title: A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results.
abstract: Acceptance and commitment therapy (ACT) is a developing approach for chronic pain. The current study was designed to pilot test a brief, widely inclusive, local access format of ACT in a UK primary care setting. Seventy-three participants (68.5% women) were randomized to either ACT or treatment as usual (TAU). Many of the participants were aged 65 years or older (27.6%), were diagnosed with fibromyalgia (30.2%) and depression (40.3%), and had longstanding pain (median = 10 years). Standard clinical outcome measures included disability, depression, physical functioning, emotional functioning, and rated improvement. Process measures included pain-related and general psychological acceptance. The recruitment target was met within 6 months, and 72.9% of those allocated to ACT completed treatment. Immediately post treatment, relative to TAU, participants in ACT demonstrated lower depression and higher ratings of overall improvement. At a 3-month follow-up, again relative to TAU, those in ACT demonstrated lower disability, less depression, and significantly higher pain acceptance; d = .58, .59, and .64, respectively. Analyses based on intention-to-treat and on treatment "completers," perhaps predictably, revealed more sobering and more encouraging results, respectively. A larger trial of ACT delivered in primary care, in the format employed here, appears feasible with some recommended adjustments in the methods used here (Trial registration: ISRCTN49827391).
  
  
  CONCLUSIONS
  This article presents a pilot randomized controlled trial of ACT for chronic pain in a primary care setting in the United Kingdom. Both positive clinical outcomes and ways to improve future trials are reported.
authors.affiliation: Health Psychology Section, Psychology Department, King's College London, London, United Kingdom; INPUT Pain Management, Guy's and St Thomas' Hospitals, London, United Kingdom. Electronic address: Lance.McCracken@kcl.ac.uk.
authors.forename: Lance M
authors.initials: LM
authors.lastname: McCracken
authors.forename: Ayana
authors.initials: A
authors.lastname: Sato
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Taylor
mesh_terms: D064869:Acceptance and Commitment Therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000150:complications / Q000523:psychology / Q000628:therapy*; D003863:Depression / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016896:Treatment Outcome
keywords: Acceptance and commitment therapy; chronic pain; cognitive behavioral therapy; pilot; psychological flexibility; randomized controlled trial
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