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Review
. 2020 May-Jun;21(5-6):529-545.
doi: 10.1016/j.jpain.2019.10.004. Epub 2019 Nov 2.

A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain

Affiliations
Review

A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain

Kevin E Vowles et al. J Pain. 2020 May-Jun.

Abstract

While much of the literature provides positive support for psychological interventions for chronic pain, 2 recent meta-analyses indicate small to moderate benefits only. This inconsistency in findings suggests that there are other treatment-related variables to consider. One possible consideration pertains to treatment format, as psychological models form the basis for both unidisciplinary psychology and integrated interdisciplinary treatments for chronic pain. Therefore, a comparative meta-analysis of unidisciplinary and interdisciplinary treatments was performed to determine whether there were differences in treatment effect size (ES) at post-treatment and follow-ups of up to 1 year. One specific treatment model, Acceptance and Commitment Therapy (ACT), was investigated as it was felt that this literature was extensive enough to perform the planned analysis, while also being circumscribed enough in size to make it feasible. In total, 29 articles met inclusion criteria, 13 reported outcomes for unidisciplinary ACT, and 15 for interdisciplinary ACT. At both post-treatment and follow-up, interdisciplinary ACT had a greater ES for physical disability, psychosocial impact, and depression compared to unidisciplinary ACT. No differences in ES were observed for pain intensity, pain-related anxiety, or pain acceptance. Findings remained the same when study heterogeneity was considered. There was a significant difference observed between treatment format and treatment duration-on average, unidisciplinary interventions were of shorter duration than interdisciplinary interventions. Moderation analyses examining the relation between total treatment duration and ES generally indicated a moderate positive relation between treatment length and ES. This relation was strong for psychosocial impact. PERSPECTIVE: A comparative meta-analysis examined the relative ES of unidisciplinary (ie, clinical psychology only) and interdisciplinary ACT for chronic pain in 29 studies. The ES for interdisciplinary ACT was larger than unidisciplinary ACT for physical disability, psychosocial impact, and depression. No differences were present for pain intensity, anxiety, and acceptance.

Keywords: Acceptance and Commitment Therapy; Chronic pain; comparative meta-analysis; outcomes; psychology.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
PRISMA flow chart.
Figure 2.
Figure 2.
(A) Physical disability—Pre- to post-treatment forest plot. (B) Physical disability—Pretreatment to follow-up forest plot.
Figure 3.
Figure 3.
(A) Psychosocial impact—Pre- to post-treatment forest plot. (B) Psychosocial impact—Pretreatment to follow-up forest plot.
Figure 4.
Figure 4.
(A) Depression—Pre- to post-treatment forest plot. (B) Depression—Pretreatment to follow-up forest plot.
Figure 5.
Figure 5.
(A) Pain-related anxiety—Pre- to post-treatment forest plot. (B) Pain-related anxiety—Pretreatment to follow-up forest plot.
Figure 6.
Figure 6.
(A) Pain intensity—Pre- to post-treatment forest plot. (B) Pain intensity—Pretreatment to follow-up forest plot.
Figure 7.
Figure 7.
(A) Pain acceptance—Pre- to post-treatment forest plot. (B) Pain acceptance—Pretreatment to follow-up forest plot.

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References

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