title: Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and whiplash-associated disorders (WAD)? A randomized controlled trial.
abstract: 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.
authors.affiliation: Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. Rikard.Wicksell@karolinska.se
authors.forename: Rikard K
authors.initials: RK
authors.lastname: Wicksell
authors.forename: Josefin
authors.initials: J
authors.lastname: Ahlqvist
authors.forename: Annika
authors.initials: A
authors.lastname: Bring
authors.forename: Lennart
authors.initials: L
authors.lastname: Melin
authors.forename: Gunnar L
authors.initials: GL
authors.lastname: Olsson
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology; D000203:Activities of Daily Living / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology / Q000534:rehabilitation; D003887:Desensitization, Psychologic; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology* / Q000534:rehabilitation; D010147:Pain Measurement; D011788:Quality of Life / Q000523:psychology*; D012050:Rehabilitation, Vocational; D012803:Sick Role; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000523:psychology* / Q000534:rehabilitation