A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain
- PMID: 31683020
- PMCID: PMC7477894
- DOI: 10.1016/j.jpain.2019.10.004
A Comparative Meta-Analysis of Unidisciplinary Psychology and Interdisciplinary Treatment Outcomes Following Acceptance and Commitment Therapy for Adults with Chronic Pain
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.
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
The authors have no conflicts of interest to declare.
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References
-
- Alonso-Fernández M, López-López A, Losada A, González JL, Wetherell JL: Acceptance and commitment therapy and selective optimization with compensation for institutionalized older people with chronic pain. Pain Med 17:264–277, 2016 - PubMed
-
- Alonso MA, Lopez A, Losada A, Gonzalez JL: Acceptance and commitment therapy and selective optimization with compensation for older people with chronic pain: A pilot study. Behav Psychol 21:59–79, 2013
-
- Baranoff JA, Hanrahan SJ, Burke ALJ, Connor JP: Changes in acceptance in a low-Intensity, group-based Acceptance and Commitment Therapy (ACT) chronic pain intervention. Int J Behav Med 23:30–38, 2016 - PubMed
-
- British Pain Society: Guidelines for Pain Management Programmes for adults: An evidence-based review prepared on behalf of the British Pain Society. London; 2013. Available at : britishpainsociety.org/static/uploads/resources/files/pmp2013_main_FINAL.... Accessed September 15, 2019.
-
- Carbonell-Baeza A, Aparicio VA, Chillon P, Femia P, Delgado-Fernandez M, Ruiz JR: Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia. Clin Exp Rheumatol 29:S97–103, 2011 - PubMed
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