title: A Clinical Pilot Study of Individual and Group Treatment for Adolescents with Chronic Pain and Their Parents: Effects of Acceptance and Commitment Therapy on Functioning.
abstract: Pediatric chronic pain is common and can result in substantial long-term disability. Previous studies on acceptance and commitment therapy (ACT) have shown promising results in improving functioning in affected children, but more research is still urgently needed. In the current clinical pilot study, we evaluated an ACT-based interdisciplinary outpatient intervention (14 sessions), including a parent support program (four sessions). Adolescents were referred to the clinic if they experienced disabling chronic pain. They were then randomized, along with their parents, to receive group (n= 12) or individual (n= 18) treatment. Adolescent pain interference, pain reactivity, depression, functional disability, pain intensity and psychological flexibility, along with parent anxiety, depression, pain reactivity and psychological flexibility were assessed using self-reported questionnaires. There were no significant differences in outcomes between individual and group treatment. Analyses illustrated significant (p< 0.01) improvements (medium to large effects) in pain interference, depression, pain reactivity and psychological flexibility post-treatment. Additionally, analyses showed significant (p< 0.01) improvements (large effects) in parent pain reactivity and psychological flexibility post-treatment. On all significant outcomes, clinically-significant changes were observed for 21%-63% of the adolescents across the different outcome measures and in 54%-76% of the parents. These results support previous findings and thus warrant the need for larger, randomized clinical trials evaluating the relative utility of individual and group treatment and the effects of parental interventions.
authors.affiliation: Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden. Marie.Kanstrup@ki.se.|Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. Marie.Kanstrup@ki.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Kanstrup
authors.affiliation: Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden. Rikard.Wicksell@karolinska.se.|Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. Rikard.Wicksell@karolinska.se.
authors.forename: Rikard K
authors.initials: RK
authors.lastname: Wicksell
authors.affiliation: Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden. Mike.Kemani@karolinska.se.|Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. Mike.Kemani@karolinska.se.
authors.forename: Mike
authors.initials: M
authors.lastname: Kemani
authors.affiliation: Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden. Camilla.Wiwe-Lipsker@karolinska.se.|Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. Camilla.Wiwe-Lipsker@karolinska.se.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wiwe Lipsker
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden. Mats.Lekander@ki.se.|Stress Research Institute, Stockholm University, 106 91 Stockholm, Sweden. Mats.Lekander@ki.se.
authors.forename: Mats
authors.initials: M
authors.lastname: Lekander
authors.affiliation: Functional Area Medical Psychology, Functional Unit Behavioral Medicine, Karolinska University Hospital Solna, P8:01, 171 76 Stockholm, Sweden. Linda.Holmstrom@ki.se.|Department of Women's and Children's health, Karolinska Institutet, H2:00, Karolinska University Hospital Solna, 171 76 Stockholm, Sweden. Linda.Holmstrom@ki.se.
authors.forename: Linda
authors.initials: L
authors.lastname: Holmström
keywords: acceptance and commitment therapy (ACT); adolescent; cognitive behavior therapy (CBT); intervention; pain disability; persistent pain; treatment