A randomized controlled trial of internet-based therapy in depression

Depression is among the most prevalent disorders worldwide. In view of numerous treatment barriers, internet-based interventions are increasingly adopted to “treat the untreated”. The present trial (registered as NCT01401296) was conducted over the internet and aimed to assess the efficacy of an online self-help program for depression (Deprexis). In random order, participants with elevated depression symptoms received program access or were allocated to a wait-list control condition. After eight weeks, participants were invited to take part in an online re-assessment. To compensate for common problems of online studies, such as low completion rates and unclear diagnostic status, reminders and incentives were used, and clinical diagnoses were externally confirmed in a subgroup of 29% of participants. Relative to the wait-list group, program users experienced significant symptom decline on the Beck Depression Inventory (BDI; primary outcome), the Dysfunctional Attitudes Scale (DAS), the Quality of Life scale (WHOQOL-BREF) and the Rosenberg Self-Esteem Scale (RSE). Compared to wait-list participants, symptom decline was especially pronounced among those with moderate symptoms at baseline as well as those not currently consulting a therapist. Completion (82%) and re-test reliability of the instruments (r = .72–.87) were good. The results of this trial suggest that online treatment can be beneficial for people with depression, particularly for those with moderate symptoms.     

A Pilot Randomized Clinical Trial of a Novel,Culturally Adapted,Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women

Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, M_age (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.     

One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia

Forty-six patients fulfilling the DSM-IV criteria for claustrophobia were assessed with behavioral, physiological, and self-report measures. They were randomly assigned to four conditions: (1) one-session (E1); or (2) five-sessions of exposure (E5); (3) five-sessions of cognitive therapy (C5); and (4) Wait-list for 5 weeks. The first condition consisted of a single 3 h session of massed exposure, and condition 2 and 3 of 5 h of gradual treatment, which was done individually by very experienced therapists. The results showed that treatment was significantly better than the wait-list condition, and the three treatments did equally well with no differences between them. At post-treatment 79% of treatment patients vs 18% of the wait-list controls had improved to a clinically significant extent. When the three treatments were compared 80% in the E1-group, 81% in the E5-group, and 79% in the C5-group were clinically improved. At the 1 year follow-up the corresponding figures were 100%, 81%, and 93%, respectively. The implications of these results are discussed.     

Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

A Pilot Randomized Controlled Trial of the Insomnia Coach Mobile App to Assess Its Feasibility,Acceptability, and Potential Efficacy

Insomnia is highly prevalent among military veterans but access to cognitive-behavioral therapy for insomnia (CBT-I) is limited. Thus, this study examined the feasibility, acceptability, and potential efficacy of Insomnia Coach, a CBT-I-based, free, self-management mobile app. Fifty U.S. veterans, who were mostly male (58%) and mean age 44.5 (range = 28–55) years with moderate insomnia symptoms were randomized to Insomnia Coach (n = 25) or a wait-list control condition (n = 25) for 6 weeks. Participants completed self-report measures and sleep diaries at baseline, posttreatment, and follow-up (12 weeks postrandomization), and app participants (n = 15) completed a qualitative interview at posttreatment. Findings suggest that Insomnia Coach is feasible to use, with three quarters of participants using the app through 6 weeks and engaging with active elements. For acceptability, perceptions of Insomnia Coach were very favorable based on both self-report and qualitative interview responses. Finally, for potential efficacy, at posttreatment, a larger proportion of Insomnia Coach (28%) than wait-list control participants (4%) achieved clinically significant improvement (p = .049) and there was a significant treatment effect on daytime sleep-related impairment (d = −0.6, p = .044). Additional treatment effects emerged at follow-up for insomnia severity (d = −1.1, p = .001), sleep onset latency (d = −0.6, p = .021), global sleep quality (d = −0.9, p = .002), and depression symptoms (d = −0.8, p = .012). These findings provide preliminary evidence that among veterans with moderate insomnia symptoms, a CBT-I-based self-management app is feasible, acceptable, and promising for improving insomnia severity and other sleep-related outcomes. Given the vast unmet need for insomnia treatment in the population, Insomnia Coach may provide an easily accessible, convenient public health intervention for individuals not receiving care.     

Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder

Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD.     

The impact of borderline personality disorder on process group outcome among women with posttraumatic stress disorder related to childhood abuse.

The outcome of a 12-week interpersonal process group therapy for women with postraumatic Stress Disorder (PTSD) related to childhood sexual abuse with and without borderline personality disorder (BPD) was assessed by comparing three naturally occurring treatment conditions: groups that did not have any members with borderline personality disorder (BPD-) (n = 18), groups in which at least one member carried the diagnosis (BPD+)(n = 16), and a 12-week waitlist (WL) (n = 15). PTSD, anger, depression, and other symptoms were significantly reduced in the BPD- groups. However, the BPD+ and WL conditions did not show any pre- to posttreatment improvements. Furthermore, the BPD+ condition showed a significant worsening on measures of anger. Analyses within the BPD+ condition indicated that women with and without the diagnosis experienced equal posttreatment increases in anger problems. These latter results suggest the presence of an anger "contagion" effect. That is, women without BPD did well in the BPD- groups but showed increased anger similar to the BPD+ women when treated in groups with them. Implications for client-treatment matching considerations in PTSD group therapy are discussed.     

Impact of Psychoeducational Interventions on Distressed Family Caregivers

This study compared the effectiveness of two active interventions to a waiting-list control condition to reduce depression and burden and increase use of adaptive coping strategies in family caregivers (N = 161) of physically and/or cognitively impaired older adults. Chi-square analysis of change in depression status from pre- to postintervention showed a higher percentage of improvement among participants in the increasing life satisfaction psychoeducational condition compared to the improvement rate in either the problem-solving psychoeducational class or the wait-list condition. Change in coping strategies and subjective level of burden also differed by group, with participants in the class conditions reporting more frequent use of cognitive or behavioral coping strategies, and less subjective burden, from pre- to postintervention. There was no change in either avoidant coping or perceived stress over time. Results show that intervention programs targeted to improve specific coping skills and psychological symptoms can have a significant impact on caregivers' distress.     

An in-Vivo Daily Self-Report Approach to the Assessment of Outcomes of Two Psychotherapies for Women With Posttraumatic Stress Disorder

Emotion regulation and interpersonal psychotherapies that do not require trauma memory processing have been shown to be effective in treating posttraumatic stress disorder (PTSD). This study used a novel method to assess in vivo outcomes in a randomized clinical trial with women (N = 147; ages 18–54; 61% of color; 94% low income) with full (79%) or partial (21%) PTSD. Participants were assigned to affect regulation or interpersonal therapy, or wait-list, and completed daily self-reports for 2 to 4 weeks at baseline and up to 30 days at posttest. Mixed model regression analyses tested pre-post change on five factor analytically derived aggregated daily self-report scores. Emotion regulation-focused therapy was associated with reduced PTSD symptoms, dysregulation, and negative affect, and improvement in adaptive self-regulation and positive affect. Interpersonal-focused therapy was associated with reduced PTSD symptoms and dysregulation. Although both therapies were associated with reduced PTSD symptoms, whether this was due to nonspecific factors rather than the treatments per se could not be determined. Daily self-report data warrant further investigation in psychotherapy research with disorders such as PTSD, in order to assess affective and interpersonal dysregulation and adaptive regulation as they occur in daily life.     

Generation of stress in the course of unipolar depression.

