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Effect of Cognitive-Behavioral Therapy or Mindfulness Therapy on Pain and Quality of Life in Patients with Diabetic Neuropathy: A Systematic Review and Meta-Analysis. Pain Manag Nurs 2022; 23:861-870. [PMID: 35934662 DOI: 10.1016/j.pmn.2022.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effectiveness of cognitive behavioral therapy (CBT) and mindfulness therapy (MT) for pain relief and quality of life (QOL) in patients with diabetic neuropathy. REVIEW/ANALYSIS METHODS Four databases were systematically searched from their respective inception dates to 29 June 2021. Relevant randomized controlled trials (RCTs) were screened and assessed for risk of bias. Eight RCTs evaluating CBT or MT were included. Statistical analysis was performed using Review Manager 5.4. RESULTS Eight RCTs involving 384 patients with painful diabetic neuropathy (PDN) tested psychological interventions, including three CBT and five MT studies. The results showed that patients' pain severity (standardized mean difference [SMD] = -0.60, 95% confidence interval [CI; -0.93 to -0.27], P = .0003) and QOL (SMD = -0.43, 95% CI [-0.83 to -0.04], p = .03) were improved immediately after treatment. Besides, the pain intensity (SMD = -0.67, 95% CI [-1.37 to 0.03], p = .06), pain interference (SMD = -0.75, 95% CI [-1.20 to -0.30], p = .001) and depressive symptoms (SMD = -0.62, 95% CI [-0.96 to -0.28], p = .0003) were superior to the control group after follow up. The subgroup analysis results of different intervention type showed that the CBT group could immediately improve pain (SMD = -0.44, 95% CI [-0.78 to -0.10], p = .01) after treatment. However, there was no statistically significant difference in the CBT group after follow-up (SMD = -0.15, 95% CI [-0.52 to 0.22], p = .42). CONCLUSIONS Cognitive behavioral therapy or MT is effective for treating pain in patients with diabetic peripheral neuropathy, improving the QOL, and reducing depressive symptoms. However, large-scale, multi-centre, rigorously designed RCTs are needed to further verify the long-term effects.
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Linking physical activity to personal values: feasibility and acceptability randomized pilot of a behavioral intervention for older adults with osteoarthritis pain. Pilot Feasibility Stud 2022; 8:164. [PMID: 35915512 PMCID: PMC9340681 DOI: 10.1186/s40814-022-01121-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) pain is common and leads to functional impairment for many older adults. Physical activity can improve OA outcomes for older adults, but few are appropriately active. Behavioral interventions can reduce physical activity barriers. We developed and tested a brief, novel behavioral intervention (i.e., Engage-PA) for older adults combining values to enhance motivation and strategic activity pacing to improve arthritis-related pain and functioning and increase physical activity. METHODS A randomized feasibility and acceptability pilot trial compared Engage-PA to treatment-as-usual plus fitness tracker (TAU+) in N = 40 adults age 65+ with OA pain in the knee or hip. Engage-PA involved two 60-min telephone sessions. All participants wore a fitness tracker to collect daily steps throughout the study and completed baseline and post-treatment assessments of secondary outcomes (arthritis-related pain and physical functioning, physical activity, psychological distress, psychological flexibility, and valued living). The impact of COVID-19 on general well-being and physical activity was also assessed. Descriptive statistics were conducted for feasibility and acceptability outcomes. Indicators of improvement in secondary outcomes were examined via change scores from baseline to post-treatment and performing independent samples t-tests to assess for between-group differences. RESULTS Feasibility was high; 100% accrual, low (5%) attrition, and 100% completion of study sessions. Acceptability was high, with 89% finding the intervention "mostly" or "very" helpful. Engage-PA participants demonstrated improvements in arthritis pain severity (Mdiff = 1.68, p = 0.044, 95% CI [- 0.26, 3.62]) and self-reported activity (Mdiff = 0.875, p = 0.038, 95% CI [- 1.85, 0.98]) from baseline to post-treatment as compared to TAU+. Due to pandemic-related challenges, there was a high level of missing data (43%) for daily steps, but available data showed no significant change in steps over time or between the groups. COVID-19 added an additional burden to participants, such that 50% were exercising less, 68% were more sedentary, and 72% lost access to spaces and social support to be active. CONCLUSIONS Engage-PA is a promising brief, novel behavioral intervention with the potential to support older adults in improving arthritis-related pain and functioning and increasing physical activity. The feasibility and acceptability of Engage-PA are particularly notable as most participants reported COVID-19 added more barriers to physical activity. TRIAL REGISTRATION ClinicalTrials.gov, NCT04490395 . Registered on July 29, 2020.
