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Casey MB, Takemasa S, O'Reilly T, Leamy M, Mc Kearney E, Buckley M, Smart KM, Segurado R, Lowry D, Flanagan D, Gopal H, Hearty C, Doody C. Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial. Eur J Pain 2024; 28:913-928. [PMID: 38348557 DOI: 10.1002/ejp.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/23/2023] [Accepted: 12/12/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) is a type of Cognitive Behavioural Therapy, which has demonstrated positive outcomes in individuals with chronic pain. The purpose of this study was to compare the effect of an 8-week programme combining Exercise with Acceptance and Commitment Therapy (ExACT) with a standalone supervised exercise programme at 1-year follow-up. METHODS One hundred and seventy-five people with chronic pain were randomly assigned to ExACT or supervised exercise only. The primary outcome was pain interference measured with the Brief Pain Inventory-Interference Scale. Secondary and treatment process outcomes included pain severity, depression, anxiety, pain catastrophizing, pain self-efficacy, fear avoidance, pain acceptance, committed action, healthcare utilization, patient satisfaction, and global impression of change. Estimates of treatment effects at 1-year follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. RESULTS Eighty-three participants (47.4%) returned the outcome measures at 1-year follow-up. No significant difference was observed between the groups for the primary outcome, pain interference. There was a statistically significant difference between the groups, in favour of ExACT for pain catastrophizing. Within group improvements that were observed within both groups at earlier timepoints were maintained at 1-year follow-up for many of the secondary and treatment process outcomes. ExACT group participants reported higher levels of satisfaction with treatment and global perceived change. CONCLUSIONS The study results showed no significant difference between the two groups for the primary outcome pain interference at 1-year follow-up. Future research could investigate factors that may predict and optimize outcomes from these types of intervention for people living with chronic pain. SIGNIFICANCE Few previous randomized controlled trials investigating ACT for chronic pain have included long-term follow-up. This study found that Exercise combined with ACT was not superior to supervised exercise alone for reducing pain interference at 1-year follow-up. Further research is necessary to identify key processes of therapeutic change and to explore how interventions may be modified to enhance clinical outcomes for people with chronic pain.
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Affiliation(s)
- M B Casey
- Department of Public Health & Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - S Takemasa
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
- Clinical Development, Clinical Development Centre, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - T O'Reilly
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Leamy
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - E Mc Kearney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M Buckley
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - K M Smart
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - R Segurado
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - D Lowry
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Flanagan
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - H Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Doody
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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2
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Wilkin K, Evans S, Van Niekerk L, Romano D, Fuller-Tyszkiewicz M, Knowles S, Chesterman S, Raven L, Mikocka-Walus A. Moving Towards Acceptance and Values: A Qualitative Study of ACTforIBD Compared to IBD Psychoeducation. J Clin Psychol Med Settings 2024; 31:245-257. [PMID: 38347385 PMCID: PMC11102374 DOI: 10.1007/s10880-023-09999-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 05/20/2024]
Abstract
The current study explored perspectives of those with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression on a hybrid acceptance and committment therapy (ACT) intervention, compared to an active control. This qualitative study was nested within a randomized controlled trial (RCT) where an experimental group received an 8-week blended delivery ACTforIBD intervention (four sessions telehealth, four sessions pre-recorded self-directed), while an active control group received a psychoeducation program of similar intensity. Semi-structured interviews were conducted post-intervention and at a 3-month follow-up. Themes were interpreted using reflexive thematic analysis. Twenty individuals participated; ten in each condition. Seven themes were constructed, including three shared themes between groups: I Am Worth Advocating For, Present Moment Is My Biggest Ally, and Ambivalence About Self-Directed Modules. Two themes were identified for the ACTforIBD group: Symptoms Are Going to Happen and Moving Toward Values while two themes identified from the ActiveControl group were: Reset and Refresh and It's Ok to Say No. Acceptance and values modules from ACTforIBD were perceived as useful in reducing psychological distress for those with IBD, while the ActiveControl group felt their program affirmed existing effective coping strategies. Access to external resources for self-directed modules and networking may increase engagement with content long term.
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Affiliation(s)
- Kathryn Wilkin
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leesa Van Niekerk
- School of Psychological Sciences, University of Tasmania, Churchill Avenue, Sandy Bay, Hobart, TAS, Australia
| | - Daniel Romano
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | | | - Simon Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan Chesterman
- School of Psychology, Deakin University, Geelong, Melbourne, VIC, Australia
| | - Leanne Raven
- Crohn's & Colitis Australia, Melbourne, VIC, Australia
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Nash A, Kaiser S, Ledwith S. Individual's experiences of adjusting to changes in body image after spinal cord injury: a literature review and thematic synthesis. Disabil Rehabil 2024; 46:1685-1698. [PMID: 37125687 DOI: 10.1080/09638288.2023.2202926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To understand how individuals experience and adjust to changes in body image after spinal cord injury (SCI). METHODS A systematic search using four databases identified eleven articles that met the inclusion criteria. The studies were critically appraised to determine quality. Interpretative thematic synthesis was used to explore adults' experiences of adjusting to changes in body image after SCI. RESULTS Three themes described the influence of sociocultural factors on body image: 'Sociocultural influences', 'Responses of others' and 'Experience of rehabilitation'. Six themes described individuals' experiences of body image. 'Loss and threat of difference', 'Discomfort and disconnection' and 'Resistance' negatively influenced body image. 'Reconnecting with the body and re-negotiating identity', 'Support network' and 'Challenging beliefs about disability' promoted positive body image. Adjustment was a dynamic process, influenced by interactions between individual, relational and sociocultural factors. CONCLUSIONS The physical impacts of SCI, individual's perceptions, relationships and sociocultural discourses influenced body image. Rehabilitation professionals could support adjustment to changes in body image by considering individual, relational and systemic influences. Furthermore, it is important to include an individual's support network within their care as social factors influenced body image experiences. Peer support could promote hope and challenge negative sociocultural beliefs about disability.