The effect of stressful events on depression has been amply demonstrated, but the opposite relation is also important. I examined event occurrence over 1 year in 14 women with unipolar depression who were compared with demographically matched groups of women with bipolar disorder (n = 11), chronic medical illness (n = 13), or no illness or disorder (n = 22). Interview assessments of life events, severity, and independence of occurrence confirmed the hypothesis that unipolar women were exposed to more stress than the normal women, had significantly more interpersonal event stress than all others, and tended to have more dependent events than the others. The implication is that unipolar women by their symptoms, behaviors, characteristics, and social context generate stressful conditions, primarily interpersonal, that have the potential for contributing to the cycle of symptoms and stress that create chronic or intermittent depression.     

Meta-Analysis of the Effects of Peer-Administered Psychosocial Interventions on Symptoms of Depression

Many community mental health centers have implemented peer treatment models that employ recovered former clients as cost‐efficient adjunct providers. The effectiveness of these and other peer‐administered interventions (PAIs) for treating depression symptoms has not been well‐established. The current study is a meta‐analysis of PAIs’ effects on depression symptoms. Twenty‐three eligible studies were identified. Study characteristics were coded by multiple raters, random‐effects models were used to compare mean effect sizes, and mixed‐effects models were used to test for moderation. PAIs produced significant pre‐post reductions in depression symptoms (d = .5043 [95 % CI .3675–.6412]). In direct comparisons, PAIs performed as well as non‐peer‐administered interventions (.0848 [?.1455–.3151]), and significantly better than no‐treatment conditions (.2011 [.0104–.3918]). PAIs that involved a professional in a secondary treatment role were significantly less effective than those that were purely peer‐administered, and educational/skills‐based PAIs produced better outcomes than those that were mainly supportive. Follow‐up data, when available, indicated that PAIs’ benefits were maintained. PAIs reduce depression symptoms and warrant further study. The clinical significance of PAIs’ benefits, and whether they are better suited as stand‐alone or adjunct treatments, remain to be established. Implications for the roles of mental health professionals are discussed.     

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health diagnosis) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Assessments at pretreatment, 12 weeks, 6 months, and 9 months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.     

Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen’s d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen’s d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.     

WOMEN WHO USE DOMESTIC VIOLENCE SHELTERS Changes in Depression Over Time

This study examined the levels of depression reported by women who had used a domestic violence shelter. Depressive symptoms were assessed three times: immediately after shelter exit, 10 weeks thereafter, and 6 months later. Whereas 83% of the women reported at least mild depression on the Center for Epidemiological Studies Depression (CES-D) scale upon shelter exit, only 58% were depressed 10 weeks later. This did not change at the 6–month follow-up. An ecological, longitudinal model was evaluated to predict battered women's depression 8/12 months postshelter exit. Results of hierarchical regression analyses suggested that, after controlling for previous levels of depression, the women's feelings of powerlessness, experience of abuse, and decreased social support contributed to their depression symptoms. The women's scores on these three variables (feelings of powerlessness, abuse, and social support) at 10 weeks postshelter exit and at 6-month follow-up predicted depression at 6 months. Thus, there were both predictive and concurrent effects for these constructs. Implications for clinical and community interventions are discussed.     

Pretherapy Cognitive Dispositions and Treatment Outcome in Cognitive Behavior Therapy for Insomnia