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Greenberg J, Mace RA, Popok PJ, Kulich RJ, Patel KV, Burns JW, Somers TJ, Keefe FJ, Schatman ME, Vranceanu AM. Psychosocial Correlates of Objective, Performance-Based, and Patient-Reported Physical Function Among Patients with Heterogeneous Chronic Pain. J Pain Res 2020; 13:2255-2265. [PMID: 32982388 PMCID: PMC7498493 DOI: 10.2147/jpr.s266455] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Improving all aspects of physical function is an important goal of chronic pain management. Few studies follow recent guidelines to comprehensively assess physical function via patient-reported, performance-based, and objective/ambulatory measures. PURPOSE To test 1) the interrelation between the 3 types of physical function measurement and 2) the association between psychosocial factors and each type of physical function measurement. METHODS Patients with chronic pain (N=79) completed measures of: 1) physical function (patient-reported disability; performance-based 6-minute walk-test; objective accelerometer step count); 2) pain and non-adaptive coping (pain during rest and activity, pain-catastrophizing, kinesiophobia); 3) adaptive coping (mindfulness, general coping, pain-resilience); and 4) social-emotional dysfunction (anxiety, depression, social isolation and emotional support). First, we tested the interrelation among the 3 aspects of physical function. Second, we used structural equation modeling to test associations between psychosocial factors (pain and non-adaptive coping, adaptive coping, and social-emotional dysfunction) and each measurement of physical function. RESULTS Performance-based and objective physical function were significantly interrelated (r=0.48, p<0.001) but did not correlate with patient-reported disability. Pain and non-adaptive coping (β=0.68, p<0.001), adaptive coping (β=-0.65, p<0.001) and social-emotional dysfunction (β=0.65, p<0.001) were associated with patient-reported disability but not to performance-based or objective physical function (ps>0.1). CONCLUSION Results suggest that patient-reported physical function may provide limited information about patients' physical capacity or ambulatory activity. While pain and non-adaptive reactions to it, adaptive coping, and social-emotional dysfunction may potentially improve patient-reported physical function, additional targets may be needed to improve functional capacity and ambulatory activity. TRIAL REGISTRATION ClinicalTrials.gov NCT03412916.
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Affiliation(s)
- Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paula J Popok
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ronald J Kulich
- Harvard Medical School, Boston, MA, USA
- Center for Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Kushang V Patel
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - John W Burns
- Division of Behavioral Sciences, Rush Medical College, Chicago, IL, USA
| | - Tamara J Somers
- Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Francis J Keefe
- Department of Medicine, Duke University School of Medicine, Durham, NC, US
| | - Michael E Schatman
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Hegarty RSM, Fletcher BD, Conner TS, Stebbings S, Treharne GJ. Acceptance and commitment therapy for people with rheumatic disease: Existing evidence and future directions. Musculoskeletal Care 2020; 18:330-341. [PMID: 32293092 DOI: 10.1002/msc.1464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Despite advances in the management of rheumatic diseases, many patients experience persistent pain and fatigue. Psychological interventions are useful adjunctive treatments, but improvements tend to be small, and progress in this area is needed. The aim of this review was to evaluate the effectiveness of acceptance and commitment therapy (ACT) for the treatment of chronic pain and fatigue in patients with rheumatic disease. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, and PsycINFO for randomised controlled trials (RCTs) of ACT for the treatment of chronic pain and fatigue in patients with rheumatic disease. Ten RCTs that included people with rheumatic disease were identified, rated for risk of bias, and summarised in terms of effects on relevant outcomes (disability, emotional functioning, pain, and quality of life). RESULTS Treatment with ACT was associated with improvements in physical and emotional functioning, pain, and quality of life in chronic pain patients. The favourable effects of ACT were evident when compared with those of treatment as usual or active control conditions (e.g., pain education and novel medication). There was consistent evidence to show that ACT is beneficial in improving physical and emotional functioning in patients with fibromyalgia but a lack of evidence pertaining to patients with other forms of rheumatic disease. CONCLUSION ACT provides benefit for fibromyalgia patients. Further high-quality research is needed to develop ACT interventions for people with inflammatory rheumatic diseases and to evaluate their effectiveness for managing the pain and fatigue associated with these conditions.