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Affiliation(s)
- Annabel Nash
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Sally Kaiser
- Midland Centre for Spinal Injuries, The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Susan Ledwith
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
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4
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VanLandingham HB, Ellison RL, Turchmanovych-Hienkel N, Alfonso D, Oh A, Kaseda ET, Basurto K, Tse PKY, Khan H. Neuropsychological assessment, intervention, and best practices for women with non-Central nervous system cancer: A scoping review of current standards. Clin Neuropsychol 2024:1-32. [PMID: 38641949 DOI: 10.1080/13854046.2024.2343147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Objective: Existing literature has sought to characterize the broad cognitive impact of non-central nervous system cancer and its treatment, including chemotherapy, radiation, surgery, and hormonal regulation. However, despite the frequency of women that are diagnosed with breast and gynecological cancer, there is limited research on the specific cognitive experiences of women undergoing cancer treatment. Presently, the current literature lacks concise guidance for neuropsychologists to support the cognitive health of women facing cancer, despite the acknowledged impact of cancer interventions and chronic illness on cognitive outcomes. Method: Applying scoping review criteria outlined by Peters et al. (2015) and adhering to Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a comprehensive examination of literature spanning multiple databases (Google Scholar, PubMed, PsychINFO) with a focus on the cognitive impact of cancer treatment on women. Conclusions: Women are subject to unique treatment-related outcomes due to the impact of hormonal alterations, differences in metabolization of certain chemotherapies, and psychosocial risk factors. Despite the known impact of cancer intervention, chronic illness, and cancer-related sequelae on cognitive outcomes, the current literature does not parsimoniously outline best practices for neuropsychologists to promote the health of women experiencing cancer. The current paper (1) provides an overview of the cognitive implications of cancer treatment with an intentional focus on cancers that are more prevalent in women versus men, (2) addresses the characteristics of this impact for women undergoing cancer intervention(s), and (3) provides possible intervention and treatment strategies for mental health providers and neuropsychologists.
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Affiliation(s)
- Hannah B VanLandingham
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachael L Ellison
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | | | - Demy Alfonso
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
| | - Alison Oh
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Erin T Kaseda
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Karen Basurto
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Phoebe K Y Tse
- Department of Psychology, The Chicago School, Chicago, IL, USA
| | - Humza Khan
- Department of Psychology, Northern Illinois University, DeKalb, IL, USA
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Adamowicz JL, Sirotiak Z, Thomas EB. Psychological flexibility and global health in young adults with and without a self-reported functional somatic syndrome: a preliminary investigation. PSYCHOL HEALTH MED 2023; 28:3091-3106. [PMID: 37227813 PMCID: PMC11062592 DOI: 10.1080/13548506.2023.2216940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
Functional somatic syndromes (FSS) are associated with functional impairments and distress. FSSs are common among young adults, and psychological flexibility may be a transdiagnostic process appropriate for treatment of FSS in this population. The objective of the current study was to compare physical and mental health in young adults with and without a self-reported FSS and examine which psychological flexibility processes are associated with better physical and mental health in the FSS subset. A total of 447 young adults participated in the current study. Individuals who reported an FSS diagnosis were coded as having a self-reported FSS. Physical and mental health and psychological flexibility were measured via self-report. FSS and non-FSS groups were compared regarding demographic characteristics and on the primary outcomes. Hierarchical regression analyses were conducted to examine the role of the psychological flexibility processes in physical and mental health in the FSS subset. Findings revealed that the FSS group scored significantly lower on measures of physical health and demonstrated less behavioral awareness than the non-FSS group. No differences regarding mental health were found. All three psychological flexibility processes were associated with physical and mental health, accounting for 26-49% of the variance in these outcomes. In conclusion, young adults with FSS experience more physical health difficulties than those without FSS. Psychological flexibility processes were related to better physical and mental health in those with FSS. These findings add to the literature and provide preliminary support for psychological flexibility as a future target for intervention development and implementation aimed at young adults with FSS.
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Affiliation(s)
| | - Zoe Sirotiak
- University of Iowa, Department of Psychological and Brain Sciences
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6
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Rose M, Graham CD, O'Connell N, Vari C, Edwards V, Taylor E, McCracken LM, Radunovic A, Rakowicz W, Norton S, Chalder T. A randomised controlled trial of acceptance and commitment therapy for improving quality of life in people with muscle diseases. Psychol Med 2023; 53:3511-3524. [PMID: 35192788 PMCID: PMC10277769 DOI: 10.1017/s0033291722000083] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/15/2021] [Accepted: 01/06/2022] [Indexed: 01/09/2023]
Abstract
UNLABELLED Abstract. BACKGROUND Chronic muscle diseases (MD) are progressive and cause wasting and weakness in muscles and are associated with reduced quality of life (QoL). The ACTMuS trial examined whether Acceptance and Commitment Therapy (ACT) as an adjunct to usual care improved QoL for such patients as compared to usual care alone. METHODS This two-arm, randomised, multicentre, parallel design recruited 155 patients with MD (Hospital and Depression Scale ⩾ 8 for depression or ⩾ 8 for anxiety and Montreal Cognitive Assessment ⩾ 21/30). Participants were randomised, using random block sizes, to one of two groups: standard medical care (SMC) (n = 78) or to ACT in addition to SMC (n = 77), and were followed up to 9 weeks. The primary outcome was QoL, assessed by the Individualised Neuromuscular Quality of Life Questionnaire (INQoL), the average of five subscales, at 9-weeks. Trial registration was NCT02810028. RESULTS 138 people (89.0%) were followed up at 9-weeks. At all three time points, the adjusted group difference favoured the intervention group and was significant with moderate to large effect sizes. Secondary outcomes (mood, functional impairment, aspects of psychological flexibility) also showed significant differences between groups at week 9. CONCLUSIONS ACT in addition to usual care was effective in improving QoL and other psychological and social outcomes in patients with MD. A 6 month follow up will determine the extent to which gains are maintained.
