Trompetter Hester R, Bohlmeijer Ernst T, Lamers Sanne M A, Schreurs Karlein M G
Centre for eHealth and Wellbeing, Department of Psychology, Health and Technology, University of Twente Enschede, Netherlands.
Centre for eHealth and Wellbeing, Department of Psychology, Health and Technology, University of TwenteEnschede, Netherlands; Roessingh Research and DevelopmentEnschede, Netherlands.
Front Psychol. 2016 Mar 11;7:353. doi: 10.3389/fpsyg.2016.00353. eCollection 2016.
The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.
基于网络提供心理社会干预措施，对于患有慢性疼痛以及其他形式身心疾病的人来说，是一种很有前景的治疗方式。尽管早期研究取得了令人鼓舞的结果，但患者从全面的基于网络的心理社会治疗中获得的益处可能存在差异。我们缺乏关于基于网络干预期间变化的调节因素和预测因素的知识，这些因素可以解释基于网络的干预措施对哪些人特别有效或无效。在这项研究中，我们主要探讨在一项大型三臂随机对照试验中，基于网络的接纳与承诺疗法（ACT）对哪些慢性疼痛患者有效或无效。除了标准的人口统计学、身体和心理社会因素外，我们还关注积极的心理健康。对来自荷兰普通人群的238名诊断各异的慢性疼痛患者的数据进行了分析，这些患者分别接受了基于网络的ACT（n = 82），或两种对照条件之一[基于网络的表达性写作（EW；n = 79）和等待名单（WL；n = 77）]。ACT和EW都由九个模块组成，持续九到十二周。使用SPSS中的PROCESS宏进行探索性线性回归分析。根据基线调节因素（与其他治疗相比影响特定治疗结果的特征）和预测因素（无论治疗如何都影响结果的特征）变量预测3个月随访时的疼痛干扰情况。结果表明，与两种对照条件相比，没有任何人口统计学或身体特征能够调节ACT治疗的变化。与EW和WL相比，唯一显著的变化调节因素是基线心理健康状况，与EW相比，疼痛强度是变化的调节因素。此外，更高的疼痛干扰、抑郁和焦虑，以及更低的情绪幸福感预示着6个月后日常生活中更高的疼痛干扰。这些结果表明，基于网络的自助式ACT可能不适用于心理韧性资源水平较低（如自我接纳、生活目标和环境掌控能力）的慢性疼痛患者。还确定了其他可能需要对（基于网络的）ACT进行特定调整的亚组。在后续关于慢性疼痛和疾病的研究中，情绪和心理健康应得到更多关注。
