Patients' experiences of internet-based Acceptance and commitment therapy for chronic pain: a qualitative study

Nina Bendelin, Pär Björkdahl, Mimmi Risell, Karin Zetterqvist Nelson, Björn Gerdle, Gerhard Andersson, Monica Buhrman, Nina Bendelin, Pär Björkdahl, Mimmi Risell, Karin Zetterqvist Nelson, Björn Gerdle, Gerhard Andersson, Monica Buhrman

Abstract

Background: Chronic pain is a globally widespread condition with complex clusters of symptoms within a heterogeneous patient group. Internet-delivered Acceptance and Commitment Therapy (IACT) has shown promising results in the treatment of chronic pain. How IACT is experienced by patients is less well known. Qualitative studies of patients' experiences are needed to further understand factors behind both engagement and negative effects. The aim of this study was to explore how IACT was experienced by chronic pain patients who had participated in a controlled trial.

Methods: Through an open and exploratory approach this study aimed to investigate how IACT was experienced when delivered as a guided self-help program to persons with chronic pain. Eleven participants were interviewed over telephone after completing IACT.

Results: Qualitative analysis based on grounded theory resulted in 2 core categories and 8 subcategories. In treatment: Physical and cognitive restraints, Time and deadline, Therapist contact, and Self-confrontation. After treatment: Attitude to pain, Image of pain, Control or Command, and Acting with pain. Individual differences as well as specific conditions of the treatment may explain variations in how the treatment was approached, experienced and what consequences it led to. Therapist guidance and deadlines for homework play complex roles in relation to autonomy and change.

Conclusions: Adjusting treatment content and format based on participants' characteristics, such as expectations, motivation and restraints, might positively affect engagement, autonomy and change. Further research on attrition and negative effects of treatment might clarify what enables chronic pain patients to benefit from IACT.

Trial registration: clinicaltrials.gov (NCT01603797). Registered 22 May 2012. Retrospectively registered.

Keywords: ACT; Attrition; Change; Constructivist grounded theory; Engagement; ICBT; Motivation; Person-based approach.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of process of analysis
Fig. 2
Fig. 2
Results presented in core categories and subcategories

