Vowles Kevin E, McNeil Daniel W, Gross Richard T, McDaniel Michael L, Mouse Angela, Bates Mick, Gallimore Paula, McCall Cindy
West Virginia University, Morgantown, WV, USA.
Behav Ther. 2007 Dec;38(4):412-25. doi: 10.1016/j.beth.2007.02.001. Epub 2007 Oct 10.
Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.
慢性疼痛的心理社会治疗是有效的。然而，有必要了解在确定这些治疗如何促成行为改变过程中所涉及的机制。控制策略和接纳策略是治疗中两个潜在的重要机制，尽管它们在方法上有显著差异。基于实验室的研究结果表明，与控制导向策略相比，接纳导向策略能显著提高疼痛耐受性和行为坚持性。然而，有必要在临床环境中直接研究接纳和控制的过程。本研究采用模拟实验设计，调查了三种简短指导方式（疼痛控制、疼痛接纳、持续练习）对74名慢性下腰痛患者身体功能障碍表现的影响。在控制了基线表现后，疼痛接纳组在一组7项标准化身体任务上的整体功能表现优于其他两组，而其他两组之间没有差异。此外，接纳组的功能障碍改善了16.3%，而疼痛控制组恶化了8.3%，持续练习组改善了2.5%。这些结果表明，接纳可能是慢性疼痛患者行为改变的关键过程。