This study consisted of secondary analyses of data from 2 randomized clinical trials to test whether pretherapy cognitions predict CBT outcomes. The sample consisted of 155 primary insomnia patients with sleep maintenance complaints. Of these, 98 were randomized to CBT, 23 were assigned to progressive muscle relaxation training (PMR), and 34 were assigned to a control (sham therapy or wait-list) condition (CON). All patients completed the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS), a sleep-related Self-Efficacy Scale (SES) and nightly sleep diaries for 2 weeks prior to receiving their assigned treatment. They then completed sleep diaries throughout an 8-week acute treatment period and during a 2-week period at a posttherapy follow-up. A subset of the sample (n = 67) also completed polysomnography immediately before and after completing their assigned treatment. Preliminary regression analyses conducted with a small subset (n = 15) of the patients receiving CBT showed those with relatively high levels of unhelpful sleep-related beliefs (Type 1 patients), as reflected by their pretherapy responses to the DBAS and SES questionnaires, showed markedly greater reductions in nocturnal wakefulness in response to CBT than did those (Type 2 patients) reporting less pronounced sleep-related beliefs. Given these findings, we used the regression equation derived from our initial analyses to dichotomize our entire sample into Type 1 (n = 82; 52.9%) and Type 2 (n = 73; 47.1%) subgroups. Subsequent comparisons showed CBT-treated Type 1 patients had significantly less wake time after sleep onset during most of the 8-week treatment phase than did the Type 1 and 2 individuals assigned to either PMR or CON. Relative to patients assigned to the PMR and CON conditions, CBT-treated Type 1 patients showed better performance across multiple subjective and objective benchmarks of clinically significant improvement, whereas the CBT-treated Type 2 patients did not. Results suggest that insomnia patients' pretherapy cognitive dispositions predict CBT outcome, and those with a pronounced sense of sleep-related helplessness are best suited for this treatment which targets this cognitive stance.     

A Brief Group Cognitive-Behavioral Program for the Prevention of Depressive Symptoms in Chinese College Students

Depression is a problem among college students in China. Yet the use of preventative group cognitive-behavioral (CB) intervention is rare. One hundred and eighty Chinese college students who were identified as being at risk for depression were randomly assigned to three groups: 1) a brief group cognitive–behavioral (CB) intervention, 2) a supportive group (SG) intervention, and 3) a wait-list control condition. The Zung Self-Rating Depression Scale (SDS), the Zung Self-Rating Anxiety Scale (SAS), and the Chinese College Student Adjustment Scale (CCSAS) were administered at pre-test, post-test, and six-month follow-up. Analysis of variance (ANOVA) conducted among the three groups revealed that the CB group demonstrated significantly less increase in measures of primary symptoms of anxiety and depression than the wait-list controls at post-test and six-month follow-up. The prevention effect of the SG group was significant only at the six-month follow-up. CB participants also showed significantly greater improvements in social adjustment than did SG participants and controls at the post-test and six-month follow-up.     

Living with the unexplained: coping,distress, and depression among women with chronic fatigue syndrome and/or fibromyalgia compared to an autoimmune disorder

Chronic fatigue syndrome (CFS) and fibromyalgia are disabling conditions without objective diagnostic tests, clear-cut treatments, or established etiologies. Those with the disorders are viewed suspiciously, and claims of malingering are common, thus promoting further distress. It was hypothesized in the current study that levels of unsupportive social interactions and the coping styles used among those with CFS/fibromyalgia would be associated with perceived distress and depressive symptoms. Women with CFS/fibromyalgia (n = 39), in fact, reported higher depression scores, greater perceived distress and more frequent unsupportive relationships than healthy women (n = 55), whereas those with a chronic, but medically accepted illness comprising an autoimmune disorder (lupus erythematosus, multiple sclerosis, rheumatoid arthritis; n = 28), displayed intermediate scores. High problem-focused coping was associated with low levels of depression and perceived distress in those with an autoimmune condition. In contrast, although CFS/fibromyalgia was also accompanied by higher depression scores and higher perceived distress, this occurred irrespective of problem-focused coping. It is suggested that because the veracity of ambiguous illnesses is often questioned, this might represent a potent stressor in women with such illnesses, and even coping methods typically thought to be useful in other conditions, are not associated with diminished distress among those with CFS/fibromyalgia.     