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Affiliation(s)
- Michael Rose
- Department of Neurology, King's College Hospital, Denmark Hill, Brixton, London, SE5 9RS, UK
| | - Christopher D. Graham
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast BT9 5BN, Northern Ireland
| | - Nicola O'Connell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Chiara Vari
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Victoria Edwards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Emma Taylor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Lance M. McCracken
- Department of Psychology, Uppsala University, Postal Box 1225, 751 42 Uppsala, Sweden
| | - Aleksander Radunovic
- Barts and the London MND Centre, Royal London Hospital, Whitechapel, London, EH1 1BB, UK
| | - Wojtek Rakowicz
- Wessex Neurological Service, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Inflammation Biology, Faculty of Life Sciences and Medicine, Centre for Rheumatic Disease, King's College London, Weston Education Centre, London, SE5 8AF, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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7
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Robinson A, De Boos D, Moghaddam N. Acceptance and commitment therapy (
ACT
) for people with dementia experiencing psychological distress: A hermeneutic single‐case efficacy design (
HSCED
) series. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023. [DOI: 10.1002/capr.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Affiliation(s)
- Amie Robinson
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Danielle De Boos
- Division of Psychiatry and Applied Psychology University of Nottingham B Floor Yang Fujia, Jubilee Campus Nottingham UK
| | - Nima Moghaddam
- College of Social Science University of Lincoln Brayford Pool Lincoln UK
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8
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Tunç H, Morris PG, Kyranides MN, McArdle A, McConachie D, Williams J. The relationships between valued living and depression and anxiety: A systematic review, meta-analysis, and meta-regression. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
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Wieringa G, Dale M, Eccles FJR. Adjusting to living with Parkinson's disease; a meta-ethnography of qualitative research. Disabil Rehabil 2022; 44:6949-6968. [PMID: 34592863 DOI: 10.1080/09638288.2021.1981467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Parkinson's disease (PD) is a condition which causes significant difficulties in physical, cognitive and psychological domains. It is a progressive condition which people have to live with for a long time; consequently, there is a need to understand what contributes to individual adjustment. This review aimed to answer the question "how do individuals adjust to PD?" METHOD A systematic search of three databases (MEDLINE, CINAHL and PsycINFO) was carried out of papers documenting the adjustment process when living with PD and the findings were synthesised using a meta-ethnographic approach. RESULTS After exclusion based on eligibility criteria, 21 articles were included and were assessed for quality prior to analysing the data. Three main themes are proposed relating to the process of adjustment: "maintaining a coherent sense of self", "feeling in control" and "holding a positive mindset". Although many of the studies described challenges of living with PD, the results are dominated by the determination of individuals to self-manage their condition and maintain positive wellbeing. CONCLUSION The results highlight the need to empower patients to self-manage their illness, mitigating the effects of Parkinson's disease and supporting future wellbeing.IMPLICATIONS FOR REHABILITATIONIndividual identity disruption impacts on the self-value and sense of self coherence in individuals living with Parkinson's disease.Healthcare professionals should appreciate the complexity of the adjustment process which is related to the ability to maintain a coherent sense of self, to feel in control and to hold a positive mindset.Healthcare professionals should ensure information and knowledge related to self-management is tailored to an individual's understanding and experience of the disease.
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Affiliation(s)
- Gina Wieringa
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
| | - Maria Dale
- Leicestershire Partnership NHS Trust, Mill Lodge, Leicestershire, UK
| | - Fiona J R Eccles
- Faculty of Health and Medicine, Division of Health Research, Furness College, Lancaster University, Lancaster, UK
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Maras D, Balfour L, Lefebvre M, Tasca GA. Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre. RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:634. [PMID: 36052881 PMCID: PMC9893049 DOI: 10.4081/ripppo.2022.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023]
Abstract
Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.
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Affiliation(s)
- Danijela Maras
- School of Psychology, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N 6N5 Canada.
| | - Louise Balfour
- School of Psychology, Faculty of Medicine, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Monique Lefebvre
- School of Psychology, University of Ottawa; The Ottawa Hospital; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Giorgio A. Tasca
- School of Psychology, Faculty of Medicine, University of Ottawa; and The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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11
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Casey MB, Smart KM, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. Exercise combined with Acceptance and Commitment Therapy compared with a standalone supervised exercise programme for adults with chronic pain: a randomised controlled trial. Pain 2022; 163:1158-1171. [PMID: 34913883 DOI: 10.1097/j.pain.0000000000002487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
ABSTRACT A prospective, 2-armed, parallel group randomised controlled trial (RCT) was conducted to compare the effectiveness of Acceptance and Commitment Therapy (ACT) combined with a supervised exercise programme with a supervised exercise programme alone for adults with chronic pain. One hundred seventy-five participants were individually randomised to receive either the combined Exercise and ACT (ExACT) intervention or supervised exercise alone. Those allocated to the ExACT group attended 8 weekly sessions with a psychologist based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group attended weekly supervised exercise classes but did not take part in an ACT programme. Both groups were followed up postintervention and again after 12 weeks. The primary outcome was pain interference at 12-week follow-up. Estimates of treatment effects at follow-up were based on intention-to-treat analyses, implemented using a linear mixed-effects model. The findings of this RCT showed no difference in the effectiveness of ExACT, compared with a supervised exercise programme alone for the primary outcome pain interference at 12-week follow-up (mean difference -0.18, 95% confidence interval -0.84 to 0.48, P = 0.59, d = 0.11). ExACT group participants reported superior outcomes for pain self-efficacy, pain catastrophising, and committed action, compared with the control group, but there were no differences between the groups for other secondary outcomes or treatment process measures. Higher levels of treatment satisfaction and global impression of change were reported by ExACT group participants. Exercise combined with Acceptance and Commitment Therapy was not superior to a standalone supervised exercise programme for reducing pain interference in adults with chronic pain.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Keith M Smart
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Damien Lowry
- Department of Psychology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Lance McCracken
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
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Lavelle J, Storan D, Eswara Murthy V, De Dominicis N, Mulcahy HE, McHugh L. Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies. J Clin Med 2022; 11:2757. [PMID: 35628884 PMCID: PMC9145285 DOI: 10.3390/jcm11102757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 12/12/2022] Open
Abstract
Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.