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Affiliation(s)
| | | | - Tamlin S Conner
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Schneider J, Malinowski P, Watson PM, Lattimore P. The role of mindfulness in physical activity: a systematic review. Obes Rev 2019; 20:448-463. [PMID: 30468299 DOI: 10.1111/obr.12795] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 02/05/2023]
Abstract
Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.
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Affiliation(s)
- J Schneider
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Malinowski
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P M Watson
- Research Institute for Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Lattimore
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
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Casey MB, Smart K, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. 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. Trials 2018; 19:194. [PMID: 29566744 PMCID: PMC5865382 DOI: 10.1186/s13063-018-2543-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/13/2018] [Indexed: 01/03/2023] Open
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. Electronic supplementary material The online version of this article (10.1186/s13063-018-2543-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Keith Smart
- Physiotherapy Department, St Vincents University Hospital, Elm Park, Dublin 4, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Damien Lowry
- Psychology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Lance McCracken
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, United Kingdom
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
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Zhang CQ, Leeming E, Smith P, Chung PK, Hagger MS, Hayes SC. Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol 2018; 8:2350. [PMID: 29375451 PMCID: PMC5769281 DOI: 10.3389/fpsyg.2017.02350] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/22/2017] [Indexed: 12/20/2022] Open
Abstract
Promoting health behavior change presents an important challenge to theory and research in the field of health psychology. In this paper, we introduce a context-driven approach, the Acceptance and Commitment Therapy (ACT) model which is built on Relational Frame Theory. The ACT-based intervention aims to promote individuals' new health behavior patterns through the improvement of the key construct of psychological flexibility, which is defined as the ability to contact the present moment more fully with acceptance and mindfulness as a conscious human being. Building on the psychological flexibility model, implemented through the six core ACT processes, individuals improve maintenance of long term health behavior change through committed acts in service of chosen values while acknowledging and accepting the existence of contrary thoughts, rules, and emotions as part of themselves but not determinant of their behaviors. Taking advantage of this context-driven approach of health behavior change, we recommend researchers and practitioners to design their health behavior change intervention programs based on ACT.
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Affiliation(s)
- Chun-Qing Zhang
- Department of Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Emily Leeming
- Department of Psychology, University of Nevada, Reno, Reno, NV, United States
| | - Patrick Smith
- Department of Psychology, University of Nevada, Reno, Reno, NV, United States
| | - Pak-Kwong Chung
- Department of Physical Education, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Martin S. Hagger
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Department of Sport Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Steven C. Hayes
- Department of Psychology, University of Nevada, Reno, Reno, NV, United States
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Gilpin HR, Keyes A, Stahl DR, Greig R, McCracken LM. Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review. THE JOURNAL OF PAIN 2017; 18:1153-1164. [PMID: 28455249 DOI: 10.1016/j.jpain.2017.04.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/24/2017] [Accepted: 04/02/2017] [Indexed: 02/07/2023]
Abstract
There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy. PERSPECTIVE In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.
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Affiliation(s)
- Helen R Gilpin
- INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Alexandra Keyes
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Daniel R Stahl
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Riannon Greig
- Royal Holloway, University of London, United Kingdom
| | - Lance M McCracken
- INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.
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Kaiser RS, Mooreville M, Kannan K. Psychological Interventions for the Management of Chronic Pain: a Review of Current Evidence. Curr Pain Headache Rep 2015. [DOI: 10.1007/s11916-015-0517-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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