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Anderson M, McCracken LM, Scott W. An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain. Front Psychol 2024; 15:1322723. [PMID: 38379625 PMCID: PMC10876841 DOI: 10.3389/fpsyg.2024.1322723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
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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Affiliation(s)
- Madeleine Anderson
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Whitney Scott
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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2
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Kruse JA, Seng EK. Changes in cognitive appraisal in a randomized controlled trial of mindfulness-based cognitive therapy for patients with migraine. Headache 2023; 63:1403-1411. [PMID: 37723970 DOI: 10.1111/head.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE This study is a secondary analysis evaluating changes in cognitive fusion and pain catastrophizing over 8 weeks of mindfulness-based cognitive therapy for migraine (MBCT-M) intervention versus waitlist/treatment as usual. BACKGROUND Migraine is a common disabling neurological condition. MBCT-M combines elements of cognitive behavioral therapy with mindfulness-based approaches and has demonstrated efficacy in reducing migraine-related disability. METHODS A total of 60 adults with migraine completed a 30-day run-in before randomization into a parallel design of either eight weekly individual MBCT-M sessions (n = 31) or waitlist/treatment as usual (n = 29): participants were followed for 1 month after. Participants completed the Pain Catastrophizing Scale (PCS) and the Cognitive Fusion Questionnaire (CFQ) at Months 0, 1, 2, and 4. RESULTS The PCS scores decreased more in the MBCT-M group (mean [SD] at baseline = 22.5 [9.6]; at Month 4 = 15.1 [8.8]) than in the waitlist/treatment as usual group (mean [SD] at baseline = 24.9 [9.0]; at Month 4 = 22.5 [10.4]) from Month 0 to 4 (β = -7.24, p = 0.001, 95% confidence interval [CI] -11.39 to -3.09). The CFQ (mean [SD] baseline = 27.6 [8.0]; at Month 4 = 25.0 [8.0]) did not change significantly from Month 0 to 4 (β = -1.2, p = 0.482, 95% CI -4.5 to 2.1). Parallel mediation analyses indicated that decreases in the PCS and CFQ together (β = -6.1, SE = 2.5, 95% CI -11.6 to -1.8), and the PCS alone (β = -4.8, SE = 2.04, 95% CI -9.1 to -1.1), mediated changes in headache disability in the MBCT-M treatment completer group (n = 19). CONCLUSION In this study, pain catastrophizing showed strong promise as a potential mechanism of MBCT-M. Future research should continue to explore cognitive appraisal changes in mindfulness-based interventions.
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Affiliation(s)
- Jessica A Kruse
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Elizabeth K Seng
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
- Montefiore Headache Center, Montefiore Medical Center, Bronx, New York, USA
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Naragon-Gainey K, DeMarree KG, Kyron MJ, McMahon TP, Park J, Biehler KM. Decentering from Emotions in Daily Life: Dynamic Associations with Affect, Symptoms, and Wellbeing. Clin Psychol Sci 2023; 11:841-862. [PMID: 37771501 PMCID: PMC10538949 DOI: 10.1177/21677026221147262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Decentering is thought to be protective against a range of psychological symptoms, but little is known about the outcomes of decentering as a momentary state in daily life. We used ecological momentary assessment (42 reports across one week) to examine the temporal ordering of the associations of decentering with affect, dysphoria, participant-specific idiographic symptoms, and wellbeing. We also hypothesized that greater decentering predicts less inertia (persistence) of each variable, and weakens the association of affect with dysphoria, idiographic symptoms, and wellbeing. Results in 345 community participants indicated that decentering and these variables were mutually reinforcing over time, and that greater decentering was associated with less inertia of negative affect and dysphoria. Decentering generally predicted reduced impact of positive and negative affect on dysphoria symptoms, but results were mixed when predicting idiographic symptoms or wellbeing. Clinical implications and refinements for theory on decentering are discussed.
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Affiliation(s)
| | - Kenneth G. DeMarree
- Department of Psychology, University at Buffalo, the State University of New York
| | - Michael J. Kyron
- School of Psychological Science, University of Western Australia
| | - Tierney P. McMahon
- Institute for Innovations in Developmental Sciences, Feinberg School of Medicine, Northwestern University
| | | | - Kaitlyn M. Biehler
- Department of Psychology, University at Buffalo, the State University of New York
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Karayannis NV, Sturgeon JA, Kemani MK, Mackey SC, Greco CM, Wicksell RK, McCracken LM. Pain acceptance and psychological inflexibility predict pain interference outcomes for persons with chronic pain receiving pain psychology. Scand J Pain 2023; 23:464-475. [PMID: 36745187 PMCID: PMC10522049 DOI: 10.1515/sjpain-2022-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023]
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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Affiliation(s)
| | - John A Sturgeon
- Department of Psychology, University of Washington, Seattle, USA
| | - Mike K Kemani
- Medical Unit Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Solna, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Sean C Mackey
- Division of Pain Medicine, Stanford University, Stanford, USA
| | - Carol M Greco
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Sweden
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Quan H, Zettle RD. The Contribution of Psychological Inflexibility and Metacognitive Processes to Emotional Distress. J Cogn Psychother 2023; 37:63-81. [PMID: 36788002 DOI: 10.1891/jcpsy-d-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Process-based cognitive behavior therapy (PB-CBT) may be informed by identifying shared mechanisms of disorder linked to shared processes of therapeutic change. Repetitive negative thinking (RNT) is a molar pathogenic process common to both generalized anxiety disorder and depression. Acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) offer separate models of the relationship between RNT and emotional distress. In a pair of related studies, the relative degree to which processes specific to the two models accounted for variability in levels of generalized anxiety and depression in college student samples was evaluated. Across both studies, processes of cognitive fusion and obstructed valued living within the ACT model and beliefs about the negative consequences of RNT within the MCT model were most predictive of variability in levels of emotional distress. Limitations of this project as well as implications for further research and practice of PB-CBT for disorders of emotional distress are discussed.
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Affiliation(s)
- Huan Quan
- Wichita State University, Wichita, Kansas, USA
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McCracken LM, Scott W. Potential Misfortunes in 'Making Sense': A Cross-Sectional Study in People with Chronic Pain. THE JOURNAL OF PAIN 2023; 24:157-166. [PMID: 36130674 DOI: 10.1016/j.jpain.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 02/08/2023]
Abstract
Making sense of one's circumstances is normally regarded as helpful, including in the context of chronic pain. However, sense-making may be associated with adverse impacts in daily functioning. To better understand the functions of sense-making, the objective of the current study was to develop, validate, and preliminarily examine a measure of potentially helpful and unhelpful forms of sense-making behavior in people seeking treatment for chronic pain. This measure is called the Sense Making Questionnaire (SMQ). Research participants included 451 adults consecutively attending a specialty interdisciplinary treatment for chronic pain. Data for this study derived from a standard set of measures participants completed prior to treatment. Exploratory Factor Analysis (EFA) produced a 3-factor solution based on 15 items, including Avoidance of Incoherence, Overthinking, and Functional Coherence. The first 2 of these factors and the total achieved adequate internal consistency. Construct validity of the SMQ scores was supported by significant correlations with measures of pain acceptance, committed action, cognitive fusion, and intolerance of uncertainty. The SMQ total score correlated significantly with pain interference, r = .23, depression, r = .41, and work and social adjustment, r = .30, all P < .001. In multiple regression analyses the total score also significantly predicted depression after age, gender, education, pain duration, pain intensity, and pain acceptance were statistically controlled, and it accounted for an additional 8.0% in explained variance. It appears that there is a distinction between literal coherence and functional coherence. In some situations, it may benefit people with chronic pain to shift focus from efforts to make literal sense of pain and instead to keep the focus on taking effective action even if this does not appear at first to make sense. PERSPECTIVE: This study in people seeking treatment for chronic pain includes development of a measure of behavior patterns related to making sense in chronic pain. It shows that sometimes these behavior patterns can be ineffective, as they appear negatively associated with emotional, physical, and social functioning.