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Affiliation(s)
- Joseph Lavelle
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Darragh Storan
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Varsha Eswara Murthy
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
| | - Noemi De Dominicis
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
| | - Hugh E. Mulcahy
- Department of Gastroenterology, Saint Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (D.S.); (N.D.D.); (H.E.M.)
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Louise McHugh
- School of Psychology, University College Dublin, D04 V1W8 Dublin, Ireland; (V.E.M.); (L.M.)
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13
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O'Connor S, Hevey D, O'Keeffe F. Illness Perceptions, Coping, Health-Related Quality of Life and Psychological Outcomes in Cervical Dystonia. J Clin Psychol Med Settings 2022; 30:129-142. [PMID: 35438357 PMCID: PMC10042972 DOI: 10.1007/s10880-022-09851-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/03/2023]
Abstract
This study examined the predictive ability of the Common-Sense Model to explain psychological outcomes in cervical dystonia, a movement disorder that affects the muscles of the head and neck. Illness Perceptions Questionnaire-Revised, brief COPE, Hospital Anxiety and Depression Scale, Cervical Dystonia Impact Profile and the Post-Traumatic Growth Inventory were completed by 118 people with cervical dystonia. Correlations and hierarchical multiple regression models were conducted. Illness perceptions and coping strategies explained 59% of variance in anxiety, 61% of variance in depression and health-related quality of life and 19% of variance in post-traumatic growth. Illness perceptions and coping strategies are significant factors to consider in terms of psychological adjustment and outcomes in cervical dystonia. Psychological interventions targeting illness perceptions and coping strategies may be beneficial in improving psychological outcomes for people with cervical dystonia.
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Affiliation(s)
- Sarah O'Connor
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- School of Psychology, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, St Vincent's University Hospital, Dublin, Ireland
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Moran O, Doyle J, Giggins O, McHugh L, Gould E, Smith S, Gavin S, Sojan N, Boyle G. Efficacy of a Digital Acceptance and Commitment Therapy Intervention for the Improvement of Self-management Behaviors and Psychological Flexibility in Adults With Cardiac Disease: Protocol for a Single Case Experimental Design. JMIR Res Protoc 2022; 11:e33783. [PMID: 35363156 PMCID: PMC9015764 DOI: 10.2196/33783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease. OBJECTIVE The objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions. METHODS The digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants' experiences with using the intervention and what factors contribute to or impede successful outcomes. RESULTS Participant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022. CONCLUSIONS The findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/33783.
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Affiliation(s)
- Orla Moran
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Julie Doyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Oonagh Giggins
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Louise McHugh
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Evelyn Gould
- Harvard Medical School, Boston, MA, United States
| | - Suzanne Smith
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Shane Gavin
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Nisanth Sojan
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
| | - Gordon Boyle
- NetwellCASALA, Dundalk Institute of Technology, Dundalk, Ireland
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15
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Sathananthan N, Morris EMJ, Gillanders D, Knox L, Dimech-Betancourt B, Wright BJ, das Nair R, Wong D. Does Integrating Cognitive and Psychological Interventions Enhance Wellbeing After Acquired Brain Injury? Study Protocol for a Phase II Randomized Controlled Trial of the VaLiANT (Valued Living After Neurological Trauma) Group Program. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:815111. [PMID: 36188858 PMCID: PMC9397748 DOI: 10.3389/fresc.2021.815111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022]
Abstract
Background and Objectives Cognitive and emotional changes affect the majority of individuals with acquired brain injury (ABI) and are associated with poorer outcomes. The evidence for “siloed” rehabilitation approaches targeting cognition and mood separately remains mixed. Valued living (i.e., acting consistently with personal values) is associated with better psychological functioning and participation in work and other productive activities. Rehabilitation interventions that concurrently address cognitive and emotional barriers to valued living may therefore result in improved outcomes. VaLiANT (Valued Living After Neurological Trauma) is an 8-week group intervention developed by our team, which uniquely combines cognitive rehabilitation and psychological therapy to improve wellbeing and meaningful participation (i.e., valued living) following ABI. Method This protocol describes the design and implementation of a Phase II parallel-group randomized controlled trial with blinded outcome assessors, to evaluate the potential efficacy of VaLiANT and the feasibility of a Phase III trial. Participants are adults with a history of ABI at least 3 months prior to study entry, who experience cognitive and/or emotional difficulties and associated reduced participation in valued activities. Random allocation to the treatment condition (8-week VaLiANT group program) or a usual care waitlist control condition occurs at a 2:1 treatment: control ratio. The primary outcome is wellbeing, measured by the Warwick-Edinburgh Mental Wellbeing Scale. Secondary outcomes include measures of valued living, mood, cognitive complaints, quality of life, community participation, post-traumatic growth, and self-efficacy. All measures are collected across three time points by blinded assessors (baseline, 8-week follow-up, 16-week follow-up). Trial feasibility will be evaluated against recruitment rates, drop-out rates, intervention acceptability, and treatment fidelity (manual adherence and therapist competence). Discussion This trial will extend current knowledge on how to improve long-term outcomes following ABI by evaluating an innovative integrated, multi-domain approach to rehabilitation concurrently addressing cognitive and emotional barriers to participation in meaningful life roles.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Eric M. J. Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - Bradley J. Wright
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Roshan das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- *Correspondence: Dana Wong
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16
