Acceptance and Commitment Therapy for Pediatric Chronic Pain: Theory and Application

Melissa Pielech, Kevin E Vowles, Rikard Wicksell, Melissa Pielech, Kevin E Vowles, Rikard Wicksell

Abstract

Acceptance and Commitment Therapy (ACT) is a third wave behavior therapy approach which aims to increase engagement in activities that bring meaning, vitality, and value to the lives of individuals experiencing persistent pain, discomfort, or distress. This goal is particularly relevant when these aversive experiences cannot be effectively avoided or when avoidance efforts risk their exacerbation, all of which may be common experiences in children and adolescents with chronic pain conditions. The primary aim of the present paper is to review and summarize the extant literature on the application, utility, and evidence for using ACT with pediatric chronic pain populations by: (1) defining the theoretical assumptions of the ACT model; (2) summarizing research study findings and relevant measures from the published literature; and (3) critically discussing the strengths, limitations and areas in need of further development.

Keywords: Acceptance and Commitment Therapy; ACT; adolescents; children; chronic  pain; pain acceptance; pediatric.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. King S., Chambers C.T., Huguet A., MacNevin R.C., McGrath P.J., Parker L., MacDonald A.J. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011;152:2729–2738. doi: 10.1016/j.pain.2011.07.016.
    1. Huguet A., Miró J. The severity of chronic pediatric pain: An epidemiological study. J. Pain. 2008;9:226–236. doi: 10.1016/j.jpain.2007.10.015.
    1. Noel M., Groenewald C.B., Beals-Erickson S.E., Gebert J.T., Palermo T.M. Chronic pain in adolescence and internalizing mental health disorders: A nationally representative study. Pain. 2016;157:1333–1338. doi: 10.1097/j.pain.0000000000000522.
    1. Loeser J.D., Melzack R., Melzack R., Wall P., Levine J., Taiwo Y., Dubner R., Ruda M., Gracely R., Lynch S., et al. Pain: An overview. Lancet. 1999;353:1607–1609. doi: 10.1016/S0140-6736(99)01311-2.
    1. van Damme S., Crombez G., Eccleston C. Coping with pain: A motivational perspective. Pain. 2008;139:1–4. doi: 10.1016/j.pain.2008.07.022.
    1. Woolf C.J., Bennett G.J., Doherty M., Dubner R., Kidd B., Koltzenburg M., Lipton R., Loeser J.D., Payne R., Torebjork E. Towards a mechanism-based classification of pain? Pain. 1998;77:227–229. doi: 10.1016/S0304-3959(98)00099-2.
    1. Simons L.E., Kaczynski K.J. The Fear Avoidance model of chronic pain: Examination for pediatric application. J. Pain. 2012;13:827–835. doi: 10.1016/j.jpain.2012.05.002.
    1. Asmundson G.J.G., Noel M., Petter M., Parkerson H.A. Pediatric fear-avoidance model of chronic pain: Foundation, application and future directions. Pain Res. Manag. 2012;17:397–405. doi: 10.1155/2012/908061.
    1. Lethem J., Slade P.D., Troup J.D., Bentley G. Outline of a Fear-Avoidance Model of exaggerated pain perception—I. Behav. Res. Ther. 1983;21:401–408. doi: 10.1016/0005-7967(83)90009-8.
    1. Vlaeyen J.W., Linton S.J. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain. 2000;85:317–332. doi: 10.1016/S0304-3959(99)00242-0.
    1. Leeuw M., Goossens M.E.J.B., Linton S.J., Crombez G., Boersma K., Vlaeyen J.W.S. The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. J. Behav. Med. 2007;30:77–94. doi: 10.1007/s10865-006-9085-0.
    1. Guite J.W., McCue R.L., Sherker J.L., Sherry D.D., Rose J.B. Relationships among pain, protective parental responses, and disability for adolescents with chronic musculoskeletal pain: The mediating role of pain catastrophizing. Clin. J. Pain. 2011;27:775–781. doi: 10.1097/AJP.0b013e31821d8fb4.
    1. Logan D.E., Simons L.E., Carpino E.A. Too sick for school? Parent influences on school functioning among children with chronic pain. Pain. 2012;153:437–443. doi: 10.1016/j.pain.2011.11.004.
    1. Palermo T.M., Valrie C.R., Karlson C.W. Family and parent influences on pediatric chronic pain: A developmental perspective. Am. Psychol. 2014;69:142–152. doi: 10.1037/a0035216.
    1. Chow E.T., Otis J.D., Simons L.E. The longitudinal impact of parent distress and behavior on functional outcomes among youth with chronic pain. J. Pain. 2016;17:729–738. doi: 10.1016/j.jpain.2016.02.014.