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Affiliation(s)
| | - Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom; INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Pahnke J, Jansson-Fröjmark M, Andersson G, Bjureberg J, Jokinen J, Bohman B, Lundgren T. Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221140749. [PMID: 36510817 DOI: 10.1177/13623613221140749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
LAY ABSTRACT Autistic adults are often stressed and feel depressed or anxious. However, mental health programs that are suited for autistic adults are few. Acceptance and commitment therapy is a psychotherapy method that seems to help people feel better, although not thoroughly evaluated in autistic individuals. In this study, 20 autistic adults had 14 weeks of acceptance and commitment therapy group treatment suited for autism (NeuroACT), while 19 autistic adults had ordinary care. The acceptance and commitment therapy group treatment program seemed logical and reasonable to the participants. Also, when comparing the participants in the NeuroACT group with those in the ordinary care group, the NeuroACT participants reported less stress and higher quality of life. Compared to the ordinary care group, they could also manage distressing thoughts better, perceived themselves as more flexible, and did not avoid stressful situations as much as before. However, there was no significant difference between the groups in depression, anxiety, sleep problems, social aspects of autism, everyday functioning, or executive challenges. Slightly more NeuroACT participants did not finish the treatment than ordinary care participants. In conclusion, the NeuroACT program may be a treatment for autistic adults who feel stressed and have reduced quality of life. More studies are needed to see how helpful the NeuroACT program is for autistic adults.
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Affiliation(s)
- Johan Pahnke
- Karolinska Institutet and Region Stockholm, Sweden
| | | | - Gerhard Andersson
- Karolinska Institutet and Region Stockholm, Sweden.,Linköping University, Sweden
| | - Johan Bjureberg
- Karolinska Institutet and Region Stockholm, Sweden.,Stanford University, USA
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de la Coba P, Rodríguez-Valverde M, Hernández-López M. Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment. Internet Interv 2022; 29:100561. [PMID: 35855947 PMCID: PMC9287477 DOI: 10.1016/j.invent.2022.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/28/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Acceptance and commitment therapy (ACT) is an effective treatment for chronic pain conditions. ACT seeks to produce clinical change by enhancing Psychological Flexibility (PF). This exploratory (feasibility and preliminary effectiveness) study presents a pilot application of an online ACT group intervention for fibromyalgia (FM) with an extensive Experiential Sampling (ES) assessment of outcome and process variables via smartphone. METHOD 5-weekly ACT online group sessions were applied to 9 female FM patients. Questionnaire-based assessments of several clinical outcomes and PF processes were conducted pre- and post-intervention, and at 6-month follow-up. Extensive (6 weeks pre- and 6 weeks post-intervention) smartphone-delivered ES was implemented to gather process and outcome data in the patients' usual contexts. Clinically significant change was evaluated both at the group level and individually. RESULTS This treatment format appears to be feasible and acceptable to participants, with good adoption and completion rates (75 %) and excellent rates of treatment completion and clinical adherence (100 %). Participants showed significant reductions in affective pain, distress and biopsychosocial impact of FM both post-intervention and at 6-month follow-up (as measured with questionnaires), as well as significant improvements in satisfaction with actions and emotional discomfort (as measured through ES). Multilevel regression analyses indicated that PF-related processes assessed through ES had a significant impact on clinical outcomes and predicted the impact of FM at the 6-month follow-up. CONCLUSIONS A brief online group ACT intervention for FM was both feasible and acceptable to participants. Also, there was preliminary evidence of effectiveness in enhancing pain-related PF and producing clinical benefits in FM.
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Affiliation(s)
- Pablo de la Coba
- Corresponding author at: Departamento de Psicología, Universidad de Jaén, 23071 Jaén, Spain.
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Ranjbar HA, Abdulcebbar A, Yilmaz E, Kantarci L, Altintas S, Eskin M, َAltan-Atalay A. Deviation from balanced time perspective and psychological distress: The mediating roles of cognitive fusion and experiential avoidance. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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The Argentinian version of the cognitive fusion questionnaire: Psychometric properties and the role of cognitive fusion as a predictor of pathological worry. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Do Cognitive Abilities Influence Physical and Mental Fatigue in Patients with Chronic Pain after Walking According to a Clinical Guideline for Physical Exercise? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413148. [PMID: 34948758 PMCID: PMC8701060 DOI: 10.3390/ijerph182413148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022]
Abstract
The objective of this study is to explore the mediator role of cognitive fusion and chronic pain acceptance on the effects that the walking pattern, following an established clinical guideline for physical exercise, can have on fatigue (physical and mental) in patients with chronic pain. The sample consisted of a total of 231 women with fibromyalgia with a mean age of 56.91 years (Standard Deviation SD = 9.58 years, range 30−78 years). The results show a significant indirect effect of the walking pattern on both physical and mental fatigue through cognitive fusion and chronic pain acceptance. Specifically, walking predicted less cognitive fusion, which predicted greater chronic pain acceptance, which, in turn, predicted less mental and physical fatigue (Beta-B- = −0.04, Standard Error SE = 0.02, 95% Confidence Interval 95% CI = [−0.09, −0.02]; B = −0.09, SE = 0.05, 95% CI = [−0.22, −0,15], respectively). It can be concluded that the walking pattern is linked to both physical and mental fatigue through cognitive defusion and chronic pain acceptance. These cognitive abilities would allow fibromyalgia patients to perceive an improvement in both physical and mental fatigue by carrying out the walking pattern. Emphasizing the training of cognitive defusion and pain acceptance would improve the adherence of these patients to walking.
