Highlights
- •Mediators of outcome in a cognitive-behavioral treatment (CBT)–based multidisciplinary pain program were investigated.
- •Contrary to the other mediators, pain-related acceptance was not targeted during treatment.
- •Still, pain-related acceptance had the strongest mediating effect.
- •It may be a key therapeutic process in CBT-based treatments for chronic pain.
- •Improved targeting of acceptance may increase the effectiveness of such treatments.
Abstract
Cognitive-behavioral therapy (CBT) is the most frequently delivered psychological
intervention for adults with chronic pain. The treatment yields modest effect sizes,
and the mechanisms of action remain understudied and unclear. Efforts are needed to
identify treatment mediators that could be used to refine CBT and improve outcomes.
The primary aim of this study was to investigate whether pain-related acceptance,
from the psychological flexibility model, mediates changes in outcome over time in
a CBT-based treatment program. This includes comparing how this variable relates to
3 other variables posited as potential mediators in standard CBT: life control, affective
distress, and social support. Participants attended a 5-week outpatient multidisciplinary
program with self-report data collected at assessment, posttreatment, and 12-month
follow-up. Multilevel structural equation modeling was used to test for mediation
in relation to 3 outcomes: pain interference, pain intensity, and depression. Results
indicate that effect sizes for the treatment were within the ranges reported in the
CBT for pain literature. Pain-related acceptance was not related to pain intensity,
which is in line with past empirical evidence and the treatment objectives in acceptance
and commitment therapy. Otherwise, pain-related acceptance was the strongest mediator
across the different indices of outcome. Accumulated results like these suggest that
acceptance of pain may be a general mechanism by which CBT-based treatments achieve
improvements in functioning. More specific targeting of pain-related acceptance in
treatment may lead to further improvements in outcome.
Perspective
Potential mediators of outcome in a CBT-based treatment for adult chronic pain were
investigated using multilevel structural equation modeling. The results highlight
the role of pain-related acceptance as an important treatment process even when not
explicitly targeted during treatment. These data may help clinicians and researchers
better understand processes of change and improve the choice and development of treatment
methods.
Key words
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Article info
Publication history
Published online: March 31, 2015
Accepted:
March 22,
2015
Received in revised form:
March 6,
2015
Received:
December 10,
2014
Footnotes
The authors have no funding source or conflict of interest to declare. The clinic, where the study was conducted, is government supported. No funding sources were provided.
Identification
Copyright
© 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.