References

    1. Adams LM, Turk DC. Central sensitization and the biopsychosocial approach to understanding pain. J Appl Biobehav Res. 2018;23(2). 10.1111/jabr.12125.
    1. Advocat J, Lindsay J. Internet-based trials and the creation of health consumers. Soc Sci Med. 2010;70(3):485–492. doi: 10.1016/j.socscimed.2009.10.051.
    1. Andersson G, Titov N. Advantages and limitations of internet-based interventions for common mental disorders. World Psychiatry. 2014;13(1):4–11. doi: 10.1002/wps.20083.
    1. Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry. 2019;18(1):20–28. doi: 10.1002/wps.20610.
    1. APA Task Force 12 . Treatment: Acceptance and commitment therapy for chronic pain. 2016.
    1. Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on internet-based mental health interventions - a systematic review. Internet Interv. 2014;1(4):205–215. doi: 10.1016/j.invent.2014.08.003.
    1. Bendelin N, Gerdle B, Andersson G. Internet-delivered aftercare following multimodal rehabilitation program for chronic pain: a qualitative feasibility study. J Pain Res. 2018;11:1715–1728. doi: 10.2147/JPR.S157939.
    1. Bendelin N, Hesser H, Dahl J, Carlbring P, Nelson KZ, Andersson G. Experiences of guided Internet-based cognitive-behavioural treatment for depression: A qualitative study. BMC Psychiatry. 2011;11:107. doi: 10.1186/1471-244X-11-107.
    1. Beukes EW, Manchaiah V, Davies ASA, Allen PM, Baguley DM, Andersson G. Participants’ experiences of an internet-based cognitive behavioural therapy intervention for tinnitus. Int J Audiol. 2018;57(12):947–954. doi: 10.1080/14992027.2018.1514538.
    1. Bremander A, Bergman S, Arvidsson B. Perception of multimodal cognitive treatment for people with chronic widespread pain changing one's life plan. Disabil Rehabil. 2009;31(24):1996–2004. doi: 10.3109/09638280902874139.
    1. Buhrman M, Gordh T, Andersson G. Internet interventions for chronic pain including headache: a systematic review. Internet Interv. 2016;4:17–34. doi: 10.1016/j.invent.2015.12.001.
    1. Buhrman M, Skoglund A, Husell J, Bergström K, Gordh T, Hursti T, et al. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behav Res Ther. 2013;51(6):307–315. doi: 10.1016/j.brat.2013.02.010.
    1. Caiata Zufferey M, Schulz PJ. Self-management of chronic low back pain: an exploration of the impact of a patient-centered website. Patient Educ Couns. 2009;77(1):27–32. doi: 10.1016/j.pec.2009.01.016.
    1. Chamberlain K, Stephens C, Lyons AC. Encompassing experience: meanings and methods in health psychology. Psychol Health. 1997;12(5):691–709. doi: 10.1080/08870449708407415.
    1. Charmaz K. Constructing grounded theory. 2. London: Sage; 2014.
    1. Charmaz K. International Encyclopedia of the Social & Behavioral Sciences. 2. 2015. Grounded theory: methodology and theory construction; pp. 402–407.
    1. Charmaz K. The power of constructivist grounded theory for critical inquiry. Qual Inq. 2016;23(1):34–45. doi: 10.1177/1077800416657105.
    1. Charmaz K. New Directions in the Sociology of Chronic and Disabling Conditions: Assaults on the Lifeworld. 2016. Studying the experience of chronic illness through grounded theory; pp. 8–36.
    1. Dear BF, Courtney C, Khor KE, McDonald S, Ricciardi T, Gandy M, et al. The pain course: exploring the feasibility of an internet-delivered pain management program when offered by a tertiary pain management service. Clin J Pain. 2018;34(6):505–514. doi: 10.1097/AJP.0000000000000565.
    1. Dear BF, Gandy M, Kdarin E, Staples LG, Johnston L, Fogliati VJ, et al. The pain course: a randomised controlled trial examining an internet-delivered pain management program when provided with different levels of clinician support. Pain. 2015;156(10):1920–1935. doi: 10.1097/j.pain.0000000000000251.
    1. Devan H, Hale L, Hempel D, Saipe B, Perry MA. What works and does not work in a self-management intervention for people with chronic pain? Qualitative systematic review and meta-synthesis. Phys Ther. 2018;98(5):381–397. doi: 10.1093/ptj/pzy029.
    1. Duggan GB, Keogh E, Mountain GA, McCullagh P, Leake J, Eccleston C. Qualitative evaluation of the SMART2 self-management system for people in chronic pain. Disabil Rehabil Assist Technol. 2015;10(1):53–60. doi: 10.3109/17483107.2013.845696.
    1. Eccleston C, Fisher E, Craig L, Duggan GB, Rosser BA, Keogh E. Psychological therapies (internet delivered) for the management of chronic pain in adults. Cochrane Database Syst Rev. 2012;2012(10):CD010152. doi: 10.1002/14651858.CD010152.
    1. Eccleston C, Fisher E, Craig L, Duggan GB, Rosser BA, Keogh E. Psychological therapies (internet-delivered) for the management of chronic pain in adults. Cochrane Database Syst Rev. 2014;2014(2):CD010152. doi: 10.1002/14651858.CD010152.pub2.