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Yu L, Scott W, Goodman R, Driscoll L, McCracken LM. Measuring 'self': preliminary validation of a short form of the Self Experiences Questionnaire in people with chronic pain. Br J Pain 2021; 15:474-485. [PMID: 34840795 DOI: 10.1177/2049463721994863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background People with chronic pain often struggle with their sense of self and this can adversely impact their functioning and well-being. Acceptance and Commitment Therapy particularly includes a process related to this struggle with self. A measure for this process, the Self Experiences Questionnaire (SEQ), was previously developed in people with chronic pain. Purpose The aim of the current study was to validate a shorter version of the SEQ in people with chronic pain to reduce respondent burden and facilitate further research. Methods Data from 477 participants attending an interdisciplinary pain management programme were included. Participants completed measures of treatment processes (self-as-context, pain acceptance, cognitive fusion and committed action) and outcomes (pain, pain interference, work and social adjustment and depression) at baseline and post-treatment. Confirmatory factor analysis was used for item reduction. Correlations between scores from the shorter SEQ and other process and outcome variables were calculated to examine validity. Change scores of the shorter SEQ and their correlations with changes in outcome variables were examined for responsiveness. Results An eight-item SEQ (SEQ-8) scale including two factors, namely Self-as-Distinction and Self-as-Observer, emerged, demonstrating good reliability (Cronbach's α = .87-.90) and validity (|r| = .14-.52). Scores from SEQ-8 significantly improved after the treatment (d = .15-21), and these improvements correlated with improvements in most outcomes. Conclusions The SEQ-8 appears to be a reliable and valid measure of self. This shorter format may facilitate intensive longitudinal investigation into sense of self and functioning and well-being.
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Affiliation(s)
- Lin Yu
- Department of Psychology, Middlesex University, London, UK.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Whitney Scott
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, London, UK
| | - Rupert Goodman
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lizzie Driscoll
- Salomons Institute for Applied Psychology, Royal Tunbridge Wells, UK
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Catala P, Suso-Ribera C, Gutierrez L, Perez S, Lopez-Roig S, Peñacoba C. Is Thought Management a Resource for Functioning in Women with Fibromyalgia Irrespective of Pain Levels? PAIN MEDICINE 2021; 22:1827-1836. [PMID: 33595650 DOI: 10.1093/pm/pnab073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by patients with fibromyalgia across different levels of pain severity (i.e., moderation). METHODS The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (standard deviation = 8.94; range = 30 to 78 years). RESULTS Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all P < 0.001). A moderation effect was also found in the relationship between cognitive fusion and fibromyalgia impact on functioning (B = -0.12, t = -2.42, P = 0.016, 95% confidence interval: -0.22 to -0.02) and between magnification and fibromyalgia impact (B = -0.37, t = -2.21, P = 0.028, 95% confidence interval: -0.69 to -0.04). This moderation was not observed for rumination and helplessness. CONCLUSIONS The results suggest that in interventions to improve functioning in people with fibromyalgia, some maladaptive forms of thought management (i.e., cognitive fusion and magnification) preferably should be challenged at milder levels of pain severity. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity; therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions in patients with fibromyalgia experiencing more severe pain levels.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Lorena Gutierrez
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Soledad Perez
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
| | - Sofia Lopez-Roig
- Department of Behavioral Sciences and Health, Miguel Hernandez University, Alicante, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Alcorcón (Madrid), Spain
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Psychometric properties of the Cognitive Fusion Questionnaire in females with fibromyalgia. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractCognitive fusion, or the degree to which a person is entangled with their thoughts and takes them literally, is considered a normal yet detrimental cognitive process associated with diverse negative outcomes across healthy and disordered functioning, including in fibromyalgia. Given the relevance of this cognitive process, the aim of the present study is to generate empirical evidence on the reliability and validity of the Cognitive Fusion Questionnaire (CFQ) in a sample of Spanish females with fibromyalgia. In this cross-sectional study, 230 Spanish females diagnosed with fibromyalgia (mean age 56.89 years; SD = 8.96) were assessed on cognitive fusion, pain catastrophizing, personality traits, positive and negative affect, anxiety symptoms, depressive symptoms and disease severity. Confirmatory factor analysis, reliability and validity analyses were performed. The CFQ showed a unidimensional structure, adequate temporal stability and good internal consistency. In addition, convergent and discriminant validity were found with respect to dispositional, pain-related, affective, mood and anxious measures; as well as incremental and criterion validity in the prediction of psychological symptoms or the disease severity status. The CFQ has been revealed as a solid and valid measure in the evaluation of cognitive fusion in Spanish females suffering from fibromyalgia, and may also be useful in clinical contexts due to the relationships it has shown with important outcomes. Limitations and future directions are also discussed.
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Rauwenhoff J, Peeters F, Bol Y, Van Heugten C. Measuring psychological flexibility and cognitive defusion in individuals with acquired brain injury. Brain Inj 2021; 35:1301-1307. [PMID: 34487472 PMCID: PMC10791065 DOI: 10.1080/02699052.2021.1972155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Acceptance and Commitment Therapy (ACT) is used increasingly for individuals with psychological distress following acquired brain injury (ABI) in different countries. However, questionnaires measuring ACT-processes are often not validated for this patient group and need cross-cultural validation. This study investigated the psychometric properties of the Acceptance and Action Questionnaire for Acquired Brain Injury (AAQ-ABI; measuring psychological flexibility related to thoughts and feelings about ABI) and the Cognitive Fusion Questionnaire (CFQ-7; measuring cognitive defusion). MATERIALS AND METHODS Score distribution, reliability, and convergent validity of the AAQ-ABI and the CFQ-7 were examined in Dutch individuals with ABI. RESULTS Seventy-three patients with ABI were included. The AAQ-ABI showed good reliability (Cronbach's α = 0.87) and the CFQ-7 excellent reliability (Cronbach's α = 0.97). Both did not show a floor or ceiling effect, nor a skewed distribution. There were strong to moderate correlations between the questionnaires and measures of psychological flexibility, mood, quality of life, and value-driven behavior (AAQ-ABI: r = -0.70-0.81; CFQ-7 = -0.67-0.84). Inter-item total correlations indicate that the questions within each questionnaire measured the same construct (AAQ-ABI: r = 0.40-0.78; CFQ-7: r = 0.84-0.93). CONCLUSIONS The current study shows that the Dutch AAQ-ABI and CFQ-7 have acceptable to good psychometric properties when measuring psychological flexibility and cognitive defusion in patients with ABI.
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Affiliation(s)
- Johanne Rauwenhoff
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, The Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht University Medical Centre, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Ecija C, Catala P, Lopez-Gomez I, Bedmar D, Peñacoba C. What Does the Psychological Flexibility Model Contribute to the Relationship Between Depression and Disability in Chronic Pain? The Role of Cognitive Fusion and Pain Acceptance. Clin Nurs Res 2021; 31:217-229. [PMID: 34301154 DOI: 10.1177/10547738211034307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the mediator role of cognitive fusion between depressive symptoms, activity avoidance and excessive persistence at different levels of pain acceptance (moderator) among fibromyalgia patients (FM). Using a sample of 231 women, multiple and moderate mediation analyses were conducted with PROCESS. Results showed that depression was positively associated with activity avoidance and excessive persistence. Furthermore, cognitive fusion and pain acceptance were found to mediate the effect of depression in both patterns. Additionally, pain acceptance was found to play a contextual role in cognitive fusion, as a moderator, between depressive symptoms and maladaptive patterns. Specifically, FM patients with high acceptance levels and low levels of depression presented the strongest associations between depression and cognitive fusion. Techniques aimed at reducing cognitive fusion, could be especially beneficial to FM women with high pain acceptance.