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Sathananthan N, Dimech-Betancourt B, Morris E, Vicendese D, Knox L, Gillanders D, Das Nair R, Wong D. A single-case experimental evaluation of a new group-based intervention to enhance adjustment to life with acquired brain injury: VaLiANT (valued living after neurological trauma). Neuropsychol Rehabil 2021; 32:2170-2202. [PMID: 34433379 DOI: 10.1080/09602011.2021.1971094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adjustment to life with acquired brain injury (ABI) requires self-identity and behaviour to be updated, incorporating injury-related changes. Identifying and enabling new values-consistent behaviours could facilitate this process. We evaluated the feasibility, acceptability, and preliminary efficacy of VaLiANT, a new group intervention that aims to enhance "valued living" following ABI. We used a non-concurrent multiple baseline single-case experimental design (SCED) with an 8-week follow-up phase and randomization to multiple baseline lengths (5-7 weeks). Eight participants (50% women, aged 26-65; 4 Stroke, 3 Traumatic Brain Injury, 1 Epilepsy) attended eight group sessions with assessments before, during, and after the group. Target behaviour was valued living, assessed weekly by the Valued Living Questionnaire. Secondary outcomes included measures of wellbeing, mood, psychological acceptance, self-efficacy regarding ABI consequences, cognitive complaints, and intervention acceptability. Target behaviour was analysed through visual and statistical analysis while secondary outcome data were analysed via reliable change indices and descriptive statistics. Target behaviour data displayed no convincing patterns of improvement. Reliable improvements were found for most participants on secondary outcomes, particularly subjective wellbeing and anxiety. Intervention delivery was feasible with high acceptability ratings. Further investigation of VaLiANT is warranted, based on the feasibility and acceptability of intervention delivery and signals of efficacy identified across adjustment-related secondary outcomes.
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Affiliation(s)
- Nick Sathananthan
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Don Vicendese
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Lucy Knox
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David Gillanders
- School of Health in Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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Depping MK, Uhlenbusch N, Löwe B. Acceptance and commitment therapy meets peer-support. Development of a supportive self-care intervention for patients with rare diseases: a multistage development process. BMJ Open 2021; 11:e042856. [PMID: 34215596 PMCID: PMC8256734 DOI: 10.1136/bmjopen-2020-042856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed at developing a patient-centred self-help programme, tailored to the needs of patients with rare chronic diseases. DESIGN Multistage, multimethod development process including a survey with validated self-report scales and open-ended questions (phase 1) and focus groups (phase 2) for needs assessment and, consolidating the first phases and the literature, the intervention development (phase 3). SETTING Phase 1: nationwide online survey in Germany, phase 2: four separate and diagnostically homogeneous focus groups. The focus groups took place at a university medical centre in Germany. PARTICIPANTS Target group were patients with rare diseases that occur at a prevalence <1:2000. Phase 1: n=300 participants with different rare diseases. Phase 2: Individuals with neurofibromatosis type 1 (n=4), primary sclerosing cholangitis (n=5), pulmonary arterial hypertension (n=4) and Marfan syndrome (n=5). RESULTS The central results of phases 1 and 2 were requests for more information about the disease and contact with other affected persons. Patients also expressed support needs in dealing with difficult emotions and identified acceptance of the disease as a turning point for quality of life. In phase 3, we identified acceptance and commitment therapy (ACT) as a suitable therapeutic approach and determined details about implementation and execution of self-management programmes. A 6-week self-help concept led by peer counsellors was developed, which includes disease-specific information and ACT-based exercises. CONCLUSION Based on a multistage needs assessment, we developed a peer-guided self-help intervention for patients with rare chronic diseases. Combining self-management, peer-counselling and ACT may help living with a rare condition. Further research needs to test the programme's efficacy. TRIAL REGISTRATION NUMBER ISRCTN13738704.
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Affiliation(s)
- Miriam K Depping
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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18
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Meek C, Moghaddam NG, Evangelou N, Oates LL, Topcu G, Allen C, das Nair R. Acceptance-based telephone support around the time of transition to secondary progressive multiple sclerosis: A feasibility randomised controlled trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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19
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EVLİ M, ŞİMŞEK N. Effect of acceptance and commitment-based counseling on smoking cessation and quality of life. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.837634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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20
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Batchelor R, Taylor MD. Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality. Epilepsy Behav 2021; 118:107911. [PMID: 33773441 DOI: 10.1016/j.yebeh.2021.107911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND People with epilepsy (PWE) are at an increased risk of anxiety, depression, and suicidality. Young adulthood is a critical developmental period which can be complicated by the unique challenges of having epilepsy. The risk factors of mental health difficulties in young adults with epilepsy (YAWE) have not been investigated. AIMS To examine the relationships between psychosocial variables (coping strategies and sources of social support) and mental health outcomes in YAWE, and determine whether these psychosocial variables independently predict mental health outcomes after controlling for sociodemographic and epilepsy-related factors. METHOD An online survey was completed by 144 YAWE (18-25-year-olds), which measured sociodemographic and epilepsy-related factors, coping strategies, sources of social support, and current mental health symptoms (anxiety, depression, and suicidality). RESULTS Avoidant-focused coping was positively correlated, and problem-focused coping and meaning-focused coping were negatively correlated, with symptoms of anxiety, depression, and suicidality. Social support from family, friends, and a special person all negatively correlated with mental health outcomes. Using multiple regression analyses, greater use of avoidant-focused coping strategies independently predicted higher symptoms of anxiety, depression, and suicidality. Greater support from friends independently predicted significantly lower anxiety and depression, whereas greater support from family independently predicted significantly lower suicidality. CLINICAL IMPLICATIONS These findings have implications for clinical practice in YAWE and suggest that screening for mental health symptoms and psychosocial variables to identify those at risk would be beneficial. Access to tailored psychological support is also needed.
