Acceptance and Commitment Therapy (ACT) is a form of Cognitive Behavioral Therapy that includes a specific therapeutic process, “psychological flexibility,” and focuses on behavior change rather than symptom reduction. One relatively well-developed research area includes ACT applied to chronic pain. The current systematic review examines outcome domains included as primary, secondary and process variables in controlled trials of ACT-based pain treatment studies, and also summarizes evidence for efficacy. The review of outcome domains is to establish whether these are in-line with recommendations, consistent with the theory underlying ACT, and optimal for further development. A systematic search identified 1034 articles and ten studies were selected as eligible for review. Overall, 15 outcome domains were assessed using 39 different measurement tools across the ten RCTs. The outcome domains assessed in the reviewed trials were, to an extent, in-line with recognized guidelines. Six of the ten studies identified primary and secondary outcomes; one included just one outcome and three did not categorize outcomes. All ten trials included a measure of some aspect of psychological flexibility; however these were not always formally identified as process variables. Pain and emotional functioning were the most frequently measured outcome domains. A review of outcome results suggests that ACT is efficacious particularly for enhancing general, mostly physical functioning, and for decreasing distress, in comparison to inactive treatment comparisons. It is recommended that future RCTs (a) formally define outcomes as primary, secondary and process variables, (b) consider including measures of physical or social functioning, rather than pain and emotional functioning, as primary outcomes, (c) address existing risks of bias, such as reporting bias, and (d) include more components of psychological flexibility, such as cognitive defusion and self-related variables.
AimThe purpose of the current study is to systematically review assessment approaches used in randomized controlled trials (RCTs) of ACT for chronic pain in adults. The specific objectives are to (a) identify the outcome domains assessed, including those defined as primary and secondary, (b) determine the degree to which these domains reflect IMMPACT versus the model underlying ACT, (c) examine current approaches to treatment process assessment in
these studies, and (d) provide a brief narrative review of treatment efficacy. A secondary objective was to consider the quality of current RCTs of the ACT-based treatments for chronic pain identified.
Katie E.J. Hann, Lance M. McCracken
Disease Category: Other
Disease Name: Chronic pain
Age Range: Unknown
Sex: Either
Nature of Intervention: Psychological & behavioural
- COS uptake study
- Systematic review
A systematic search was performed in OVID: Embase (1980 to week 14 2014), PsycINFO (1806 to April week 1 2014) and Medline (1946 to March week 4 2014). A further search was carried in EBSCO: CINAHL (January 1999 to April 2014) and The Cochrane Library. All searches were carried out on 5 April 2014. Each search was then limited to include only journal articles published in English in the past 15 years (1999–2014).