Might psychological flexibility processes and Acceptance and Commitment Therapy (ACT) apply in adults with painful diabetic neuropathy? A cross-sectional survey

The Relationship Between Psychological Inflexibility and Well-Being in Adults: A Meta-Analysis of the Acceptance and Action Questionnaire

Psychological inflexibility is defined as the rigid responding to stimuli (e.g., unpleasant thoughts and feelings) that interferes with well-being and valued actions. It is the treatment target in acceptance and commitment therapy (ACT). Despite the centrality of the link between inflexibility and well-being to ACT theory, an empirical review clarifying the nature of this relationship has not been conducted. As such, the current meta-analysis examined the meta-correlation between psychological inflexibility, measured by the Acceptance and Action Questionnaire (AAQ) and its variants, and well-being. A systematic review yielded 151 studies, including 25 versions of the AAQ and 43 well-being measures. Consistent with ACT theory, higher psychological inflexibility was associated with worse well-being (r = -.47, 95% CI[-.49, -.45]). In addition, sample diagnosis, type of AAQ, and type of well-being measure significantly moderated this relationship. Overall, our findings support the hypothesized link between psychological inflexibility and worse well-being. Limitations include reliance on cross-sectional data, precluding causal interpretation.

Psychosocial Care for People With Diabetic Neuropathy: Time for Action

Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.

Quality of life of persons with painful diabetic neuropathy: How can we improve it?

Painful diabetic neuropathy (PDN) is difficult to treat, with pharmacological treatments providing only partial pain relief that is limited by medication side effects. This necessitates a holistic approach to pain control,with pharmacological treatments supplemented by the management of psychosocial aspects of pain experience. Pain catastrophising and psychological flexibility are among the psychological constructs impacting persons' adaptation to PDN. While the former increases disability and reduces quality of life (QoL), the latter leads to less functional impairment and depression. Specific fears, and in particular, fear of falling, are significantly associated with pain-related disability and reduced QoL. The role of secondary parameters ofpain experience, including sleep and mood disturbancesas the potential guides to the selection of pharmacological treatmentsis yet to be established. Over the past decade there has been a steady increase in studies testing psychological interventions, including cognitive behavioural therapy and its several modifications, to manage pain in DN sufferers.Thesepilot and feasibility studies demonstrated the potential beneficial effects on pain severity and pain interference, depression and QoL in adults with PDN.Adequately powered trials are needed to confirm the effectiveness of these interventions in terms of pain experience and their impact on QoL.

Usability and Acceptability of a Videoconference Program for the Treatment of Depression in Adults With Peripheral Neuropathy

Peripheral neuropathy is a debilitating neurological disorder affecting 13% to 14% of the US population. Estimates for co-occurring mood disorders in individuals with neuropathy range from 30% to 47%, but sparse evidence exists regarding depression treatment for adults with neuropathy. A cognitive-behavioral treatment, Acceptance and commitment therapy, is known to reduce depression in people with chronic pain, but little is known about its effectiveness in adults with neuropathy, particularly when the treatment is provided via videoconference. Acceptability and usability of this therapeutic treatment provided via videoconference was assessed in participants with peripheral neuropathy and symptoms of depression. Participants completed pre- and post-self-report outcome measures: the nine-item depression scale of the Patient Health Questionnaire and the 36-item Short-Form Health Survey. They also completed the Acceptability e-Scale and Post-Study System Usability Questionnaire after treatment. Depression decreased significantly, with scores declining from an average of 9.2 to 5.1 on the Patient Health Questionnaire ( P < .05). The Short-Form Health Survey indicated significant improvement post-treatment on the "Energy/Fatigue" and "Emotional Well Being" subscales. The intervention was rated by participants as acceptable and demonstrated high usability. This initial therapeutic treatment via videoconference offers promise to treat depression in older adults with neuropathy.

Online Acceptance and Commitment Therapy (ACT) interventions for chronic pain: A systematic literature review

BACKGROUND

We systematically reviewed all literature concerning online Acceptance and Commitment Therapy (ACT) interventions for chronic pain to evaluate their (1) ACT content, (2) design characteristics, (3) design rationales, and (4) adherence.

MATERIAL AND METHODS

A systematic search was performed on July 9th, 2020 in; PubMed, PsycINFO, CINAHL, and Web of Science. Search terms related to: Acceptance and Commitment Therapy, chronic pain, and eHealth. Extracted data concerned ACT content, design characteristics, adherence, and design rationales.

RESULTS

20 articles, in which 14 interventions were described, met all inclusion criteria. Adherence and design rationales were described to a limited extent in the included studies. In total, the majority provided an overview of the included ACT processes. In 10 articles it was described that the intervention was delivered via a dedicated website (n = 10), which was sometimes combined with an app (n = 3). Guidance was included in most studies (n = 19). Studies including RCT's (n = 8) reported online ACT interventions to be effective.

CONCLUSION

Online ACT interventions for chronic pain have been shown to be effective and have generally been constructed in line with ACT theory. However, the majority of studies does not provide information about the choices to optimize the fit between task, technology, and user. Considerations behind the choices for intervention features as well as design rationales could help to optimize future online ACT interventions. Additionally, consistent attention should be paid to measurement and operationalization of adherence, since this is a crucial link between content, design and effectiveness.

Peoples' experiences of painful diabetic neuropathy: are pain management programmes appropriate?

OBJECTIVE

Painful diabetic neuropathy (PDN) is a painful complication of diabetes. This study aimed to explore: (1) strategies used by participants to manage impacts of PDN and (2) their perspectives on whether strategies from pain management programmes (PMPs) had applicability for PDN.

DESIGN

Participants were recruited through local National Health Service (NHS) diabetes and PDN clinics, and nationally from a diabetes support charity. One-to-one interviews were conducted. The transcribed data were analysed using inductive thematic analysis.

RESULTS

Twenty-three people were interviewed who had PDN symptoms for mean 10 years. Four themes emerged from the data: seeking help and advice, pragmatic approach to management, perspectives on physical activity and perspectives on psychological coping strategies.

CONCLUSION

Some participants were open to the strategies advised by PMP strategies. There were also strong opinions that no exercise or psychological approach could help with diabetes-related pain. It is possible PMPs as currently delivered need to be adapted to maximise engagement from people with PDN. Research is required to understand the healthcare priorities of people with PDN and whether these priorities can be mapped to existing management strategies.

Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom: A Single-Arm Feasibility Trial

OBJECTIVE

This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified.

METHODS

Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility.

RESULTS

Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance.

CONCLUSIONS

This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.