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Affiliation(s)
| | - Michelle D Taylor
- Royal Holloway, University of London, Surrey, UK; Health Psychology Research Limited (HPR Ltd.), 188 Egham High Street, Surrey, UK
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21
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Iida H, Fujimoto S, Wakita T, Yanagi M, Suzuki T, Koitabashi K, Yazawa M, Kawarazaki H, Ishibashi Y, Shibagaki Y, Kurita N. Psychological Flexibility and Depression in Advanced CKD and Dialysis. Kidney Med 2020; 2:684-691.e1. [PMID: 33319193 PMCID: PMC7729231 DOI: 10.1016/j.xkme.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Rationale & Objective Depression is prevalent and highly associated with mortality among patients with chronic kidney disease (CKD). Psychological flexibility can be captured as acceptance in psychology, and its improvement by behavioral therapy is associated with reduced depression in some clinical settings. However, no study has been reported on patients with CKD. This study aimed to examine the association between psychological flexibility and depression in patients with CKD. Study Design Cohort study. Setting & Participants This multicenter study of 5 hospitals in Japan included patients with nondialysis stage 3-5 CKD or stage 5D CKD receiving hemodialysis or peritoneal dialysis. Predictor Psychological flexibility measured using the 7-item Acceptance and Action Questionnaire (AAQ-II). Outcomes The prevalence and incidence of depression after 1 year, which was defined by a score ≥ 16 points on the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Analytical Approach Gamma regression was used in the examination of correlates of the psychological flexibility value. Modified Poisson regression models were fit for the prevalence and incidence of depression. Results The cross-sectional and longitudinal analyses included 433 and 191 patients, respectively. Lower (ie, worse) psychological flexibility levels were associated with hemodialysis and peritoneal dialysis. Higher (ie, better) psychological flexibility levels were associated with lower prevalence of depression (per 5-point increase; adjusted prevalence ratio, 0.75; 95% CI, 0.70-0.80) and lower incidence of depression (per 5-point increase; adjusted risk ratio, 0.72; 95% CI, 0.61-0.85). Limitations Depression was assessed using the CES-D questionnaire. Cultural differences may exist in the interpretation of AAQ-II scores. Conclusions Better psychological flexibility was associated with lower prevalence and incidence of depression in patients with CKD. Further studies are warranted to determine the possible prevention and treatment of depression by the development of behavioral interventions to improve psychological flexibility.
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Affiliation(s)
- Hidekazu Iida
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,You Home Clinic, Tokyo, Japan
| | - Shino Fujimoto
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Mai Yanagi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tomo Suzuki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan.,Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Masahiko Yazawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroo Kawarazaki
- Department of Nephrology, Inagi Municipal Hospital, Tokyo, Japan
| | - Yoshitaka Ishibashi
- Division of Nephrology, Department of Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
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22
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Sauer C, Maatouk I. [Development and Evaluation of an Acceptance and Commitment Therapy (ACT)-Based Group Intervention for Cancer Patients with Psychological Burden]. Psychother Psychosom Med Psychol 2020; 71:90-98. [PMID: 32634840 DOI: 10.1055/a-1174-0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Cancer is associated with many psychosocial stressors that lead to high psychological distress in over 50% of patients. About one third of patients make use of psycho-oncological services. Acceptance and Commitment Therapy (ACT), a transdiagnostic approach of the third wave of cognitive behavioral therapy, represents a promising approach for psycho-oncological interventions. However, the German-speaking area lacks a manualized ACT-based group intervention that is tested for feasibility and effectiveness. METHODS To bridge this gap, we developed and preliminarily tested an ACT group intervention in this one-arm monocentric pilot study. It targets psychological burdened cancer patients in all disease stages. During 8 sessions, the ACT core processes mindfulness, values and acceptance are worked out by means of metaphors and experience-oriented exercises. RESULTS Pre-Post-Data of our pilot study with n=25 patients indicate reductions in fear of progression, depression and psychological inflexibility, as well as an increase in psychological health-related quality of life and well-being. Regression analyses showed that changes in psychological flexibility predicted changes in all psychological outcome measures. The very high adherence underlines the feasibility of the intervention for the integrated outpatient clinic setting. DISCUSSION Our pilot study provides first evidences for the good feasibility and effectiveness of an ACT-based group intervention in the German-speaking area. These results on effectivness should be interpreted with caution due to the lack of an experimental control group. CONCLUSION Future studies should test the effectiveness of the intervention in randomized controlled trials (RCTs) with longer follow-up periods.
