Department of Psychology, Uppsala University, Uppsala, Sweden
Department of Psychology, Middlesex University, London, UK.
BMJ. 2022 Feb 28;376:e057212. doi: 10.1136/bmj-2021-057212.
Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called "third wave" CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.
慢性疼痛状况较为常见，对健康和幸福感有重大影响。认知行为疗法（CBT）可减轻这种影响，它是应用于慢性疼痛的最常见心理疗法。与此同时，CBT 仍在不断发展，现在包括有时被称为“第三波”CBT 的疗法。在本次综述中，我们研究了接受和承诺疗法（ACT）在慢性疼痛患者中的应用证据，ACT 是这种新一波或最新一代治疗方法的主要范例。我们确定了 25 项针对成人慢性疼痛的 ACT 随机对照试验。在纳入的试验中，对于疼痛干扰、残疾、抑郁和生活质量等关键结局，ACT 有从小到中等的治疗效果。三项研究提供了一些支持 ACT 治疗慢性疼痛的成本效益的证据。证据还支持了理论上一致的治疗效果变化过程（心理灵活性）在治疗结果中的中介作用。对结局的调节因素和预测因素的调查有限且不一致。未来，建议更注重基于过程的治疗。这应包括继续确定基于证据的治疗效果变化过程，以及更适合了解个体的体验和需求的研究方法。