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Affiliation(s)
- Carmen Ecija
- Rey Juan Carlos University, Alcorcón, Madrid, Spain
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17
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Zacharia M, Ioannou M, Theofanous A, Vasiliou VS, Karekla M. Does Cognitive Fusion show up similarly across two behavioral health samples? Psychometric properties and invariance of the Greek–Cognitive Fusion Questionnaire (G-CFQ). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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18
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Cognitive Defusion Is a Core Cognitive Mechanism for the Sensory-Affective Uncoupling of Pain During Mindfulness Meditation. Psychosom Med 2021; 83:566-578. [PMID: 33790200 DOI: 10.1097/psy.0000000000000938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Mindfulness meditation can downregulate the experience of pain. However, its specific underlying regulatory mechanisms are still largely unknown. Here, we aimed to investigate the role of cognitive defusion-a form of psychological distancing from internal experiences-in mindfulness-based pain regulation. METHODS We implemented a thermal heat paradigm that was designed to amplify the cognitive-affective aspects of pain in 43 novice meditators (2-day formal training; 51.2% women; 53.2 ± 7.0 years old) and 27 expert meditators (>10,000-hour practice; 44.4% women; 51.9 ± 8.4 years old). We collected pain intensity and unpleasantness reports and trait measures of pain catastrophizing assessed by the Pain Catastrophizing Scale (PCS), cognitive defusion assessed by the Drexel Defusion Scale (DDS), and cognitive fusion assessed by the Cognitive Fusion Questionnaire, as well as of several other constructs commonly reported in the literature. RESULTS Experts reported lower PCS (6.9 ± 5.2 versus 17.2 ± 8.5, p < .001) but higher DDS (39.4 ± 6.4 versus 28.9 ± 6.6, p < .001) than novices. Across participants, the PCS and DDS were negatively correlated and shared unique variance that survived adjusting for other mindfulness-related and cognitive-emotional constructs (β = -0.64, p < .001). Conversely, the relationships between PCS and other commonly reported constructs did not seem specific, as none of the relationships survived adjusting for DDS (adjusted β < 0.25, p > .05). Further supporting the relevance of DDS to pain, both the DDS and PCS specifically predicted pain unpleasantness as opposed to pain intensity. However, DDS seemed to be a more specific predictor of unpleasantness than PCS, as the relationship between DDS and unpleasantness survived adjusting for PCS (adjusted β = -0.33, p = .016), but not vice versa (adjusted β = 0.20, p = .162). We also found that the Cognitive Fusion Questionnaire showed a similar pattern of associations with PCS and pain self-reports to what was found for the DDS, although these associations were less consistent. CONCLUSIONS Collectively, these findings highlight the central role of cognitive defusion in mindfulness-based pain regulation.
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Ahola Kohut S, Martincevic I, Turrell SL, Church PC, Walters TD, Weiser N, Iuliano A. Online Acceptance and Commitment Therapy and Nutrition Workshop for Parents of Children with Inflammatory Bowel Disease: Feasibility, Acceptability, and Initial Effectiveness. CHILDREN-BASEL 2021; 8:children8050396. [PMID: 34069305 PMCID: PMC8156170 DOI: 10.3390/children8050396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Parents of children with inflammatory bowel disease (IBD) are important members of their healthcare team and influence their child’s adaptation to disease. The primary aim of this research was to test the feasibility and acceptability of a three-session online parent workshop based on acceptance and commitment therapy (ACT) and address concerns about eating well and nutrition in IBD. The secondary aim was to explore the initial effectiveness of this workshop in parent reported psychological flexibility, mindfulness, experiential avoidance, cognitive fusion, valued living, and symptoms of depression, anxiety, and stress. We used a single arm pragmatic prospective study design with parents of children attending the IBD program at a tertiary pediatric healthcare centre in Canada. Mixed methods patient reported outcomes were measured at baseline, immediate post participation, and 3 months post participation in the workshop. Thirty-seven parents enrolled in the study and feasibility and acceptability goals were largely met. Parents qualitatively described changes to their parenting, what aspects of the workshop were most helpful, and targeted feedback on how to improve workshop. Findings suggest that providing parents of children with IBD a brief online ACT workshop including nutrition guidance is feasible and leads to changes in parenting behaviours.
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Affiliation(s)
- Sara Ahola Kohut
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
- Department of Psychiatry, University of Toronto, Toronto, ON M5G 1X8, Canada
- Correspondence:
| | - Inez Martincevic
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | | | - Peter C. Church
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Thomas D. Walters
- Department of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (P.C.C.); (T.D.W.)
- Department of Paediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
| | - Armanda Iuliano
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON M5G 1X8, Canada; (N.W.); (A.I.)
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20
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Lee SJ, Lee S. Korean Version of the Thought-Action Fusion Scale: The Evidence for Its Psychometric Properties. Psychiatry Investig 2021; 18:348-356. [PMID: 33849242 PMCID: PMC8103018 DOI: 10.30773/pi.2020.0396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The Thought-Action Fusion Scale (TAFS) is a self-reported instrument used to measure a cognitive bias, namely, thoughtaction fusion (TAF), in which intrusive thoughts have moral and actual consequences. The aim of this study is to investigate the reliability and validity of the Korean version of the 19-item TAFS (K-TAFS) in Korean samples. METHODS In this study, 628 university students and 93 patients with obsessive-compulsive disorder (OCD) completed the K-TAFS and several other psychological scales. Descriptive analyses, correlations, group comparisons, and exploratory and confirmatory factor analyses were performed. RESULTS The results of the exploratory and confirmatory factor analyses indicated a two-factor structure with TAF-Morality and TAFLikelihood that best fits the data in the university sample. The reliability analyses showed that TAFS and its factors had excellent internal consistencies. Regarding the concurrent validity, positive correlations were observed between TAF-Likelihood and cognitive fusion, while the TAFS scores did not show any consistent correlations with other symptoms such as depression and anxiety. Compared to the university students, the OCD patients showed higher TAFS scores and their obsessive-compulsive symptoms were significantly associated with both TAF-Morality and TAF-Likelihood. CONCLUSION Overall, the findings of this study support the reliability and validity of the K-TAFS.
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Affiliation(s)
- Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Soonhee Lee
- Counseling Center, University of Maryland, Baltimore County (UMBC), Baltimore, MD, USA
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21
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Donati MA, Berrocal C, Bernini O, Gori C, Primi C. Measuring cognitive fusion through the Cognitive Fusion Questionnaire-7: Measurement invariance across non-clinical and clinical psychological samples. PLoS One 2021; 16:e0246434. [PMID: 33534868 PMCID: PMC7857615 DOI: 10.1371/journal.pone.0246434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Cognitive fusion (CF) occurs when people are entangled in their private experiences. Rigid patterns of CF are a risk factor for various forms of psychopathology. The most widely used self-report instrument for assessing CF is the Cognitive Fusion Questionnaire-7 (CFQ-7), a unidimensional scale with good reliability and validity. However, its psychometric properties have been studied mainly in non-clinical samples and by applying Classical Test Theory. The goal of this study was to use Item Response Theory to investigate the adequacy of the scale in a non-clinical sample and to test measurement invariance across non-clinical and clinical psychological samples. The non-clinical sample consisted of 258 undergraduate students (68.2% females, Mage = 24.3), while the clinical sample consisted of 105 undergraduate students with psychological distress (60.7% females, Mage = 23.8). The results showed that CFQ-7 assesses a wide range of CF severity among non-clinical subjects and that it is useful to discriminate different levels of CF. Moreover, the results showed the scale was sufficiently informative for a broad range of the trait. The relationships of CFQ-7 scores with theoretically related constructs provided further support to the validity of the scale. The Differential Item Functioning analysis showed that CFQ-7 is invariant across different types of population. Overall, findings in this study provide support for the adequacy of the CFQ-7 both in non-clinical and clinical contexts.
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Affiliation(s)
- Maria Anna Donati
- Department of Neuroscience, Psychology, Drug, and Child’s Health, Section of Psychology, University of Florence, Florence, Italy
| | - Carmen Berrocal
- Department of Surgical, Medical and Molecular Pathology, and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Olivia Bernini
- University Counselling Centre, University of Pisa, Pisa, Italy
| | - Costanza Gori
- Department of Surgical, Medical and Molecular Pathology, and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Caterina Primi
- Department of Neuroscience, Psychology, Drug, and Child’s Health, Section of Psychology, University of Florence, Florence, Italy
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22
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Cognitive fusion potentiates the effect of maladaptive posttraumatic cognitions on posttraumatic stress symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Yu L, Inspector Y, McCracken LM. Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain. Br J Pain 2020; 15:175-186. [PMID: 34055339 DOI: 10.1177/2049463720926559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective Acceptance and commitment therapy (ACT), based in the psychological flexibility model, may benefit people with chronic abdominal pain. The current study preliminarily investigates associations between psychological flexibility processes and daily general, social and emotional functioning in chronic abdominal pain. Methods An online survey comprising measures of psychological flexibility processes and daily functioning was distributed through social media. Subjects In total, 89 participants with chronic abdominal pain were included in the analyses. Results All investigated psychological flexibility processes significantly correlated with pain interference, work and social adjustment, and depression, in the expected directions (|r| = .35-.68). Only pain acceptance significantly correlated with gastrointestinal (GI) symptoms, r = -.25. After adjusting for pain in the analyses, pain acceptance remained significantly associated with all outcomes, |β| = .28-.56, but depression. After adjusting for pain and pain acceptance, only cognitive fusion remained significantly associated with anxiety, β = -.27, and depression, β = .43. When contrasting GI-specific anxiety with psychological flexibility processes, pain acceptance was uniquely associated with pain-related interference and work and social adjustment, and cognitive fusion and committed action were uniquely associated with depression. Conclusions Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. ACT may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain.
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Affiliation(s)
- Lin Yu
- Pain Management Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Psychology, Middlesex University, London, UK
| | - Yoram Inspector
- Psychological Medicine Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Lance M McCracken
- Pain Management Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychology, Uppsala University, Uppsala, Sweden
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24
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Psychedelics and psychological flexibility – Results of a prospective web-survey using the Acceptance and Action Questionnaire II. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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25
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Singh RS, O'Brien WH. The impact of work stress on sexual minority employees: Could psychological flexibility be a helpful solution? Stress Health 2020; 36:59-74. [PMID: 31755638 DOI: 10.1002/smi.2913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 09/21/2019] [Accepted: 11/14/2019] [Indexed: 11/10/2022]
Abstract
In the workplace, people who identify as sexual minorities experience elevated levels of incivility, discrimination, and a general lack of protection from unfair workplace practices. These difficulties can then lead to adverse physical, psychological, and social outcomes. Internalized homonegativity may contribute to these negative outcomes as well. Psychological flexibility has been associated with improved psychological and physical health. The current study is a cross-sectional assessment of adults who identify as sexual minorities (n = 312) examining the relation among work stress, well-being, psychological flexibility, and internalized homonegativity. It was hypothesized that greater work stress would be related to lower well-being, lower psychological flexibility, and higher internalized homonegativity. Further, it was hypothesized that internalized homonegativity and psychological flexibility would mediate the relation between work stress and well-being. Results indicated that psychological flexibility was a significant mediator between work stress and well-being, but internalized homonegativity was not. This suggests that psychological flexibility could be a useful tool for sexual minorities to respond effectively in difficult workplace situations.
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Affiliation(s)
- Rajinder Sonia Singh
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio.,South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, Little Rock, Arkansas.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - William H O'Brien
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
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26
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The BrainACT study: acceptance and commitment therapy for depressive and anxiety symptoms following acquired brain injury: study protocol for a randomized controlled trial. Trials 2019; 20:773. [PMID: 31881916 PMCID: PMC6935100 DOI: 10.1186/s13063-019-3952-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/03/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Following an acquired brain injury, individuals frequently experience anxiety and/or depressive symptoms. However, current treatments for these symptoms are not very effective. A promising treatment is acceptance and commitment therapy (ACT), which is a third-wave behavioural therapy. The primary goal of this therapy is not to reduce symptoms, but to improve psychological flexibility and general well-being, which may be accompanied by a reduction in symptom severity. The aim of this study is to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people with acquired brain injury who experience anxiety and/or depressive symptoms. METHODS The study is a multicenter, randomized, controlled, two-arm parallel trial. In total, 94 patients who survive a stroke or traumatic brain injury will be randomized into an ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures are the Hospital Anxiety and Depression Scale and the Depression Anxiety Stress Scale. Outcomes will be assessed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months. DISCUSSION This study will contribute to the existing knowledge on how to treat psychological distress following acquired brain injury. If effective, BrainACT could be implemented in clinical practice and potentially help a large number of patients with acquired brain injury. TRIAL REGISTRATION Dutch Trial Register, NL691, NTR 7111. Registered on 26 March 2018. https://www.trialregister.nl/trial/6916.
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27
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Yu L, Scott W, McCracken LM. Change in fatigue in acceptance and commitment therapy‐based treatment for chronic pain and its association with enhanced psychological flexibility. Eur J Pain 2019; 24:234-247. [DOI: 10.1002/ejp.1480] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/05/2019] [Accepted: 08/30/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Lin Yu
- Pain Management Department Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Whitney Scott
- INPUT Pain Unit Guy’s and St Thomas’ NHS Foundation Trust London UK
- Health Psychology Section, Psychology Department, King’s College London Institute of Psychiatry London UK
| | - Lance M. McCracken
- INPUT Pain Unit Guy’s and St Thomas’ NHS Foundation Trust London UK
- Health Psychology Section, Psychology Department, King’s College London Institute of Psychiatry London UK
- Department of Psychology Uppsala University Uppsala Sweden
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28
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Sánchez-Rodríguez E, de la Vega R, Racine M, Roy R, Jensen MP, Miró J. Support for the Spanish version of the CPAQ-8 as a measure of chronic pain acceptance. J Eval Clin Pract 2019; 25:881-888. [PMID: 30592117 DOI: 10.1111/jep.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/30/2022]
Abstract
AIM AND OBJECTIVE To provide evidence regarding the psychometric properties of the Spanish eight-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8). METHOD Three hundred adults with chronic pain completed measures of pain acceptance, committed action, fear of movement, anxiety, depression, and health-related quality of life. A confirmatory factor analysis (CFA) of the CPAQ-8 was performed. Reliability and validity were also evaluated. RESULTS The CFA confirmed a two-factor structure. The CPAQ-8 Total and subscale scores showed acceptable-to-good internal consistency. Furthermore, the Total and the Activity Engagement scale scores showed moderate associations with Committed Action scores, supporting construct validity. Both the Total and the two subscale scores showed good criterion validity. CONCLUSION The findings provide further support for the reliability and validity of the Spanish version of the CPAQ-8 Total and subscale scores.