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Affiliation(s)
- Christina Sauer
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg
| | - Imad Maatouk
- Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg
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Kibbey MM, DiBello AM, Babu AA, Farris SG. Validation of the Valuing Questionnaire (VQ) in adults with cardiovascular disease and risk. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Balabanovic J, Hayton P. Engaging patients with "medically unexplained symptoms" in psychological therapy: An integrative and transdiagnostic approach. Psychol Psychother 2020; 93:347-366. [PMID: 30618182 DOI: 10.1111/papt.12213] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Patients with "medically unexplained symptoms" or "MUS" experience subjectively compelling and distressing somatic symptoms that are not fully explained by underlying physical pathology. Effective treatment of these patients has been impeded by multiple barriers. Problems with patient engagement have been highlighted in the clinical and research literature, yet few exploratory studies have been conducted in this area. This research explores how experienced psychological therapists in a specialist MUS service work to engage these patients. DESIGN An in-depth qualitative study was conducted to explore the process of engaging patients with MUS in psychological therapy. METHOD Semi-structured depth interviews were conducted with psychological therapists who work with complex patients with MUS. The therapists interviewed were recruited from an NHS primary care psychological therapy service that specializes in working with this patient group. Data were analysed using grounded theory to develop a model of this process. RESULTS The analysis identified how multiple interacting layers of systemic, interpersonal, and intrapsychic disconnections impede engagement. The research introduces a new theoretical framework 'Negotiating disconnection' that conceptualizes the process of engagement in terms of a series of stages, namely 'Drawing in' (negotiating systemic disconnection), 'Meeting' (connecting in the disconnection), and 'Nudging Forward' (cultivating new connections), and illustrates how these are negotiated by therapists. CONCLUSIONS The model shows that it is critical for therapists to collaborate closely with GPs to engage these patients while also highlighting barriers to doing this, reflecting the complexities of organizational and cultural change. Clinically, the model illustrates the importance of adopting a flexible, pluralistic, and integrative approach that is person-centred and process-led. Doctors and therapists should embrace a holistic, biopsychosocial stance towards MUS and be sensitively attuned to its complex phenomenology. PRACTITIONER POINTS To engage patients with MUS psychological therapists should be person-centred and process-led rather than theory- or protocol-led. A pluralistic and integrative mindset facilitates this by enhancing clinicians' flexibility. A multidisciplinary approach is essential. Clinicians should embrace a biopsychosocial stance towards MUS and work closely with medical colleagues to help them do the same. Structural and cultural change is needed to tackle this issue effectively.
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Dulude E, Coutu MF, Durand MJ. Promoting resilience in work rehabilitation: development of a transdiagnostic intervention. Disabil Rehabil 2020; 43:3652-3662. [PMID: 32228191 DOI: 10.1080/09638288.2020.1744041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to develop an operationalized transdiagnostic resilience-based intervention for workers at risk of long-term work disability. METHODS A sequential mixed method design was used. Expert clinicians (n = 10) first answered a questionnaire including closed and open-ended questions on the clarity, applicability, relevance and exhaustiveness of a preliminary resilience intervention developed from evidenced-informed resilience factors to prompt reflection. Second, proposals from the questionnaire were discussed at a consensus group meeting with the same experts, yielding a final and improved intervention. Third, semi-structured interviews with work-disabled workers (n = 6) explored the intervention's acceptability to them. Thematic analysis of the verbatim was performed. RESULTS Experts identified 15 statements on clarity, applicability, relevance or exhaustiveness in the questionnaire that did not achieve consensus and generated 41 modification proposals. The consensus group adopted 15 modifications. The adapted intervention was well-accepted by the workers who had completed a work rehabilitation program. They perceived the intervention as positive, relevant, coherent, useful and consistent with their values. CONCLUSION A new transdiagnostic resilience intervention in work rehabilitation is available and was on exploratory basis seen acceptable by workers. Next step would be to validate it at a larger scale with more workers and other stakeholders.IMPLICATIONS FOR REHABILITATIONPromoting workers resilience in work rehabilitation fosters a holistic approach in clinical practice.Resilience interventions should be integrated into work rehabilitation programs.A new transdiagnostic resilience intervention designed to complement current work rehabilitation programs is available.
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Affiliation(s)
- Eve Dulude
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-France Coutu
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
| | - Marie-José Durand
- Centre de recherche Charles-Le Moyne-Saguenay-Lac-Saint-Jean sur les innovations en santé (CR-CSIS), Université de Sherbrooke ‒ Centre d'action en prévention et réadaptation de l'incapacité au travail (CAPRIT), Longueuil, Canada
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Individuals perspectives related to acceptance, values and mindfulness following participation in an acceptance-based pain management programme. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Shepherd L, Turner A, Reynolds DP, Thompson AR. Acceptance and commitment therapy for appearance anxiety: three case studies. Scars Burn Heal 2020; 6:2059513120967584. [PMID: 35154811 PMCID: PMC8832325 DOI: 10.1177/2059513120967584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Due to scarring, appearance anxiety is a common psychological difficulty in
patients accessing burns services. Appearance anxiety can significantly
impact upon social functioning and quality of life; thus, the availability
of effective psychological therapies is vital. Acceptance and Commitment
Therapy (ACT) is considered useful for treating distress associated with
other health conditions and may lend itself well to appearance anxiety.
However, no published research is currently available. Methods: Three single case studies (two male burns patients; one female necrotising
fasciitis patient) are presented where appearance anxiety was treated using
ACT. A treatment protocol was followed and evaluated: the Derriford
Appearance Scale measured appearance anxiety; the Work and Social Adjustment
Scale measured impairment in functioning; the Acceptance and Action
Questionnaire measured acceptance (willingness to open up to distressing
internal experiences); and the Committed Action Questionnaire measured
engagement in meaningful and valued life activities. Measures were given at
every treatment session and patient feedback was obtained. One-month
follow-up data were available for two cases. Results: After the intervention, all patients had reduced functional impairment and
were living more valued and meaningful lives. No negative effects were
found. Discussion: These case studies suggest that ACT may be a useful psychological therapy for
appearance anxiety. The uncontrolled nature of the intervention limits the
conclusions that can be drawn. Conclusion: A pilot feasibility study to evaluate the effectiveness of ACT for appearance
anxiety is warranted. Lay Summary Many patients with scars can feel distressed about their appearance. This is
known as appearance anxiety and can include patients accessing burns
services. Appearance anxiety can stop patients from enjoying a good quality
of life and impact upon important areas of daily functioning. It is
therefore important that psychological therapies are effective. However,
research investigating the effectiveness of psychological therapies is
limited. This paper describes the psychological therapy of three patients
who were distressed about scarring. A psychological therapy called
Acceptance and Commitment Therapy (ACT) was used as part of standard care
and evaluated using questionnaires and patient feedback. After the course of
ACT, all patients were less impacted day-to-day by their appearance anxiety
and were living more valued and meaningful lives. No negative effects were
found. These case studies suggest that ACT may be a useful psychological
therapy for appearance anxiety and further research evaluating it should be
completed.
