A Comprehensive Examination of the Model Underlying Acceptance and Commitment Therapy for Chronic Pain

The therapeutic model underlying Acceptance and Commitment Therapy (ACT) is reasonably well-established as it applies to chronic pain. Several studies have examined measures of single ACT processes, or subsets of processes, and have almost uniformly indicated reliable relations with patient functioning. To date, however, no study has performed a comprehensive examination of the entire ACT model, including all of its component processes, as it relates to functioning. The present study performed this examination in 274 individuals with chronic pain presenting for an assessment appointment. Participants completed a battery of self-report questionnaires, assessing multiple aspects of the ACT model, as well as pain intensity, disability, and emotional distress. Initial exploratory factor analyses examined measures of the ACT model and measures of patient functioning separately with each analysis identifying three factors. Next, the fit of a model including ACT processes on the one hand and patient functioning on the other was examined using Structural Equation Modeling. Overall model fit was acceptable and indicated moderate correlations among the ACT processes themselves, as well as significant relations with pain intensity, emotional distress, and disability. These analyses build on the existing literature by providing, to our knowledge, the most comprehensive evaluation of the ACT theoretical model in chronic pain to date.     

Comparing the role of psychological flexibility and traditional pain management coping strategies in chronic pain treatment outcomes

Psychologically-based interventions for chronic pain traditionally include a mix of methods, including physical conditioning, training in relaxation or attention control, strategies to decrease irrational or dysfunctional thinking patterns, and activity management training. Recent developments suggest additional methods to promote acceptance, mindfulness, values-based action, and cognitive defusion (a cognitive process entailing change in the influences exerted by thoughts without necessarily changing their form or frequency). Collectively, these processes entail what is referred to as psychological flexibility. This study examined how changes in traditionally conceived methods of coping compare to changes in psychological flexibility in relation to improvements in functioning over the course of an interdisciplinary treatment program. Participants were 114 chronic pain sufferers. Results indicated that changes in the traditionally conceived methods were essentially unrelated to treatment improvements, while changes in psychological flexibility were consistently and significantly related to these improvements. We suggest that psychological flexibility appears highly relevant to the study of chronic pain and to future treatment developments. The utility of more traditionally conceived pain management strategies, on the other hand, may require a reappraisal.     

A prospective analysis of acceptance of pain and values-based action in patients with chronic pain.

OBJECTIVE: Acceptance of pain and values-based action appear important in the emotional, physical, and social functioning of individuals with chronic pain. The purpose of the current study was to prospectively investigate these combined processes. METHOD: 115 patients attending an assessment and treatment course for chronic pain in the U.K. completed a standard set of measures on two occasions separated by an average of 18.5 weeks. RESULTS: Correlation analyses showed that acceptance of pain and values-based action measured at Time 1 were significantly correlated with pain, pain-related distress, pain-related anxiety and avoidance, depression, depression-related interference with functioning, and physical and psychosocial disability measured at Time 2. Multiple regression analyses, in which pain and relevant patient background variables were controlled, showed that the combined acceptance and values measures accounted for between 6.5% and 27.0% of variance in six key measures of patient functioning later in time. CONCLUSION: These results support the importance of acceptance and values-related processes in relation to chronic pain. These results also encourage continued applications of a functional contextual model of psychopathology, the model underlying Acceptance and Commitment Therapy and related approaches such as Contextual Cognitive-Behavioral Therapy.     

先天易的数学基础初探——试论先天卦序与二进位制

本文从自然数及其记数法的基本慨念出发。辨析了与二进位制相关的几个容易混淆的概念,指出序数概念的引入在近代数学发展中有重要意义。作为邵雍数学学派的数学基础,先天易是数学史上第一个专门定义的序数体系,该序数体系在数学史上率先采用了二进位制记数法。先天易作为二进制序数体系这一事实在明清时期引起不同的反响,反对者认为它使易道沦落,大数学家汪莱则从P进制的角度论证它的优越性。本文最后还对近年来反对先天易与二进制有关的两种典型观点进行了剖析．指出其谬误所在。     

Targeting Acceptance,Mindfulness, and Values-Based Action in Chronic Pain: Findings of Two Preliminary Trials of an Outpatient Group-Based Intervention

Cognitive behavior therapy (CBT) for chronic pain is effective, although a number of issues in need of clarification remain, including the processes by which CBT works, the role of cognitive changes in the achievement of outcomes, and the formulation of a coherent theoretical model. Recent developments in psychology have attempted to address these issues by focusing specifically on processes of acceptance, present-focused awareness (e.g., mindfulness), and values-based action. The present study evaluated the effectiveness of Acceptance and Commitment Therapy (ACT), perhaps the most widely researched of these developing approaches. Initial evidence suggests that ACT-consistent treatments for chronic pain are effective, although there is a need to study treatment in more traditional pain-management settings, where treatment is generally time-limited, unidisciplinary, and outpatient. Data from two pilot studies are presented. Results support the feasibility of treatment and suggest that effectiveness rates compare favorably with more established forms of treatment, in this case, CBT. Although these data are preliminary, they set a foundation upon which more intensive evaluations can take place.     

Emotional and autonomic responses to visual traumatic stimuli

A fine-grain analysis of autonomic responses are presented with the purpose of extending the conclusions from a previously published paper (Christianson & Nilsson, 1984) on emotional and memorial responses to traumatic visual stimuli. Control subjects were presented with a series of 18 slides of neutral faces, whereas the experimental subjects were presented with six slides of horrible facial injuries in positions 7–12, interspersed between six slides of neutral faces in the beginning, and six slides of neutral faces at the end of the series. The time course of heart rate (HR) and skin conductance (SC) during stimulus presentation was recorded. These data showed an initial pattern of increase in SC, but not in HR. This pattern was subsequently replaced by a combined increase in both SC and HR. The results are discrepant to previous work and are interpreted as effects of not informing the subjects about the gruesome slides to be presented.     

The role of age on reactivity and memory for emotional pictures

The purpose of this study was to investigate subjects' reactivity to emotional pictures and their recollection of these pictures, and to examine these two factors as they relate to age. Adolescents and young adults were shown emotionally arousing scenic pictures for long (4-s) and very brief (50-ms) durations. Recognition of the pictures and recall and recognition of words presented along with the pictures were assessed both immediately after the presentation and six weeks later. The results showed that very negative pictures are retained better than neutral or even positive pictures, and that very negative pictures reduce memory for associated information. It was also found that adolescents show a somewhat lower reactivity to very negative pictures and a higher degree of retention of these pictures than adults. The results are discussed in relation to (a) habituation effects, (b) strategies that subjects might develop to block emotional involvement, and (c) the notion that watching violence might serve as a powerful prime to socially undesirable behaviour.     

Personality organization defined by DMT and the Structural Interview

The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.