    1. Eccleston C, Williams ACDC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009;(2):CD007407. 10.1002/14651858.CD007407.pub2.
    1. Eng TR, Gustafson DH, Henderson J, Jimison H. Introduction to evaluation of interactive health communication applications. Am J Prev Med. 1999;16(1):10–15. doi: 10.1016/S0749-3797(98)00107-X.
    1. Fisher E, Law E, Palermo TM, Eccleston C. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2015;2015(3). 10.1002/14651858.CD011118.pub2.
    1. Flink IK, Sfyrkou C, Persson B. Customized CBT via internet for adolescents with pain and emotional distress: a pilot study. Internet Interv. 2016;4:43–50. doi: 10.1016/j.invent.2016.03.002.
    1. Gerdle B, Molander P, Stenberg G, Stålnacke BM, Enthoven P. Weak outcome predictors of multimodal rehabilitation at one-year follow-up in patients with chronic pain - a practice based evidence study from two SQRP centres. BMC Musculoskelet Disord. 2016;17(1):1–14. doi: 10.1186/s12891-016-1346-7.
    1. Hann KEJ, McCracken LM. A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: outcome domains, design quality, and efficacy. J Contextual Behav Sci. 2014;3(4):217–227. doi: 10.1016/j.jcbs.2014.10.001.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. doi: 10.1016/j.brat.2005.06.006.
    1. Huet HV, Innes E, Whiteford G. Living and doing with chronic pain: narratives of pain program participants. Disabil Rehabil. 2009;31(24):2031–2040. doi: 10.3109/09638280902887784.
    1. Hughes LS, Clark J, Colclough JA, Dale E, McMillan D. Acceptance and commitment therapy (ACT) for chronic pain. Clin J Pain. 2017;33(6):552–568. doi: 10.1097/AJP.0000000000000425.
    1. Johansson O, Michel T, Andersson G, Paxling B. Experiences of non-adherence to internet-delivered cognitive behavior therapy: a qualitative study. Internet Interv. 2015;2(2):137–142. doi: 10.1016/j.invent.2015.02.006.
    1. Karekla M, Kasinopoulos O, Neto DD, Ebert DD, Van Daele T, Nordgreen T, et al. Best practices and recommendations for digital interventions to improve engagement and adherence in chronic illness sufferers. Eur Psychol. 2019;24(1):49–67. doi: 10.1027/1016-9040/a000349.
    1. MacEa DD, Gajos K, Daglia Calil YA, Fregni F. The efficacy of web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. J Pain. 2010;11(10):917–929. doi: 10.1016/j.jpain.2010.06.005.
    1. Marshall CJ, Pranata A, Paay J, Sterling L, Merolli M. Studies in Health Technology and Informatics. 2019. User-centered value specifications for technologies supporting chronic low-back pain management; pp. 1288–1292.
    1. Martorella G, Boitor M, Berube M, Fredericks S, Le May S, Gélinas C. Tailored web-based interventions for pain: systematic review and meta-analysis. J Med Internet Res. 2017;19(11). 10.2196/jmir.8826.
    1. McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014;69(2):178–187. doi: 10.1037/a0035623.
    1. Simpson PA, Mars T, Esteves JE. A systematic review of randomised controlled trials using acceptance and commitment therapy as an intervention in the management of non-malignant, chronic pain in adults. Int J Osteopath Med. 2017;24:18–31. doi: 10.1016/j.ijosm.2017.03.001.
    1. Veehof MM, Oskam MJ, Schreurs KMG, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain. 2011;152(3):533–542. doi: 10.1016/j.pain.2010.11.002.
    1. Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KMG. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016;45(1):5–31. doi: 10.1080/16506073.2015.1098724.
    1. Vereenooghe L, Gega L, Langdon PE. Intellectual disability and computers in therapy: views of service users and clinical psychologists. Cyberpsychology. 2017;11(1). 10.5817/CP2017-1-11.
    1. Willig C. Introducing qualitative research in psychology: adventures in theory and method. Maidenhead: McGare Hill/Open University Press; 2008.
    1. Vugts MAP, Joosen MCW, van der Geer JE, Zedlitz AMEE, Vrijhoef HJM. The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: a systematic review and meta-analysis. PLoS One. 2018;13(5). 10.1371/journal.pone.0196467.
    1. Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot Feasibility Stud. 2015a;1(1). 10.1186/s40814-015-0033-z.
    1. Yardley L, Morrison L, Bradbury K, Muller I. The person-based approach to intervention development: application to digital health-related behavior change interventions. J Med Internet Res. 2015;17(1):e30. doi: 10.2196/jmir.4055.
    1. Yardley L, Morrison LG, Andreou P, Joseph J, Little P. Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision. BMC Med Inform Decis Mak. 2010;10(1). 10.1186/1472-6947-10-52.

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