Guided Internet-delivered Acceptance and Commitment Therapy for Chronic Pain Patients

Guided Internet-delivered Acceptance and Commitment Therapy for Chronic Pain Patients: a Randomized Controlled Trial

The aim of this study was to investigate if guided internet-delivered acceptance and commitment therapy (ACT)would help chronic pain patients.

Study Overview

• Status: Completed
• Conditions: Chronic Pain
• Intervention / Treatment: Behavioral: Guided internet-delivered acceptance and commitment therapy

Detailed Description

The present study investigates internet-delivered ACT for persons with chronic pain. The use of internet as a delivery format for interventions could be a way of overcome many barriers (financial obstacles, reluctance to seek treatment and paucity of clinicians trained in ACT) that hinder persons with chronic pain to seek or receive adequate help. Persons were randomized to either treatment for 7 weeks or to a control group who were invited to participate in a moderated online discussion forum. Follow up data was collected six months after the treatment.

• Study Type: Interventional
• Enrollment (Actual): 76
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• that participants had undergone medical investigation (within one year)
• had regular access to the internet
• had functional impairment caused by chronic pain
• had internet access

Exclusion Criteria:

• ongoing medical investigations or treatment that could interfere with participation in the study, such as planned surgery and suffering from acute physical or psychological conditions
• not fluent in the Swedish language

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Internet delivered ACT; Internet delivered acceptance and commitment therapy (ACT), 7 weeks treatment	Behavioral: Guided internet-delivered acceptance and commitment therapy; The treatment program consisted of seven sections and was based on ACT.The first part was about creative hopelessness and was followed in the next section by an introduction to willingness and to the process of acceptance of pain. Information and assignments about committed action and values were also part of the treatment program. Mindfulness exercises were a regular feature in the program. The last part was about how to maintain learned strategies but also an evaluation of the program.
Active Comparator: Online discussion forum; Active wait-list condition. Were offered to participate in a moderated online discussion forum. After post-treatment assessment the control group were offered treatment.	Behavioral: Guided internet-delivered acceptance and commitment therapy; The treatment program consisted of seven sections and was based on ACT.The first part was about creative hopelessness and was followed in the next section by an introduction to willingness and to the process of acceptance of pain. Information and assignments about committed action and values were also part of the treatment program. Mindfulness exercises were a regular feature in the program. The last part was about how to maintain learned strategies but also an evaluation of the program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Chronic Pain Acceptance Questionnaire (CPAQ)	CPAQ consists of 20 items divided into two subscales: activity engagement and pain willingness. Items are rated on a scale from 0 (never true) to 6 (always true). Higher scores denote greater activity engagement and pain willingness. Studies show acceptable reliability (α =.72-.92).	One week pre- and post-treatment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hospital and Anxiety Depression Scale (HADS)	HADS contains 14 items and evaluates severity of symptoms of depression and anxiety without contamination of scores of physical symptomatology.	One week pre- and post- treatment
The Coping Strategies Questionnaire (CSQ)	The CSQ contains 50 items divided into eight scales measuring different cognitive and behavioural coping strategies and has been widely used by chronic pain patients. The coping strategies scales are: diverting attention, re-interpreting pain sensations, coping self-statements, ignoring sensations, praying and hoping, catastrophizing and increased behavioral activities	One week pre- and post- treatment
Multidimensional Pain Inventory (MPI-S)	The Swedish version of MPI (MPI-S) consists of 34 items divided into 8 scales. The first section addresses: Pain Severity, Interference, Life Control, Affective Distress and Support. The second section addresses the patient's perception of how significant others respond to their displays of pain: Punishing Responses, Solicitous Responses and Distracting Responses.	One week pre- and post- treatment
The Pain and Impairment Relationship Scale (PAIRS)	PAIRS assess beliefs and attitudes associated with the experience of chronic pain and one's ability to function despite pain. It consists of 15 personal statements that reflect thoughts, attitudes and opinions about pain.	One week pre- and post- treatment
Quality of Life Inventory (QOLI)	QOLI consists of 32 items for assessing life satisfaction. The assessment yields an overall score and profile in 16 areas of life; health, self-esteem, goals and values, money, work, play, learning, creativity, helping, love, friends, children, relatives, home, neighborhood, and community.	One week pre- and post- treatment

Collaborators and Investigators

• Sponsor: Gerhard Andersson
• Investigators: Study Director: Gerhard Andersson, Professor, Linkoeping University; Principal Investigator: Monica Buhrman, MSc, Uppsala University; Study Chair: Timo Hursti, PhD, Uppsala University; Study Chair: Torsten Gordh, Professor, Uppsala University; Study Chair: Tomas Furmark, Professor, Uppsala University; Study Chair: Astrid Skoglund, MSc, Uppsala University; Study Chair: Josefin Husell, MSc, Uppsala University; Study Chair: Kristina Bergström, MSc, Uppsala University; Study Chair: Nina Bendelin, MSc, Linkoeping University

Publications and helpful links

General Publications

• Bendelin N, Bjorkdahl P, Risell M, Nelson KZ, Gerdle B, Andersson G, Buhrman M. Patients' experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study. BMC Musculoskelet Disord. 2020 Apr 6;21(1):212. doi: 10.1186/s12891-020-03198-1.

Study record dates

Study Major Dates

• Study Start: February 1, 2010
• Primary Completion (Actual): May 1, 2010
• Study Completion (Actual): December 1, 2010

Study Registration Dates

• First Submitted: May 19, 2012
• First Submitted That Met QC Criteria: May 21, 2012
• First Posted (Estimate): May 22, 2012

Study Record Updates

• Last Update Posted (Estimate): October 3, 2012
• Last Update Submitted That Met QC Criteria: October 2, 2012
• Last Verified: October 1, 2012

More Information

Terms related to this study

• Keywords: chronic pain; acceptance and commitment therapy; mindfulness; internetdelivered CBT; guided self help
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Chronic Pain
• Other Study ID Numbers: smartaSIAMB_GA