Thursday, August 19, 2010

The Effectiveness of an Acceptance and Commitment Therapy Self-Help Intervention for Chronic Pain

Originally considered a medical problem, newer biopsychosocial models of pain address physical, psychological, and environmental factors that influence how people experience pain. Interestingly, the first mindfulness meditation program Kabat-Zinn’s Mindfulness-Based Stress Reduction was developed for people with chronic pain for whom other medical treatments had failed. There is growing research on the use of mindful acceptance in allowing people to live more effectively with their pain. Recently, a group of researchers in New Zealand led by Marnie Johnston evaluated an Acceptance and Commitment Therapy (ACT) self-help book for chronic pain called Living Beyond Your Pain. ACT emphasizes active acceptance of one’s experiences and movement towards meaningful life directions.

Researchers randomly assigned participants to either receive a copy of the book that they reviewed over a 6-week period, or to remain on a waitlist for 6 weeks before receiving the book. For participants who received the book, the researchers also conducted weekly phone check-ins, asking whether they had done any of the reading and exercises, how easy the reading was, and how useful they found the book. The researchers then answered any questions participants had about the book. Participants in the waitlist condition simply received weekly phone calls evaluating their pain. Everyone completed a battery of tests at the beginning and end of the study.

Results indicate that people who used the book reported reduced pain. Additionally, they reported improvements in acceptance, quality of life, satisfaction with their lives, and living according to their values. The results suggest people with chronic pain may successfully use Living Beyond Your Pain as a self-help book—with minimal support. This latter point is worth emphasizing. As participants received weekly phone calls—which they commented were helpful in increasing motivation and allowing them to ask questions—it remains unclear whether people using the book alone would be as successful. (By contrast, John Forsyth has conducted a more naturalistic study of his self-help book, the Mindfulness and Acceptance Workbook for Anxiety).

Overall, these results are very promising. At the very least this study suggests Living Beyond Your Pain may be a useful adjunct to psychotherapy, something clients can work on between sessions with a little therapist guidance. It also adds to the growing body of literature on the use of mindfulness and acceptance-based treatments for pain.

For members of Association for Contextual Behavioral Science, you can download a copy of the article here. You can find a copy of the book here.

For the full article:

Johnston, M., Foster, M., Shennan, J., Starkey, N. J., &; Johnson, A. (2010). The effectiveness of an Acceptance and Commitment Therapy self-help intervention for chronic pain. Clinical Journal of Pain, 26(5), 393-402.

The full title for the self-help book is:
Dahl, J., & Lundgren, T. (2008). Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland, CA: New Harbinger.

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