    1. Simons L.E., Smith A., Kaczynski K., Basch M. Living in fear of your child’s pain: The Parent Fear of Pain Questionnaire. Pain. 2015;156:694–702. doi: 10.1097/j.pain.0000000000000100.
    1. Hayes S.C., Strosahl K.D., Wilson K.G. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. 2nd ed. Guilford Press; New York, NY, USA: 2012.
    1. Zettle R.D. The Evolution of a Contextual Approach to Therapy: From Comprehensive Distancing to ACT. Int. J. Behav. Consult. Ther. 2005;1:77–89. doi: 10.1037/h0100736.
    1. Biglan A., Hayes S.C. Should the behavioral sciences become more pragmatic? The case for functional contextualism in research on human behavior. Appl. Prev. Psychol. 1996;5:47–57. doi: 10.1016/S0962-1849(96)80026-6.
    1. Noel M., Petter M., Parker J.A., Chambers C.T. Cognitive Behavioral Therapy for Pediatric Chronic Pain: The Problem, Research, and Practice. J. Cogn. Psychother. 2012;26:143–156. doi: 10.1891/0889-8391.26.2.143.
    1. Palermo T.M., Law E.F., Bromberg M., Fales J., Eccleston C., Wilson A.C. Problem Solving Skills Training for Parents of Children with Chronic Pain: A Pilot Randomized Controlled Trial. Pain. 2016;157:1213–1223. doi: 10.1097/j.pain.0000000000000508.
    1. Hayes S.C., Bissett R., Korn Z., Zettle R.D., Rosenfarb I., Cooper L., Grundt A. The impact of acceptance versus control rationales on pain tolerance. Psychol. Rec. 1999;49:33–47.
    1. Keogh E., Bond F.W., Hanmer R., Tilston J. Comparing acceptance- and control-based coping instructions on the cold-pressor pain experiences of healthy men and women. Eur. J. Pain. 2005;9:591–598. doi: 10.1016/j.ejpain.2004.12.005.
    1. McMullen J., Barnes-Holmes D., Barnes-Holmes Y., Stewart I., Luciano C., Cochrane A. Acceptance versus distraction: Brief instructions, metaphors and exercises in increasing tolerance for self-delivered electric shocks. Behav. Res. Ther. 2008;46:122–129. doi: 10.1016/j.brat.2007.09.002.
    1. Gutiérrez O., Luciano C., Rodríguez M., Fink B.C. Comparison between an acceptance-based and a cognitive-control-based protocol for coping with pain. Behav. Ther. 2004;35:767–783. doi: 10.1016/S0005-7894(04)80019-4.
    1. Masedo A.I., Esteve M.R. Effects of suppression, acceptance and spontaneous coping on pain tolerance, pain intensity and distress. Behav. Res. Ther. 2007;45:199–209. doi: 10.1016/j.brat.2006.02.006.
    1. Branstetter-Rost A., Cushing C., Douleh T. Personal values and pain tolerance: Does a values intervention add to acceptance? J. Pain. 2009;10:887–892. doi: 10.1016/j.jpain.2009.01.001.
    1. Vowles K.E., McNeil D.W., Gross R.T., McDaniel M.L., Mouse A., Bates M., Gallimore P., McCall C. Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behav. Ther. 2007;38:412–425. doi: 10.1016/j.beth.2007.02.001.
    1. Páez-Blarrina M., Luciano C., Gutiérrez-Martínez O., Valdivia S., Ortega J., Rodríguez-Valverde M. The role of values with personal examples in altering the functions of pain: Comparison between acceptance-based and cognitive-control-based protocols. Behav. Res. Ther. 2008;46:84–97. doi: 10.1016/j.brat.2007.10.008.
    1. McCracken L.M., Vowles K.E. Acceptance and Commitment Therapy and mindfulness for chronic pain: Model, process, and progress. Am. Psychol. 2014;69:178–187. doi: 10.1037/a0035623.
    1. Wicksell R.K., Dahl J., Magnusson B., Olsson G.L. Using acceptance and commitment therapy in the rehabilitation of an adolescent female with chronic pain: A case example. Cogn. Behav. Pract. 2005;12:415–423. doi: 10.1016/S1077-7229(05)80069-0.
    1. Vowles K.E., Sowden G., Ashworth J. A comprehensive examination of the model underlying acceptance and commitment therapy for chronic pain. Behav. Ther. 2014;45:390–401. doi: 10.1016/j.beth.2013.12.009.
    1. LMcCracken M., Vowles K.E., Eccleston C. Acceptance of chronic pain: Component analysis and a revised assessment method. Pain. 2004;107:159–166. doi: 10.1016/j.pain.2003.10.012.
