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Neuropsychological Functioning and Treatment Outcomes in Acceptance and Commitment Therapy for Chronic Pain

  • Matthew Scott Herbert
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    VA San Diego Healthcare System, University of California, San Diego, California

    Department of Psychiatry, University of California, San Diego, California
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  • Niloofar Afari
    Correspondence
    Address reprint requests to Niloofar Afari, PhD, Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0737, La Jolla, CA 92093.
    Affiliations
    Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California

    VA San Diego Healthcare System, University of California, San Diego, California

    Department of Psychiatry, University of California, San Diego, California
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  • J.B. Robinson
    Affiliations
    VA San Diego Healthcare System, University of California, San Diego, California
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  • Andrew Listvinsky
    Affiliations
    VA San Diego Healthcare System, University of California, San Diego, California
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  • Mark W. Bondi
    Affiliations
    VA San Diego Healthcare System, University of California, San Diego, California

    Department of Psychiatry, University of California, San Diego, California
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  • Julie Loebach Wetherell
    Affiliations
    VA San Diego Healthcare System, University of California, San Diego, California

    Department of Psychiatry, University of California, San Diego, California
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Published:February 26, 2018DOI:https://doi.org/10.1016/j.jpain.2018.02.008

      Highlights

      • Poorer neuropsychological performance related to worse baseline functioning.
      • Relatively low neuropsychological performance not contraindicated for acceptance and commitment therapy.
      • Executive function and processing speed were important moderators of outcomes.

      Abstract

      Neuropsychological (NP) performance has been associated with psychosocial treatment outcomes in nonpain conditions, but has never been investigated in chronic pain. We performed a secondary analysis on the association of baseline NP performance with treatment outcomes among veterans with chronic pain (N = 117) undergoing an 8-week acceptance and commitment therapy (ACT) intervention. Participants completed measures of pain interference, pain severity, quality of life, activity levels, depression, and pain-related anxiety at baseline, midtreatment, and post-treatment. Executive functioning, working memory, processing speed, learning, and verbal memory were assessed at baseline. All study measures significantly improved from baseline to post-treatment. NP performance was related to changes in depression and pain-related anxiety during treatment. Specifically, relatively lower executive functioning and processing speed was associated with greater decreases in depressive symptoms, and relatively lower processing speed was associated with greater decreases in pain-related anxiety. Consistent with research in nonpain conditions, those with relatively lower NP functioning received greater benefit from psychosocial treatment, although most study outcomes did not differ as a function of NP performance. Our results suggest relatively lower NP functioning is not contraindicated for participation in psychosocial interventions like ACT but instead may be associated with greater relief.

      Perspective

      This study suggests that NP functioning is unrelated to changes in pain interference associated with ACT, and that those with relatively lower NP functioning may experience greater reductions in depressive symptoms and pain-related anxiety. This article contains important information for researchers and clinicians interested in cognition and chronic pain.

      Key words

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