Changes in Empathy Mediate the Effects of Cognitive-Behavioral Group Therapy but Not Mindfulness-Based Stress Reduction for Social Anxiety Disorder

Social anxiety disorder (SAD) has been shown to be associated with difficulty in the ability to vicariously share others’ positive emotions (positive affective empathy). Mixed evidence also suggests potentially impaired recognition of the positive and negative emotions of others (cognitive empathy) and impaired or enhanced sharing of the negative emotions of others (negative affective empathy). Therefore, we examined whether two efficacious treatments for SAD, cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR), improve empathy in SAD relative to a wait-list condition and whether improvements in empathy mediate improvements in social anxiety. In the context of a randomized controlled trial, participants with SAD completed an empathy task at baseline, posttreatment/wait-list (N = 81), and 1-year follow-up (N = 37). Relative to both MBSR and wait-list, CBGT resulted in significant improvements in positive affective empathy. CBGT-related changes in positive affective empathy also mediated improvements in social anxiety at both posttreatment/wait-list and at 1-year follow-up. Other indices of empathy did not change differentially across the three conditions. Therefore, one way in which CBGT may specifically confer benefits to individuals with SAD is through increasing their ability or willingness to share in the positive emotions of others.     

Efficacy of Telehealth Treatments for Posttraumatic Stress-Related Symptoms: A Meta-Analysis

This meta-analysis summarizes the findings of outcome research on the degree to which telehealth treatments reduce posttraumatic stress disorder (PTSD)-related symptoms. In a search of the literature, 13 studies were identified for inclusion in the meta-analysis and were coded for relevant variables. A total of 725 participants were included. Results indicate that telehealth treatments are associated with significant pre- to postreduction in PTSD symptoms (d = 0.99, 95% confidence interval [CI]: 0.87–1.11, p < .001), and result in superior treatment effects relative to a wait-list comparison condition (d = 1.01, 95% CI: 0.76–1.26, p < .001). However, no significant findings were obtained for telehealth intervention relative to a supportive counseling telehealth comparison condition (d = 0.11, 95% CI: ? 0.38 to 0.60, p = .67), and telehealth intervention produced an inferior outcome relative to a face-to-face intervention (d = ? 0.68, 95% CI: ? 0.39 to ? 0.98, p < .001). Findings for depression symptom severity outcome were generally consistent with those for PTSD outcome. Telehealth interventions produced a significant within-group effect size (d = 0.98, 95% CI: 0.86 to 1.10, p < .001) and superior effect relative to wait-list comparison condition (d = 0.80, 95% CI: 0.56–1.05, p < .001). Relative to face-to-face interventions, telehealth treatments produced comparable depression outcome effects (d = 0.13, 95% CI: ? 0.55 to 0.28, p = .53). Taken together, these findings support the use of telehealth treatments for individuals with PTSD-related symptoms.     

Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial

Although 14% to 42% of people with whiplash injuries end up with chronic debilitating pain, there is still a paucity of empirically supported treatments for this group of patients. In chronic pain management, there is increasing consensus regarding the importance of a behavioural medicine approach to symptoms and disability. Cognitive behaviour therapy has proven to be beneficial in the treatment of chronic pain. An approach that promotes acceptance of, or willingness to experience, pain and other associated negative private events (e.g. fear, anxiety, and fatigue) instead of reducing or controlling symptoms has received increasing attention. Although the empirical support for treatments emphasizing exposure and acceptance (such as acceptance and commitment therapy) is growing, there is clearly a need for more outcome studies, especially randomized controlled trials. In this study, participants (N = 21) with chronic pain and whiplash-associated disorders were recruited from a patient organization and randomized to either a treatment or a wait-list control condition. Both groups continued to receive treatment as usual. In the experimental condition, a learning theory framework was applied to the analysis and treatment. The intervention consisted of a 10-session protocol emphasizing values-based exposure and acceptance strategies to improve functioning and life satisfaction by increasing the participants' abilities to behave in accordance with values in the presence of interfering pain and distress (psychological flexibility). After treatment, significant differences in favor of the treatment group were seen in pain disability, life satisfaction, fear of movements, depression, and psychological inflexibility. No change for any of the groups was seen in pain intensity. Improvements in the treatment group were maintained at 7-month follow-up. The authors discuss implications of these findings and offer suggestions for further research in this area.