    1. Weiss K.E., Hahn A., Wallace D.P., Biggs B., Bruce B.K., Harrison T.E. Acceptance of pain: Associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program. J. Pediatr. Psychol. 2013;38:756–765. doi: 10.1093/jpepsy/jst028.
    1. Kalapurakkel S., Carpino E.A., Lebel A., Simons L.E. ‘pain can’t stop Me’: Examining pain self-efficacy and acceptance as resilience processes among youth with chronic headache. J. Pediatr. Psychol. 2014;40:926–933. doi: 10.1093/jpepsy/jsu091.
    1. Hayes S.C., Shenk C. Operationalizing Mindfulness Without Unnecessary Attachments. Clin. Psychol. Sci. Pract. 2006;11:249–254. doi: 10.1093/clipsy.bph079.
    1. McCracken L.M., Gauntlett-Gilbert J., Vowles K.E. The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain. 2007;131:63–69. doi: 10.1016/j.pain.2006.12.013.
    1. McCracken L.M. Committed action: An application of the psychological flexibility model to activity patterns in chronic pain. J. Pain. 2013;14:828–835. doi: 10.1016/j.jpain.2013.02.009.
    1. Vowles K., Fink B., Cohen L. Acceptance and Commitment Therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability. J. Context. Behav. Sci. 2014;3:74–80. doi: 10.1016/j.jcbs.2014.04.003.
    1. Vowles K.E., Thompson M. Acceptance and Commitment Therapy for chronic pain. In: McCracken L.M., editor. Mindfulness and Acceptance in Behavioral Medicine: Current Theory and Practice. New Harbinger Publications; Oakland, CA, USA: 2011. pp. 31–60.
    1. Wicksell R.K., Olsson G.L., Hayes S.C. Mediators of change in acceptance and commitment therapy for pediatric chronic pain. Pain. 2011;152:2792–2801. doi: 10.1016/j.pain.2011.09.003.
    1. Smith A.M., Sieberg C.B., Odell S., Randall E., Simons L.E. Living Life With My Child’s Pain. Clin. J. Pain. 2015;31:633–641. doi: 10.1097/AJP.0000000000000140.
    1. Wallace D.P., McCracken L.M., Weiss K.E., Harbeck-Weber C. The role of parent psychological flexibility in relation to adolescent chronic pain: Further instrument development. J. Pain. 2015;16:235–246. doi: 10.1016/j.jpain.2014.11.013.
    1. Wicksell R.K., Melin L., Lekander M., Olsson G.L. Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain—A randomized controlled trial. Pain. 2009;141:248–257. doi: 10.1016/j.pain.2008.11.006.
    1. Casier A., Goubert L., Theunis M., Huse D., de Baets F., Matthys D., Crombez G. Acceptance and well-being in adolescents and young adults with cystic fibrosis: A prospective study. J. Pediatr. Psychol. 2011;36:476–487. doi: 10.1093/jpepsy/jsq111.
    1. Arch J.J., Craske M.C. Acceptance and Committment Therapy and Cognitive Behavioral Therapy for anxiety disorders: Different treatments, similar mechanisms? Clin. Psychol. Sci. Pract. 2008;15:263–279. doi: 10.1111/j.1468-2850.2008.00137.x.
    1. Kallesøe K.H., Schröder A., Wicksell R.K., Fink P., Ørnbøl E., Rask C.U. Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial. BMJ Open. 2016;6:e012743. doi: 10.1136/bmjopen-2016-012743.
    1. Wicksell R.K., Kanstrup M., Kemani M.K., Holmström L., Olsson G.L. Acceptance and Commitment Therapy for children and adolescents with physical health concerns. Curr. Opin. Psychol. 2015;2:1–5. doi: 10.1016/j.copsyc.2014.12.029.
    1. Halliburton A.E., Cooper L.D. Applications and adaptations of Acceptance and Commitment Therapy (ACT) for adolescents. J. Context. Behav. Sci. 2014;4:1–11. doi: 10.1016/j.jcbs.2015.01.002.
    1. Murrell A.R., Coyne L.W., Wilson K.G. ACT with children, adolescents, and their parents. In: Hayes S.C., Strosahl K.D., editors. A Practical Guide to Acceptance and Commitment Therapy. Springer; New York, NY, USA: 2005.
    1. Palermo T.M., Chambers C.T. Parent and family factors in pediatric chronic pain and disability: An integrative approach. Pain. 2005;119:1–4. doi: 10.1016/j.pain.2005.10.027.
    1. Wicksell R.K., Melin L., Olsson G.L. Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain—A pilot study. Eur. J. Pain. 2007;11:267–274. doi: 10.1016/j.ejpain.2006.02.012.
    1. Ghomian S., Shairi M.R. The Effectiveness of Acceptance and Commitment Therapy for Children with Chronic Pain on the Quality of Life on 7 to 12. Int. J. Pediatr. 2014;2:47–56.
