense of connectedness through one-to-one sessions. Theme 1 reflected that ethnic minority carers valued ACT techniques, highlighting their usefulness and simplicity, leading to perceived benefits. Theme 2 revealed the irrelevance of examples provided of carer experiences throughout the programme due to differences in family carers' experiences of providing care within ethnic minority communities. Theme 3 highlighted that carers' engagement with the programme was facilitated by feelings of validation and encouragement received from their therapist via weekly written feedback. Finally, Theme 4 highlighted that additional one-to-one support sessions allowed both carers and therapists to develop strong therapeutic relationships. This enhanced subsequent text-based online interactions, allowing carers to be more open and engaged. Also, therapists reported that a strong sense of connectedness helped them to tailor their feedback. Enhanced iACT4CARERS that uses carers' experiences more relevant to ethnic minority communities may be more acceptable.
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| 47. |
- Kishita, Naoko, et al.
(author)
-
Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS) : a feasibility study
- 2022
-
In: Aging & Mental Health. - : Taylor & Francis. - 1360-7863 .- 1364-6915. ; 26:10, s. 1933-1941
-
Journal article (peer-reviewed)abstract
- Objectives: The feasibility of research into internet-delivered guided self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia is not known. This study assessed this in an uncontrolled feasibility study.Method: Family carers of people with dementia with mild to moderate anxiety or depression were recruited from primary and secondary healthcare services in the UK. Participants were offered eight, guided, self-help online ACT sessions adapted for the needs of family carers of people with dementia with optional online peer support groups. Pre-defined primary indicators of success included recruitment of 30 eligible carers over 6 months and ≥70% completing at least two online sessions.Results: Thirty-three participants (110% of the target sample) were recruited over 6 months and 30 participants (91%) completed two or more sessions, and thus both indicators of success were met. Further, 70% of participants completed seven or all eight sessions, and 27% of participants were lost to follow-up, but none of the reasons for early withdrawal were related to the intervention.Conclusion: This study supports the feasibility, including recruitment and treatment completion. A full-scale trial to assess the clinical- and cost-effectiveness of the intervention including its long-term effects is warranted.
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| 48. |
- Knight, Lucie D, et al.
(author)
-
Assessment and patient selection process for a pain management programme : a case study in specialty care.
- 2019
-
In: British journal of pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 13:2, s. 74-81
-
Journal article (peer-reviewed)abstract
- Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service.Method: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used.Results: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensive residential programme (30.5%, with an additional 11.6% offered case management first), followed by the five session outpatient programme (8.1%) and a minority was offered individual treatment (2.5%); 44.7% of the patients were discharged following the assessment. The three most frequently used reasons for exclusion were: not ready to engage with the pain management approach (35%), complex psychological or other needs needing to be prioritised (29.5%) and the patient declining a programme (19.3%).Conclusion: Reviewing the use of inclusion/exclusion criteria revealed some challenges regarding patient selection. For example, a sizable proportion of patients were still seeking pain reduction and were not open to a self-management approach when this was the recommended treatment for them. Complex patients might need other treatment approaches before they can be considered for a programme. Having a range of pain management options of varying intensities available seems helpful in meeting individual patient need.
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| 49. |
- Lai, Lizu, et al.
(author)
-
The efficacy of acceptance and commitment therapy for chronic pain : A three-level meta-analysis and a trial sequential analysis of randomized controlled trials
- 2023
-
In: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 165
-
Journal article (peer-reviewed)abstract
- The current study included randomized controlled trials (RCTs) to assess the benefits of Acceptance and commitment therapy (ACT) for chronic pain. Searches were conducted in Web of Science, PsycINFO, PubMed, Scopus, Cochrane Library, and Embase from inception until September 30, 2022. Thirty-three RCTs, including 2293 participants, were included. Small to medium effect sizes for pain intensity/physical function favoring ACT were found both at post-treatment (pain intensity: g = 0.44; physical function: g = 0.59) and follow-up (pain intensity: g = 0.34; physical function: g = 0.56). The effect sizes on psychological outcomes were significant at post-treatment (depression: g = 0.43; anxiety: g = 0.43; quality of life: g = 0.45) and follow-up (depression: g = 0.43; anxiety: g = 0.35; quality of life: g = 0.43). The results of the trial sequential analyses indicated that pooled estimates were unlikely to be incidental findings, as effects of multiple testing were controlled and power was adequate. Face-to-face ACT yielded significantly larger effects on physical outcomes than internet-delivered ACT. Participants with chronic headache and fibromyalgia showed greater benefit from ACT compared to those with non-specific pain or mixed pain. In addition, the longer the follow-up duration, the smaller the effect sizes for pain intensity/physical function at follow-up. The present meta-analysis suggests sufficient evidence for the significant benefits of ACT for people with chronic pain.
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| 50. |
- Lavefjord, Amani, et al.
(author)
-
Assessment methods in single case design studies of psychological treatments for chronic pain : A scoping review
- 2021
-
In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 21, s. 121-135
-
Research review (peer-reviewed)abstract
- Single case designs (SCDs) represent an excellent approach for developing and testing treatments, and for generating general knowledge of treatment mechanisms and outcomes. Their ability to generate knowledge, however, will depend on their methods being reliable, valid, clearly described, and replicable. This scoping review aims to map assessment methods in SCD studies of psychological treatments for chronic pain. The particular aims were to review the specific measures used, their modes of administration, their adequacy as measures, and opportunities for improvement. PubMed, PsycINFO, CINAHL and OpenGrey were searched for SCD studies of psychological treatments for chronic pain in adults. Two reviewers independently assessed eligibility, with input from two additional reviewers, and then extracted relevant data from the 55 included studies. The most common outcome domains were “pain”, “physical functioning” and “psychological processes.” Non-behavioral measures were more common than behavioral or physiological measures. Measures were often standardized. Measures in each domain were highly varied, and administration information was lacking. Evi dence for adequacy of measures was based on psychometric analyses of aggregated group data for nonbehavioral measures and agreement for behavioral and physiological measures, but was frequently not re ported. Non-behavioral idiographic measures were often inadequate in that adapted measures were often used but validation was reported for original versions. Outcome domains did not correspond with currently available guidelines for measures employed in clinical trials in pain. A new set of guidelines, that is more suited to psy chological treatments and to SCDs, is needed. Researchers should consider following an idiographic framework by using individualized measures more often. When measures are individually applied, it is recommended that their adequacy is not based on nomothetic psychometric approaches. Rather, behavioral assessment principles should be employed. Overall, adequacy reporting, usage of SCD consistent terminology, and information on how measures are administered need improvement.
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