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Affiliation(s)
- Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Rocío de la Vega
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mélanie Racine
- Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Rubén Roy
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Tarragona, Spain.,Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
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Viskovich S, Pakenham KI. Randomized controlled trial of a web-based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students. J Clin Psychol 2019; 76:929-951. [PMID: 31468528 DOI: 10.1002/jclp.22848] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study evaluated a 4-week web-based Acceptance and Commitment Therapy (ACT) mental health promotion intervention for university students. METHOD Participants were randomized to intervention (n = 596) or waitlist control (n = 566). Assessment of primary outcomes (depression, anxiety, stress, well-being, self-compassion, life satisfaction, and academic performance) and ACT processes (acceptance, cognitive fusion, education values, valued living, and present moment awareness) occurred at pre- and post-intervention and 12-week follow-up for intervention participants, and the same pre-post interval for waitlist control participants. RESULTS Analyses showed significant improvements from pre- to post-intervention compared with waitlist control on all primary outcomes and ACT processes. All intervention gains were maintained at follow-up. Improvements on all primary outcomes were mediated by three or more ACT processes in both samples. Intervention effects were consistent across both sample groupings. CONCLUSION Findings provide support for a web-based ACT mental health promotion intervention for university students.
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Affiliation(s)
- Shelley Viskovich
- Doctor of Philosophy, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Kenneth Ian Pakenham
- Professor of Clinical and Health Psychology, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
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Carvalho SA, Trindade IA, Gillanders D, Pinto-Gouveia J, Castilho P. Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months. Clin Psychol Psychother 2019; 26:616-625. [PMID: 31240784 DOI: 10.1002/cpp.2386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/08/2022]
Abstract
This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.
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Affiliation(s)
- Sérgio A Carvalho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Inês A Trindade
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - José Pinto-Gouveia
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- Cognitive-Behavioural Research Centre (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Pahnke J, Hirvikoski T, Bjureberg J, Bölte S, Jokinen J, Bohman B, Lundgren T. Acceptance and commitment therapy for autistic adults: An open pilot study in a psychiatric outpatient context. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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32
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Might psychological flexibility processes and Acceptance and Commitment Therapy (ACT) apply in adults with painful diabetic neuropathy? A cross-sectional survey. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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33
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Lin J, Scott W, Carpenter L, Norton S, Domhardt M, Baumeister H, McCracken LM. Acceptance and commitment therapy for chronic pain: protocol of a systematic review and individual participant data meta-analysis. Syst Rev 2019; 8:140. [PMID: 31200768 PMCID: PMC6570828 DOI: 10.1186/s13643-019-1044-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) can be effective in treating chronic pain. Despite evidence supporting the effectiveness of ACT, uncertainties remain regarding which subgroups in the chronic pain population are likely to benefit most and least. This protocol describes the application for two meta-analytic approaches, one at the level of individual participant data and the other at the level of aggregated data, from randomized controlled trials of ACT for chronic pain (ACT-CP-MA). METHODS We will systematically conduct literature searches in CENTRAL, MEDLINE, EMBASE, PsycINFO, and trial registers. Two reviewers will independently select studies for inclusion and data extraction. ACT-CP-MA will include randomized controlled trials with ACT for chronic pain compared to control conditions for adults (≥ 18 years) with chronic pain (> 3 months). We will invite the authors of all eligible trials to share individual participant data. Outcomes will include standardized measures of pain interference, pain intensity, depression, anxiety, health-related quality of life, participants' rating of overall improvement, and ACT-related process variables. Using the Cochrane Collaboration's tool and GRADE, reviewers will independently check for risk of bias, quality of evidence, and strength of recommendations. In the individual participant data meta-analysis, we will use a one-step approach where participants are clustered with studies and data from all studies are modeled simultaneously. For analyses, we will use mixed-effects models. Additionally, we will employ a meta-analysis with aggregate data and compare the results of both meta-analyses. DISCUSSION This collaborative meta-analysis of individual participant data from randomized controlled trials of ACT for chronic pain versus control conditions will demonstrate how the known benefits of ACT for chronic pain vary across different subtypes of the chronic pain population. The results of the meta-analyses will be based on a comprehensive search of multiple databases and will help to inform future clinical trials and decision-making on the use of ACT in chronic pain and improve the quality, design, and reporting of future trials in this field. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019120901.
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Affiliation(s)
- Jiaxi Lin
- Sportpsychology, Institute for Sports and Sport Science, University of Freiburg, Freiburg, Germany
| | - Whitney Scott
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Lewis Carpenter
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sam Norton
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Ulm University, Ulm, Germany
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Edwards DJ. Age, Pain Intensity, Values-Discrepancy, and Mindfulness as Predictors for Mental Health and Cognitive Fusion: Hierarchical Regressions With Mediation Analysis. Front Psychol 2019; 10:517. [PMID: 30899236 PMCID: PMC6416201 DOI: 10.3389/fpsyg.2019.00517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Several studies have confirmed that higher levels of psychological flexibility predict better functioning for those suffering with chronic pain. However, few studies have investigated the role of the individual components of psychological flexibility within a chronic pain population in relation to aging specifically and the related indirect mediational processes. Aim: The present study aimed to compare how age, pain intensity, mindfulness, and values-discrepancy predicted mental health and cognitive fusion separately. It also explored the indirect process relations through the use of a mediated analysis. Methods: Two hundred and thirty three participants completed an online survey which included demographical questions as well as the following questionnaires; Short Form McGill Pain Questionnaire (SF-MPQ); General Health Questionnaire 12; Cognitive Fusion 7-Item Questionnaire (CFQ-7); Mindfulness Attention Awareness Scale (MAAS); and the Chronic Pain Values Inventory (CPVI). The relationships from the responses of the questionnaires and demographics were then analyzed through two hierarchical regression models followed by further mediation analysis. Results: In the first model, values-discrepancy, pain intensity, and mindfulness all predicted mental health, but age did not. However, age did account for a significant portion of the variance in the second model when cognitive fusion was used as the dependent measure. It was also found that cognitive fusion mediated the relationship between age and mental health. Conclusion: These results are discussed within the context of using indirect process relations of psychological flexibility and third wave therapies such as acceptance and commitment therapy for a chronic pain population.