    1. Gauntlett-Gilbert J., Connell H., Clinch J., Mccracken L.M. Acceptance and values-based treatment of adolescents with chronic pain: Outcomes and their relationship to acceptance. J. Pediatr. Psychol. 2013;38:72–81. doi: 10.1093/jpepsy/jss098.
    1. Martin S., Wolters P.L., Toledo-Tamula M.A., Schmitt S.N., Baldwin A., Starosta A., Gillespie A., Widemann B. Acceptance and commitment therapy in youth with neurofibromatosis type 1 (NF1) and chronic pain and their parents: A pilot study of feasibility and preliminary efficacy. Am. J. Med. Genet. Part A. 2016;170:1462–1470. doi: 10.1002/ajmg.a.37623.
    1. Wallace D.P., Woodford B., Connelly M. Promoting psychological flexibility in parents of adolescents with chronic pain: Pilot study of an 8-week group intervention. Clin. Pract. Pediatr. Psychol. 2016;4:405–416. doi: 10.1037/cpp0000160.
    1. Greco L.A., Lambert W., Baer R.A. Psychological inflexibility in childhood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychol. Assess. 2008;20:93–102. doi: 10.1037/1040-3590.20.2.93.
    1. Greco L.A., Baer R.A., Smith G.T. Assessing mindfulness in children and adolescents: Development and validation of the Child and Adolescent Mindfulness Measure (CAMM) Psychol. Assess. 2011;23:606–614. doi: 10.1037/a0022819.
    1. Cheron D.M., Ehrenreich J.T., Pincus D.B. Assessment of parental experiential avoidance in a clinical sample of children with anxiety disorders. Child Psychiatry Hum. Dev. 2009;40:383–403. doi: 10.1007/s10578-009-0135-z.
    1. McCracken L.M., Gauntlett-Gilbert J., Eccleston C. Acceptance of pain in adolescents with chronic pain: Validation of an adapted assessment instrument and preliminary correlation analyses. Eur. J. Pain. 2010;14:316–320. doi: 10.1016/j.ejpain.2009.05.002.
    1. Wallace D.P., Harbeck-Weber C., Whiteside S.P.H., Harrison T.E. Adolescent acceptance of pain: Confirmatory factor analysis and further validation of the chronic pain acceptance Questionnaire, Adolescent version. J. Pain. 2011;12:591–599. doi: 10.1016/j.jpain.2010.11.004.
    1. McCracken L.M., Gauntlett-Gilbert J. Role of psychological flexibility in parents of adolescents with chronic pain: Development of a measure and preliminary correlation analyses. Pain. 2011;152:780–785. doi: 10.1016/j.pain.2010.12.001.
    1. Walker L.S., Levy R.L., Whitehead W.E. Validation of a measure of protective parent responses to children’s pain. Clin. J. Pain. 2006;22:712–716. doi: 10.1097/01.ajp.0000210916.18536.44.
    1. Simons L.E., Sieberg C.B., Kaczynski K.J. Measuring parent beliefs about child acceptance of pain: A preliminary validation of the Chronic Pain Acceptance Questionnaire, parent report. Pain. 2011;152:2294–2300. doi: 10.1016/j.pain.2011.06.018.
    1. Society of Clinical Psychology . Acceptance and Committment Therapy for Chronic Pain. American Psychological Association; Washington, DC, USA: 2013. [(accessed on 21 May 2015)]. Available online: .
    1. Vowles K., McCracken L., Sowden G., Ashworth J. Psychological flexibility in coping with chronic pain: Further examination of the brief pain coping inventory-2. Clin. J. Pain. 2014;30:324–330. doi: 10.1097/AJP.0b013e31829ea187.
    1. McCracken L.M., Vowles K.E. Psychological flexibility and traditional pain management strategies in relation to patient functioning with chronic pain: An examination of a revised instrument. J. Pain. 2007;8:700–707. doi: 10.1016/j.jpain.2007.04.008.
    1. McCracken L.M., Yang S. The role of values in a contextual cognitive-behavioral approach to chronic pain. Pain. 2006;123:137–145. doi: 10.1016/j.pain.2006.02.021.
    1. Jensen M.P., Vowles K.E., Johnson L.E., Gertz K.J. Living well with pain: Development and preliminary evaluation of the Valued Living Scale. Pain Med. 2015;16:2109–2120. doi: 10.1111/pme.12802.
    1. Pielech M., Bailey R.W., McEntee M.L., Ashworth J., Levell J., Sowden G., Vowles K.E. Preliminary evaluation of the values tracker: A two-item measure of engagement in valued activities in those with chronic pain. Behav. Modif. 2016;40:239–256. doi: 10.1177/0145445515616911.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi