The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain
The Mediating Role of Acceptance in Multidisciplinary Cognitive-Behavioral Therapy for Chronic Pain
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DOI：
10.1016/j.jpain.2015.03.007
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发表时间：
2015-07-01
期刊：
影响因子：
4
通讯作者：
McCracken, Lance M.
中科院分区：
文献类型：
--
作者：
Akerblom, Sophia;Perrin, Sean;McCracken, Lance M.
认知行为疗法（CBT）是对慢性疼痛成人最常见的心理干预。治疗产生适度的效果，作用机制仍然研究不足，不清楚。需要努力确定可用于完善CBT和改善结果的治疗介质。本研究的主要目的是调查是否疼痛相关的接受，从心理灵活性模型，介导的变化，随着时间的推移，在基于CBT的治疗方案的结果。这包括比较这个变量与标准CBT中作为潜在中介的其他3个变量的关系：生活控制，情感困扰和社会支持。参与者参加了为期5周的门诊多学科项目，并在评估、治疗后和12个月随访时收集了自我报告数据。多水平结构方程模型用于检验与3种结局相关的中介作用：疼痛干扰、疼痛强度和抑郁。结果表明，治疗的效应量在CBT疼痛文献中报告的范围内。疼痛相关的接受与疼痛强度无关，这与过去的经验证据和接受和承诺治疗的治疗目标一致。否则，疼痛相关的接受是最强的调解人在不同的指标的结果。这些累积的结果表明，接受疼痛可能是基于CBT的治疗实现功能改善的一般机制。更具体的目标，疼痛相关的接受治疗可能会导致进一步改善outcome.Perspective：潜在的调解人的结果，在一个基于CBT的治疗成人慢性疼痛进行了调查，使用多层次结构方程模型。结果强调了疼痛相关的接受作为一个重要的治疗过程的作用，即使在治疗过程中没有明确的目标。这些数据可以帮助临床医生和研究人员更好地了解变化过程，并改善治疗方法的选择和开发。(C)2015年美国疼痛协会American Pain Society
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. (C) 2015 by the American Pain Society