Behavior Medicine Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden Department of Psychology, University of Nevada, Reno, NV, USA.
Pain. 2011 Dec;152(12):2792-2801. doi: 10.1016/j.pain.2011.09.003. Epub 2011 Oct 11.
Even though psychological interventions are well established in the treatment of pediatric chronic pain, there is a clear need for further development, especially with severely disabled patients. However, optimizing effectiveness in psychological treatments for pain requires clarification of the mechanisms of action. Studies addressing change processes are scarce, however, particularly in relation to pediatric chronic pain. Acceptance and Commitment Therapy (ACT), as an extension of traditional cognitive behavior therapy, is essentially aimed at improving functioning by increasing the ability to act effectively in the presence of pain and distress, that is, psychological flexibility. ACT has shown promising results for both adult and pediatric chronic pain. In the present study, the mediators of change in an ACT-oriented treatment for pediatric chronic pain were examined using a bootstrapped cross product of coefficients approach. Pain interference and depression were used as outcome variables. Six different variables relevant to theories underlying ACT and cognitive behavior therapy were included in the analyses as possible mediators of change: pain impairment beliefs, pain reactivity, self-efficacy, kinesiophobia, catastrophizing, and pain intensity. Results illustrated that pain impairment beliefs and pain reactivity were the only variables that significantly mediated the differential effects of treatment on outcomes at follow-up. Also, these 2 mediators were shown to independently predict effects in outcome variables at follow-up while controlling for earlier effects in outcome, but only for the ACT condition. Although tentative, the pattern of results suggests that variables consistent with psychological flexibility mediate the effects of ACT-based interventions to improve functioning in patients with chronic debilitating pain.
尽管心理干预在儿童慢性疼痛的治疗中已得到充分证实，但显然仍需要进一步发展，尤其是对于严重残疾的患者。然而，要优化疼痛心理治疗的效果，就需要明确其作用机制。然而，针对疼痛变化过程的研究却很少，尤其是针对儿童慢性疼痛。接受与承诺疗法（ACT）作为传统认知行为疗法的延伸，其主要目的是通过提高在疼痛和痛苦存在的情况下有效行动的能力，即心理灵活性，来改善功能。ACT 已显示出对成人和儿童慢性疼痛都有良好的效果。在本研究中，使用 bootstrap 交叉乘积系数方法，对以 ACT 为导向的儿童慢性疼痛治疗的变化中介因素进行了检验。疼痛干扰和抑郁被用作结果变量。分析中纳入了与 ACT 和认知行为疗法基础理论相关的六个不同的可能变化中介变量：疼痛损害信念、疼痛反应性、自我效能感、运动恐惧、灾难化和疼痛强度。结果表明，疼痛损害信念和疼痛反应性是治疗对随访时结果的差异影响的唯一中介变量。此外，这 2 个中介变量在控制了早期结果的情况下，对随访时的结果变量具有独立的预测作用，但仅在 ACT 条件下。尽管结果还不确定，但这种模式表明，与心理灵活性一致的变量可以介导基于 ACT 的干预措施对改善慢性致残性疼痛患者功能的效果。
