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Effects and mediators of web-based acceptance and commitment therapy in patients with chronic pain- a randomized controlled trial: the role of psychological inflexibility, values-based living and mindfulness in improving pain interference

Braun, V. (2013) Effects and mediators of web-based acceptance and commitment therapy in patients with chronic pain- a randomized controlled trial: the role of psychological inflexibility, values-based living and mindfulness in improving pain interference.

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Abstract:Background. Pain interference in daily life is a serious problem that chronic pain patients, their social environment, their community, and our societies in general suffer from. Although CBT was shown to be effective in the treatment of chronic pain, it is not useful for all patients who suffer from chronic pain. Acceptance and Commitment Therapy (ACT), including mindfulness has shown to be effective in the treatment of chronic pain conditions. Through improving psychological flexibility, ACT aims at accepting pain and living in accordance with personal values instead of expending energy to reduce symptoms. Although the empirical support for treatments emphasizing ACT and mindfulness is growing, there is clearly a need for more outcome and process studies, especially randomized controlled trials. Aim. This study examined the effects of a web-based ACT intervention on the outcome variable pain interference, and the three response styles of ACT, conceptualized of the process variables psychological inflexibility, values-based living and mindfulness in patients with chronic pain conditions. Furthermore, the proposed mediation role of these three response styles on pain interference was investigated. Method. Participants were randomly assigned to the experimental condition (ACT), a control condition receiving a minimal web-based Expressive Writing intervention (EW), or a Waiting list (WL). All participants completed measures at baseline/pre-test, after four, eight, and 12 weeks of intervention (end intervention), and at 3-month follow-up. Additionally, the ACT and EW group completed measures at 9-month follow-up. Results. With repeated measures- and one way ANOVAs, it was shown that the web-based ACT treatment is especially effective in improving psychological inflexibility and pain interference. Values-based living and mindfulness were also improved, but these effects were not specific for the ACT group. Effects specific for the ACT group occurred mainly after four to eight weeks of the intervention and were in general maintained over a 3- and 9-month follow-up period. Mediation analysed by PROCESS showed that changes in pain interference during the intervention were only mediated by changes in psychological inflexibility. Conclusion. In sum, we concluded that a web-based ACT treatment could be effective in improving pain interference through decreasing psychological inflexibility in patients with chronic pain conditions, thereby supporting the important role of psychological flexibility in ACT-based treatments. More research is needed to strengthen these results and to clarify the mechanisms of change in ACT- and mindfulness-based treatments.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
Link to this item:http://purl.utwente.nl/essays/64879
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