Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Pain. 2018 Apr;159(4):663-672. doi: 10.1097/j.pain.0000000000001134.
One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change. One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy (ACT) with its focus on increasing psychological flexibility (PF). The aim of the present study was to examine the role of PF as a mechanism of change in ACT. This is based on mediation analyses of data from a previously reported randomized controlled trial, evaluating the effectiveness of an ACT-based online intervention for chronic pain (ACTonPain). We performed secondary analyses on pretreatment, posttreatment, and follow-up data from 302 adults, receiving a guided (n = 100) or unguided (n = 101) version of ACTonPain, or allocated to the waitlist control group (n = 101). Structural equation modelling and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment through pretreatment and posttreatment changes in the latent construct reflecting PF. The latent construct consisted of data from the Chronic Pain Acceptance Questionnaire and the Acceptance and Action Questionnaire. The outcomes were pretreatment to follow-up changes in pain interference, anxiety, depression, pain, and mental and physical health. Structural equation modelling analyses revealed that changes in PF significantly mediated pretreatment to follow-up changes in all outcomes in the intervention groups compared with waitlist (standardized estimates ranged from I0.16I to I0.69I). Global model fit yielded modest but acceptable results. Findings are consistent with the theoretical framework behind ACT and contribute to growing evidence, supporting a focus on PF to optimize treatment effects.
提高慢性疼痛治疗效果的一种方法是识别和改善治疗效果变化的控制机制。一种包含特定提出机制的治疗方法是接受和承诺疗法（ACT），其重点是提高心理灵活性（PF）。本研究的目的是检验 PF 作为 ACT 变化机制的作用。这是基于对先前报告的一项随机对照试验数据的中介分析，该试验评估了基于 ACT 的慢性疼痛在线干预（ACTonPain）的有效性。我们对 302 名成年人的预处理、后处理和随访数据进行了二次分析，他们接受了指导（n=100）或非指导（n=101）版本的 ACTonPain，或分配到等待名单对照组（n=101）。结构方程模型和偏校正自举方法用于通过反映 PF 的潜在结构的预处理和后处理变化来检验治疗的间接影响。潜在结构由慢性疼痛接受问卷和接受与行动问卷的数据组成。结果是从预处理到随访疼痛干扰、焦虑、抑郁、疼痛以及心理和身体健康的变化。结构方程模型分析表明，与等待名单相比，干预组中 PF 的变化显著中介了从预处理到随访的所有结果的变化（标准化估计值范围从 I0.16I 到 I0.69I）。总体模型拟合产生了适度但可接受的结果。研究结果与 ACT 的理论框架一致，并为越来越多的支持关注 PF 以优化治疗效果的证据做出了贡献。