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Affiliation(s)
- Darren J Edwards
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, United Kingdom
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Carvalho SA, Pinto-Gouveia J, Gillanders D, Castilho P. Pain and Depressive Symptoms: Exploring Cognitive Fusion and Self-Compassion in a Moderated Mediation Model. THE JOURNAL OF PSYCHOLOGY 2018; 153:173-186. [DOI: 10.1080/00223980.2018.1507990] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Feliu-Soler A, Montesinos F, Gutiérrez-Martínez O, Scott W, McCracken LM, Luciano JV. Current status of acceptance and commitment therapy for chronic pain: a narrative review. J Pain Res 2018; 11:2145-2159. [PMID: 30323649 PMCID: PMC6174685 DOI: 10.2147/jpr.s144631] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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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Affiliation(s)
- Albert Feliu-Soler
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
| | - Francisco Montesinos
- Department of Psychology, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Instituto ACT, Madrid, Spain
| | | | - Whitney Scott
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lance M McCracken
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- INPUT Pain Management, Guys and St Thomas NHSFT, London, UK
| | - Juan V Luciano
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain,
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Madrid, Spain,
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Gilpin HR, Stahl DR, McCracken LM. A theoretically guided approach to identifying predictors of treatment outcome in Contextual Cognitive Behavioural Therapy for chronic pain. Eur J Pain 2018; 23:354-366. [PMID: 30176099 DOI: 10.1002/ejp.1310] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 01/01/2023]
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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Affiliation(s)
- Helen R Gilpin
- INPUT Pain Management, Guys and St.Thomas NHS Foundation Trust Hospitals, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Daniel R Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lance M McCracken
- INPUT Pain Management, Guys and St.Thomas NHS Foundation Trust Hospitals, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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McCracken LM, Patel S, Scott W. The role of psychological flexibility in relation to suicidal thinking in chronic pain. Eur J Pain 2018; 22:1774-1781. [PMID: 29934957 DOI: 10.1002/ejp.1273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicidal thinking (ST) is common in people with chronic pain. It is relevant as it can be associated with suicidal attempts, and typically reflects significant suffering. While little is known about the psychological processes that contribute to ST, current psychological models, such as the Psychological Flexibility (PF) model, could help guide further investigation. This study investigates relations between ST and components of PF in chronic pain. METHODS Participants were 424 adults attending treatment for chronic pain in the UK. Included in measures administered before treatment were standardized measures of depression, pain, pain-related interference, and measures of PF, including acceptance, cognitive defusion, committed action, and self-as-context. An item from the measure of depression was used to reflect ST. RESULTS A large proportion of the sample reported ST, 45.7%. ST was uncorrelated with participant background characteristic, medications taken, or pain intensity. However, it was correlated with the presence of widespread pain, pain-related interference, and depression. Each component of PF was found to be significantly negatively associated with ST, as predicted. General acceptance correlated with ST at a level equal to that achieved by the depression score. In adjusted multivariate logistic regression general acceptance and committed action remained significantly uniquely associated with it. CONCLUSION This preliminary study suggests for the first time that components of PF are associated with part of a pattern of suicidal behaviour in people with chronic pain. They may be relevant for reducing avoidance in general and providing more positive behavioural options. SIGNIFICANCE This study provides evidence that components of psychological flexibility are associated with a reduced frequency of suicidal thinking in people with chronic pain. Treatments targeting psychological flexibility may help mitigate the impact of chronic pain on suicidal thinking.
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Affiliation(s)
- L M McCracken
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,INPUT Pain Management, Guy's and St Thomas' NHSFT, London, UK
| | - S Patel
- INPUT Pain Management, Guy's and St Thomas' NHSFT, London, UK
| | - W Scott
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,INPUT Pain Management, Guy's and St Thomas' NHSFT, London, UK
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China C, Hansen LB, Gillanders DT, Benninghoven D. Concept and validation of the German version of the Cognitive Fusion Questionnaire (CFQ-D). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Viskovich S, Pakenham KI. Pilot evaluation of a web-based acceptance and commitment therapy program to promote mental health skills in university students. J Clin Psychol 2018; 74:2047-2069. [PMID: 29962090 DOI: 10.1002/jclp.22656] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study evaluated a 4-week web-based acceptance and commitment therapy (ACT) mental health promotion program called YOLO (You Only Live Once) for university students. METHOD A total of 130 participants were randomized to one of three intervention groups investigating varied program delivery methods. Primary outcomes assessed: depression, anxiety, stress, well-being, self-compassion, alcohol use, and life satisfaction. ACT processes assessed: acceptance, cognitive fusion, education values, valued living, and mindfulness. RESULTS Improvement on the primary outcomes and ACT processes did not differ among the three intervention groups. Analyses showed significant improvements on all primary outcomes (except alcohol use), and on all ACT processes. All ACT processes mediated changes on one or more primary outcomes in the intent-to-treat sample. Intervention effects were consistent on most primary outcomes and ACT processes across three sample groupings. CONCLUSIONS These preliminary findings provide support for a web-based ACT mental health promotion program for university students.
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Affiliation(s)
- Shelley Viskovich
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Kenneth I Pakenham
- School of Psychology, University of Queensland, St Lucia, Brisbane, Queensland, Australia
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Scott W, Daly A, Yu L, McCracken LM. Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT). PAIN MEDICINE 2018; 18:252-264. [PMID: 28204691 DOI: 10.1093/pm/pnw073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective The purpose of this study was to examine the effectiveness of acceptance and commitment therapy (ACT) for older adults with chronic pain. Secondarily, we examined the associations between changes on processes of psychological flexibility and treatment outcome variables. Subjects Participants were 60 adults with chronic pain age 65 and older selected from a larger consecutive sample of 928 adults of any age. All participants had longstanding pain that was associated with significant distress and disability. Methods Participants completed measures of pain, functioning, and depression, and processes of psychological flexibility at baseline, immediately post-treatment, and at a 9-month follow-up. Treatment consisted of a 2- or 4-week residential program based on principles of ACT delivered by an interdisciplinary team. Treatment was designed to increase daily functioning by enhancing key processes of psychological flexibility, including openness, awareness, and committed action. Results Participants showed significant improvements in functioning and mental health at posttreatment. Participants also showed significant increases in pain acceptance and committed action from pre- to post-treatment. Small effect sizes were observed for most treatment outcome and process variables in the pre-treatment to follow-up intervals; however, these improvements were not statistically significant. In secondary analyses, changes in facets of psychological flexibility were significantly associated with improvements in social functioning and mental health. Conclusion This study supports the potential effectiveness of ACT for chronic pain among older adults. Future research is needed to determine how to maximize the impact of this treatment, particularly through greater impact on psychological flexibility.
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Affiliation(s)
- Whitney Scott
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Aisling Daly
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Lin Yu
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Lance M McCracken
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia. THE JOURNAL OF PAIN 2018; 19:741-753. [PMID: 29481976 DOI: 10.1016/j.jpain.2018.02.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/03/2017] [Accepted: 02/13/2018] [Indexed: 01/14/2023]
Abstract
In this study, 67 participants (95% female) with fibromyalgia (FM) were randomly assigned to an online acceptance and commitment therapy (online ACT) and treatment as usual (TAU; ACT + TAU) protocol or a TAU control condition. Online ACT + TAU participants were asked to complete 7 modules over an 8-week period. Assessments were completed at pre-treatment, post-treatment, and 3-month follow-up periods and included measures of FM impact (primary outcome), depression, pain, sleep, 6-minute walk, sit to stand, pain acceptance (primary process variable), mindfulness, cognitive fusion, valued living, kinesiophobia, and pain catastrophizing. The results indicated that online ACT + TAU participants significantly improved in FM impact, relative to TAU (P <.001), with large between condition effect sizes at post-treatment (1.26) and follow-up (1.59). Increases in pain acceptance significantly mediated these improvements (P = .005). Significant improvements in favor of online ACT + TAU were also found on measures of depression (P = .02), pain (P = .01), and kinesiophobia (P = .001). Although preliminary, this study highlights the potential for online ACT to be an efficacious, accessible, and cost-effective treatment for people with FM and other chronic pain conditions. PERSPECTIVE Online ACT reduced FM impact relative to a TAU control condition in this randomized controlled trial. Reductions in FM impact were mediated by improvements in pain acceptance. Online ACT appears to be a promising intervention for FM.
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Guildford BJ, Daly-Eichenhardt A, Hill B, Sanderson K, McCracken LM. Analgesic reduction during an interdisciplinary pain management programme: treatment effects and processes of change. Br J Pain 2017; 12:72-86. [PMID: 29796259 DOI: 10.1177/2049463717734016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Long-term use of opioid medication is associated with a host of negative effects on health and quality of life. Guidelines state that people with chronic pain taking high doses of opioids without benefit should be supported to discontinue them. Little research has investigated psychological processes associated with analgesic use and tapering. This study investigated (1) analgesic use pre- and post-participation in an interdisciplinary pain management programme and its relationship to functioning and (2) psychological processes associated with analgesic use. Opioid use was associated with poorer functioning at baseline. Participating in an interdisciplinary pain management programme was associated with reductions in opioid dose and number of classes of analgesics used. Reductions in analgesic use were associated with improvements in functioning. Psychological inflexibility was associated with using higher doses of opioid medication and with using a greater number of classes of analgesics. Psychological flexibility appears relevant in explaining analgesic use. Future research could focus on targeting this process to improve tapering outcomes.
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Affiliation(s)
- Beth J Guildford
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,NIHR Maudsley Biomedical Research Centre, King's Health Partners, London, UK
| | - Aisling Daly-Eichenhardt
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bethany Hill
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Sanderson
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lance M McCracken
- INPUT Pain Management Unit, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Derived insensitivity: Rule-based insensitivity to contingencies propagates through equivalence. LEARNING AND MOTIVATION 2017. [DOI: 10.1016/j.lmot.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Yu L, Norton S, McCracken LM. Change in “Self-as-Context” (“Perspective-Taking”) Occurs in Acceptance and Commitment Therapy for People With Chronic Pain and Is Associated With Improved Functioning. THE JOURNAL OF PAIN 2017; 18:664-672. [DOI: 10.1016/j.jpain.2017.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 12/01/2022]
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An Acceptance and Commitment Therapy (ACT) intervention for Chronic Fatigue Syndrome (CFS): A case series approach. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
OBJECTIVES Acceptance and Commitment Therapy (ACT) has been shown to be an effective treatment for chronic pain in young people. Cognitive fusion is a key concept of ACT that is hypothesized to contribute to distress and suffering. In this study, we sought to: (1) test hypothesized associations between cognitive fusion and pain intensity, disability, and catastrophizing; and (2) examine the function of cognitive fusion as a possible mediator between catastrophizing and disability. METHODS A community sample of 281 young people (11 to 20 y) completed measures assessing cognitive fusion, pain intensity, disability, and pain catastrophizing. RESULTS Cognitive fusion was positively related to pain intensity (r=0.24, P<0.01), disability (r=0.32, P<0.001), and pain catastrophizing (r=0.47, P<0.001). Moreover, cognitive fusion was found to mediate the association between pain catastrophizing and disability (β=0.01, 95% confidence interval=0.002-0.024, 5000 bootstrap resamples). DISCUSSION The findings indicate that cognitive fusion is moderately to strongly associated with pain-related outcomes, which support the need for further research to (1) better understand the relationship between cognitive fusion and adjustment to chronic pain, and (2) determine whether the benefits of treatments such as ACT are mediated, at least in part, by reductions in cognitive fusion.
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Özkan S, Zale EL, Ring D, Vranceanu AM. Associations Between Pain Catastrophizing and Cognitive Fusion in Relation to Pain and Upper Extremity Function Among Hand and Upper Extremity Surgery Patients. Ann Behav Med 2017; 51:547-554. [DOI: 10.1007/s12160-017-9877-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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49
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Scott W, McCracken LM, Norton S. A Confirmatory Factor Analysis of Facets of Psychological Flexibility in a Sample of People Seeking Treatment for Chronic Pain. Ann Behav Med 2016; 50:285-96. [PMID: 26608280 PMCID: PMC4823341 DOI: 10.1007/s12160-015-9752-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Evidence supports the validity of individual components of the psychological flexibility model in the context of chronic pain. However, there is a need to test the inter-relationships amongst measures of individual components of psychological flexibility in a more integrative manner. In particular, research is needed to examine whether a model with discrete facets as proposed is indeed reflected in data from currently used assessment measures in people with chronic pain. Purpose This cross-sectional study investigated the underlying structure of measures of processes of psychological flexibility amongst individuals with chronic pain and the associations between this measurement model and patient functioning. Methods Five-hundred and seventy-three adults with chronic pain completed measures of pain, physical and social functioning, mental health, depression and processes of psychological flexibility, including acceptance, cognitive defusion, decentering and committed action. Confirmatory factor analyses tested lower-order, higher-order and bifactor models to examine the structure of psychological flexibility process measures. Results A single general factor reflecting openness explained variability in items across all of the psychological flexibility process measures. In addition to this general factor, distinct decentering and committed action group factors emerged in the data. As expected, the general factor was strongly correlated with measures of social functioning, mental health and depression. Conclusions Future research is needed to determine the most useful means by which the presence of the general factor can be reflected in the measurement and theory of psychological flexibility.
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Affiliation(s)
- Whitney Scott
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Lance M McCracken
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Guy's Campus, London, SE1 9RT, UK. .,INPUT Pain Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Guy's Campus, London, SE1 9RT, UK
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Model and Processes of Acceptance and Commitment Therapy (ACT) for Chronic Pain Including a Closer Look at the Self. Curr Pain Headache Rep 2016; 20:12. [PMID: 26803836 DOI: 10.1007/s11916-016-0541-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of chronic pain with a specific emphasis on the parts of the model that address self-related processes.
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