A comprehensive examination of the theoretical framework underlying acceptance and commitment therapy for chronic pain

Acceptance and Commitment Therapy (ACT), as both a theoretical and applied model, is established as it applies to chronic pain. Several studies have examined measures of single ACT processes, such as acceptance of chronic pain, present-focused awareness, and values, or discrete subsets of these processes, and have almost uniformly provided supportive evidence. To date, however, no study has performed a comprehensive examination of the entire model, including all six of the specified component processes. The present study performed this examination and also evaluated relations of the model to key indices of patient functioning. In total, 205 individuals with chronic pain completed a battery of self-report questionnaires at an assessment appointment, including measures of physical and emotional functioning and multiple aspects of the ACT model. Initial factor analyses examined measures of the ACT model and measures of patient functioning separately in half of the sample. Each analysis identified three factors, which were supported in confirmatory factor analyses using the other half of the sample. Finally, Structural Equation Modeling was used to examine the fit of the entire model to the data. Overall fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional functioning, and disability. These analyses build on the existing literature by providing the first comprehensive evaluation of the ACT theoretical model in chronic pain.