Cederberg Jenny Thorsell, Cernvall Martin, Dahl JoAnne, von Essen Louise, Ljungman Gustaf
Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Int J Behav Med. 2016 Feb;23(1):21-9. doi: 10.1007/s12529-015-9494-y.
Cognitive behavior therapy (CBT) is considered effective for chronic pain, but little is known about active treatment components. Although acceptance correlates with better health outcomes in chronic pain patients, no study has examined its mediating effect in an experimental design.
The aim of the present study is to investigate acceptance as a mediator in acceptance and commitment therapy (ACT), a third wave CBT intervention, for chronic pain.
A bootstrapped cross product of coefficients approach was used on data from a previously published RCT evaluating ACT for chronic pain. To address the specificity of acceptance as a mediator, anxiety and depression were also tested as mediators. Outcome variables were satisfaction with life and physical functioning. Two change scores, pre-assessment to 6-month follow-up (n = 53) and pre-assessment to 12-month follow-up (n = 32), were used.
Acceptance was found to mediate the effect of treatment on change in physical functioning from pre-assessment to follow-up at 6 months. Further, a trend was shown from pre-assessment to follow-up at 12 months. No indirect effect of treatment via acceptance was found for change in satisfaction with life.
This study adds to a small but growing body of research using mediation analysis to investigate mediating factors in the treatment of chronic pain. In summary, the results suggest that acceptance may have a mediating effect on change in physical functioning in ACT for persons with chronic pain. However, given the small sample size of the study, these findings need to be replicated.
认知行为疗法（CBT）被认为对慢性疼痛有效，但对于其有效治疗成分知之甚少。尽管接纳与慢性疼痛患者更好的健康结果相关，但尚无研究在实验设计中检验其介导作用。
本研究旨在探讨接纳在接纳与承诺疗法（ACT）（一种第三代CBT干预方法）治疗慢性疼痛中作为介导因素的作用。
对先前发表的一项评估ACT治疗慢性疼痛的随机对照试验（RCT）数据采用系数的自抽样交叉乘积法。为了检验接纳作为介导因素的特异性，还将焦虑和抑郁作为介导因素进行了测试。结果变量为生活满意度和身体功能。使用了两个变化分数，即从预评估到6个月随访（n = 53）以及从预评估到12个月随访（n = 32）。
研究发现接纳介导了治疗对从预评估到6个月随访期间身体功能变化的影响。此外，在从预评估到12个月随访期间呈现出一种趋势。未发现治疗通过接纳对生活满意度变化产生间接影响。
本研究补充了一小部分但数量在不断增加的利用中介分析来探究慢性疼痛治疗中介导因素的研究。总之，结果表明接纳可能在ACT治疗慢性疼痛患者的身体功能变化中具有介导作用。然而，鉴于本研究样本量较小，这些发现需要重复验证。
