title: Changes in Acceptance in a Low-Intensity, Group-Based Acceptance and Commitment Therapy (ACT) Chronic Pain Intervention.
abstract: BACKGROUND
  Acceptance and commitment therapy has shown to be effective in chronic pain rehabilitation, and acceptance has been shown to be a key process of change. The influence of treatment dose on acceptance is not clear, and in particular, the effectiveness of a non-intensive treatment (<20 h) in a tertiary pain clinic is required.
  
  
  OBJECTIVE
  The purpose of the study was to assess the effectiveness of a low-intensity, acceptance and commitment therapy (ACT) group program for chronic pain. The study sought to compare, at both groups and individual patient levels, changes in acceptance with changes observed in previous ACT studies.
  
  
  METHODS
  Seventy-one individuals with chronic pain commenced a 9-week ACT-based group program at an outpatient chronic pain service. In addition to acceptance, outcomes included the following: pain catastrophizing, depression, anxiety, quality of life, and pain-related anxiety. To compare the current findings with previous research, effect sizes from seven studies were aggregated using the random-effects model to calculate benchmarks. Reliable change indices (RCIs) were applied to assess change on an individual patient-level.
  
  
  RESULTS
  The ACT intervention achieved a statistically significant increase in acceptance and medium effect size (d = 0.54) at a group level. Change in acceptance was of a similar magnitude to that found in previous ACT studies that examined interventions with similar treatment hours (<20 h). Results across other outcome measures demonstrated small to medium effect sizes (d = 0.01 to 0.48, mean = 0.26). Reliable improvement in acceptance occurred in approximately one-third (37.2, 90% CI) of patients. Approximately three-quarters (74.3, 90% CI) demonstrated reliable change in at least one of the outcome measures.
  
  
  CONCLUSIONS
  The low-intensity, group-based ACT intervention was effective at a group level and showed a similar magnitude of change in acceptance to previous ACT studies employing low-intensity interventions. Three-quarters of patients reported reliable change on at least one outcome measure.
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia. johnb@psy.uq.edu.au.
authors.forename: John A
authors.initials: JA
authors.lastname: Baranoff
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia.|School of Human Movement Studies, The University of Queensland, Brisbane, Australia.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Hanrahan
authors.affiliation: Pain Management Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Anne L J
authors.initials: AL
authors.lastname: Burke
authors.affiliation: Discipline of Psychiatry, The University of Queensland, Brisbane, QLD, 4072, Australia.|Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Connor
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000328:Adult; D001519:Behavior; D058443:Catastrophization / Q000503:physiopathology / Q000523:psychology; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Acceptance; Chronic pain; Contextual behavioral; Psychological processes; Reliable change index