By John M. de Castro, Ph.D.
“meditation practice is the best ongoing foundation for working with pain: Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” – Christiane Wolf
We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for a wide swath of humanity pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.
Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable to project that mindfulness practices would be helpful in pain management. Indeed, these practices have been shown to be safe and beneficial in pain management.
Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.
In today’s Research News article “Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain?” See:
or below or view the full text of the study at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/
Cederberg and colleagues investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in the treatment of chronic pain and to identify potential intermediaries; factors that are altered by ACT that are responsible for improved pain tolerance. They randomly assigned chronic pain patients to either receive ACT or relaxation therapy targeted to pain. The patients were measured before after treatment and again 6 and 12 months later for acceptance of chronic pain, pain intensity, satisfaction with life, physical functioning, anxiety, and depression.
They found that the patients receiving ACT had significant improvements in of acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning, while the relaxation group did not. Both groups showed reductions in anxiety, and depression. These effects were for the most part still present 12 months after the completion of treatment. They performed a sophisticated statistical analysis to identify whether the effects of ACT on acceptance, anxiety, or depression were responsible for the effects on physical functioning and satisfaction with life. They found that acceptance of pain was responsible for ACT’s effects on physical functioning, but not satisfaction with life.
These results are exciting and important demonstrating a mindfulness based treatment, Acceptance and Commitment Therapy (ACT), is effective in improving the ability of chronic pain patients to function and their satisfaction with life, and reducing their pain, anxiety, and depression. They further demonstrate that acceptance of pain is the important variable underlying the improvement in physical functioning. This underlines the importance of acceptance which is a predominant component of ACT. These results strongly suggest that ACT is an excellent, long-lasting, and safe treatment for people suffering with chronic pain.
So, ACT for chronic pain
“This perspective provides a new way to relate to distressing thoughts and emotions so they can be accepted as natural rather than avoided. In a similar way, patients are encouraged to re-engage in previously avoided valued activities10. Importantly, a therapeutic focus on strategies that reduce avoidance through increased acceptance have proved useful for people with chronic pain.” – Michael Hogan
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Cederberg, J. T., Cernvall, M., Dahl, J., von Essen, L., & Ljungman, G. (2016). Acceptance as a Mediator for Change in Acceptance and Commitment Therapy for Persons with Chronic Pain? International Journal of Behavioral Medicine, 23, 21–29. http://doi.org/10.1007/s12529-015-9494-y
Abstract
Background: Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design.
Purpose: The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain.
Method: A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, pre-assessment to 6-month follow-up (n = 53) and pre-assessment to 12-month follow-up (n = 32), were used.
Results: Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life.
Conclusion: This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748004/
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