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Affiliation(s)
- Laura Shepherd
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
- Laura Shepherd, Department of Clinical
Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust,
Queens Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK.
| | - Anna Turner
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
| | - Darren P Reynolds
- Department of Clinical Psychology &
Neuropsychology, Nottingham University Hospitals NHS Trust, Queens Medical Centre
Campus, Nottingham, UK
| | - Andrew R Thompson
- South Wales Clinical Psychology Training
Programme, School of Psychology, Cardiff University, Cardiff, Wales, UK
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Assessing values – Psychometric properties of the Swedish version of the Valuing Questionnaire in adults with chronic pain. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Garcia MV, Luckett T, Johnson M, Hutchinson A, Lal S, Phillips JL. The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis. J Adv Nurs 2019; 75:1953-1965. [PMID: 31012133 DOI: 10.1111/jan.14039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/12/2019] [Accepted: 03/28/2019] [Indexed: 12/01/2022]
Abstract
AIM To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease. DESIGN A secondary analysis of semi-structured interview data. METHODS Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping. RESULTS Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial. CONCLUSION This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management. IMPACT This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.
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Affiliation(s)
- Maja Villanueva Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Ann Hutchinson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Sara Lal
- School of Life Sciences, University of Technology, Sydney, New South Wales, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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30
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Reilly ED, Ritzert TR, Scoglio AA, Mote J, Fukuda SD, Ahern ME, Kelly MM. A systematic review of values measures in acceptance and commitment therapy research. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2018.10.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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31
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Ramos K, Hastings SN, Bosworth HB, Fulton JJ. Life Program: Pilot Testing a Palliative Psychology Group Intervention. J Palliat Med 2018; 21:1641-1645. [DOI: 10.1089/jpm.2017.0454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Katherine Ramos
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - S. Nicole Hastings
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
| | - Hayden B. Bosworth
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Jessica J. Fulton
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Rehabilitation, Geriatric, Palliative, and Hospice Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
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32
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White K, Issac MSM, Kamoun C, Leygues J, Cohn S. The THRIVE model: A framework and review of internal and external predictors of coping with chronic illness. Health Psychol Open 2018; 5:2055102918793552. [PMID: 30151224 PMCID: PMC6104221 DOI: 10.1177/2055102918793552] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This article explores the ways in which people cope with social and clinical dimensions of their chronic conditions. Existing literature was reviewed to categorize factors identified as being key. They were sorted into six groupings which are reflected by the acronym THRIVE: therapeutic interventions, habit and routine, relational-social, individual differences, values and beliefs, and emotional factors. We found little evidence to suggest different conditions prompt unique coping responses; rather, a range of common factors were observed across diverse conditions. The THRIVE framework not only summarizes current literature but provides a starting point for further research and development of future interventions.
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Affiliation(s)
| | | | | | | | - Simon Cohn
- London School of Hygiene & Tropical Medicine, UK
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33
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Casey MB, Smart K, Segurado R, Hearty C, Gopal H, Lowry D, Flanagan D, McCracken L, Doody C. Exercise combined with Acceptance and Commitment Therapy (ExACT) compared to a supervised exercise programme for adults with chronic pain: study protocol for a randomised controlled trial. Trials 2018; 19:194. [PMID: 29566744 PMCID: PMC5865382 DOI: 10.1186/s13063-018-2543-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 02/13/2018] [Indexed: 01/03/2023] Open
Abstract
Background Acceptance and Commitment Therapy (ACT) is a form of cognitive behavioural therapy, which may be beneficial for people with chronic pain. The approach aims to enhance daily functioning through increased psychological flexibility. Whilst the therapeutic model behind ACT appears well suited to chronic pain, there is a need for further research to test its effectiveness in clinical practice, particularly with regards to combining ACT with physical exercise. Methods/design This prospective, two-armed, parallel-group, single-centre randomised controlled trial (RCT) will assess the effectiveness of a combined Exercise and ACT programme, in comparison to supervised exercise for chronic pain. One hundred and sixty patients, aged 18 years and over, who have been diagnosed with a chronic pain condition by a physician will be recruited to the trial. Participants will be individually randomised to one of two 8-week, group interventions. The combined group will take part in weekly psychology sessions based on the ACT approach, in addition to supervised exercise classes led by a physiotherapist. The control group will attend weekly supervised exercise classes but will not take part in an ACT programme. The primary outcome will be pain interference at 12-week follow-up, measured using the Brief Pain Inventory-Interference Scale. Secondary outcomes will include self-reported pain severity, self-perception of change, patient satisfaction, quality of life, depression, anxiety and healthcare utilisation. Treatment process measures will include self-efficacy, pain catastrophising, fear avoidance, pain acceptance and committed action. Physical activity will be measured using Fitbit ZipTM activity trackers. Both groups will be followed up post intervention and again after 12 weeks. Estimates of treatment effects at follow-up will be based on an intention-to-treat framework, implemented using a linear mixed-effects model. Individual and focus group qualitative interviews will be undertaken with a purposeful sample of participants to explore patient experiences of both treatments. Discussion To our knowledge, this will be the first RCT to examine whether combining exercise with ACT produces greater benefit for patients with chronic pain, compared to a standalone supervised exercise programme. Trial registration www.ClinicalTrials.gov, ID: NCT03050528. Registered on 13 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2543-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Máire-Bríd Casey
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Keith Smart
- Physiotherapy Department, St Vincents University Hospital, Elm Park, Dublin 4, Ireland
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hearty
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Hari Gopal
- Department of Pain Medicine, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Damien Lowry
- Psychology Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Dearbhail Flanagan
- Physiotherapy Department, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland
| | - Lance McCracken
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, United Kingdom
| | - Catherine Doody
- School of Public Health, Physiotherapy and Sports Science, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
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