title: Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain.
  
  
  METHODS
  On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance.
  
  
  RESULTS
  Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up.
  
  
  CONCLUSIONS
  More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.
authors.affiliation: *Behavioral Medicine Pain Treatment Services, Karolinska University Hospital Departments of †Clinical Neuroscience ‡Physiology and Pharmacology, Karolinska Institutet §Stress Research Institute, Stockholm University, Stockholm ∥Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Mike K
authors.initials: MK
authors.lastname: Kemani
authors.forename: Gunnar L
authors.initials: GL
authors.lastname: Olsson
authors.forename: Mats
authors.initials: M
authors.lastname: Lekander
authors.forename: Hugo
authors.initials: H
authors.lastname: Hesser
authors.forename: Erik
authors.initials: E
authors.lastname: Andersson
authors.forename: Rikard K
authors.initials: RK
authors.lastname: Wicksell
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000191:economics* / Q000379:methods; D000328:Adult; D001007:Anxiety / Q000628:therapy; D001294:Attitude to Health; D059350:Chronic Pain / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012064:Relaxation Therapy / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome