McCracken UCL ACT Talk 0609

7/27/2019 McCracken UCL ACT Talk 0609

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Acceptance andAcceptance andCommitment TherapyCommitment Therapy

(ACT) and Chronic Pain(ACT) and Chronic Pain

Lance M. McCracken, PhDLance M. McCracken, PhD

Centre for Pain ServicesCentre for Pain Services

Roya !ationa "ospita for Rhe#matic DiseasesRoya !ationa "ospita for Rhe#matic Diseases

Centre for Pain ResearchCentre for Pain Research$niversity of %ath$niversity of %ath

%ath $&%ath $&


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'#tine of Tak'#tine of Tak

Propose that psychooica approaches toPropose that psychooica approaches to

chronic pain are deveopinchronic pain are deveopin

Descrie an ACT mode.Descrie an ACT mode.

S#mmari*e the state of o#tcome iterat#reS#mmari*e the state of o#tcome iterat#reon ACT for chronic pain.on ACT for chronic pain.

S#est thatS#est that

o S#fferin is normaS#fferin is norma

o contro is often #n+orkaecontro is often #n+orkae

o yo#r mind cannot e tr#stedyo#r mind cannot e tr#sted


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The vo#tion of Cinica Psychooy

$nderyin-rame+ork

Processes ofPathooy

Taret TherapyProcesses

'perant Conditionin %ehavior Conditionin

Conitive%ehaviora

Conditionin,attention, coias, thinkin,eievin

%ehavior andsymptoms(physica emotiona)

Skis trainin,e/pos#re,conitivetherapy

Conte/t#a(M%SR, ACT) Avoidance,co f#sion,sef, va#es,commitment,oss of present

%ehavior Acceptance,def#sion,mindf#ness,va#es, skistrainin,reationship


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0101there is itte empirica s#pport forthere is itte empirica s#pport for

the roe of conitive chane as ca#sathe roe of conitive chane as ca#sain symptomatic improvementsin symptomatic improvements

achieved in C%T.2achieved in C%T.2

(Lonmore 3orre, 4556)(Lonmore 3orre, 4556)


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MethodMethod

! 7 4,89: peope attendin treatment! 7 4,89: peope attendin treatment

for chronic pain.for chronic pain.

Meas#res of o#tcome administeredMeas#res of o#tcome administeredpre;, post, and < month foo+;#p.pre;, post, and < month foo+;#p.

Meas#res of adherence to treatmentMeas#res of adherence to treatment

methods meas#red at < month foo+;methods meas#red at < month foo+;#p.#p.


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Res#tsRes#ts

Adherence to pacin, tho#htAdherence to pacin, tho#ht

chaenin, stretchin, and e/ercisechaenin, stretchin, and e/ercise

had very sma reations +ith o#tcomehad very sma reations +ith o#tcomevariaes.variaes.

=ariance in +eein at foo+;#p=ariance in +eein at foo+;#p

acco#nted for y adherence factorsacco#nted for y adherence factors

raned from < to 4>.raned from < to 4>.


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If taken at face value, the findingsIf taken at face value, the findings

suggest that both theory and practicesuggest that both theory and practice

of recommending adherence toof recommending adherence totreatment methods require re-treatment methods require re-

examination if not overhaul. (p !"#examination if not overhaul. (p !"#


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Therapist DriftTherapist Drift

Therapists often to not f#y impementTherapists often to not f#y impement

C%T.C%T.

This #s#ay inc#des shiftin foc#sThis #s#ay inc#des shiftin foc#sfromfrom doindointoto takintakin..

This arises from therapist conitiveThis arises from therapist conitive

distortions, emotiona reactions, anddistortions, emotiona reactions, andavoidance.avoidance.

3aer ?. vidence;ased treatment and therapist drift.

%RAT 455@ 96B


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00'#r iest sine proem in impementin C%T'#r iest sine proem in impementin C%T

is that many cinicians fai to p#sh for ehavioris that many cinicians fai to p#sh for ehavior

chane (e.., e/pos#re, ehaviora activation, 1)chane (e.., e/pos#re, ehaviora activation, 1)

despite the evidence that these eements ofdespite the evidence that these eements of

treatment are the most important.2treatment are the most important.2

00'#r ein nice to or protective of the patient'#r ein nice to or protective of the patient

can +orsen the proem.2can +orsen the proem.2


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Enternationa Fo#rna of Stress Manaement 455:B


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Suffering is Normal

o to 85> of ad#ts have chronic pain. to 85> of ad#ts have chronic pain.

o to 85> of the pop#ation s#ffers to 85> of the pop#ation s#ffers

from a dianosae psychooicafrom a dianosae psychooica

disorder in any iven year.disorder in any iven year.

o The ifetime prevaence of psychooicaThe ifetime prevaence of psychooica

disorders is neary :5>.disorders is neary :5>.

&esser et a. Arch ?en Psychiatry 455: G4B :@8;G54.


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The ACT mode of Psychopathooy

Psychooica

Enfe/iiity

Dominance of the

Concept#ai*ed Past and -eared

-#t#re

Lack of =a#es

Carity

Enaction, Emp#sivity,or Avoidant

Persistence

Attachment to the

Concept#ai*ed Sef

Conitive

-#sion

/perientia

Avoidance


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-romB "ayes et a. $ehav %es &her455G 99B


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ACT Treatment Processes

Psychological

Flexibility

Contact with the

Present Moment

Values

Committed

Action

Self as

Context

CognitiveDefusion

Acceptance


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/perience Tho#hts and -eeins/perience Tho#hts and -eeins

DetectDetect kno+ a tho#ht orkno+ a tho#ht or

feein is presentfeein is present

Reister the contentReister the content

#nderstand the#nderstand themessae of themessae of thee/periencee/perience

%eieveHheed%eieveHheed take it as tr#etake it as tr#e

-#se-#se contact it as the onycontact it as the ony

e/perience presente/perience present


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Chronic Pain and S#fferinChronic Pain and S#fferin

nwillingness

!nflexibility

Avoidance

Poor

Functioning

Distress "Discomfort

Pain


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nwillingness

!nflexibility

Avoidance

Poor

Functioning


Pain


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nwillingness

!nflexibility

Avoidance

Poor

Functioning


Pain


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ACT;%ased Treatment forACT;%ased Treatment for

Chronic PainChronic Pain

Dah et a., 4559. %ehav TherDah et a., 4559. %ehav Ther

McCracken et a., 455:. %ehav Res TherMcCracken et a., 455:. %ehav Res Ther

McCracken et a., 4556. #r F PainMcCracken et a., 4556. #r F Pain =o+es McCracken, 455I. F Cons#t Cin=o+es McCracken, 455I. F Cons#t Cin

PsychoPsycho

3ickse et a., 455I. #r F Pain3ickse et a., 455I. #r F Pain

=o+es et a. 455@. Co %ehav Practice=o+es et a. 455@. Co %ehav Practice


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8 Jear -oo+;#p S#rvey in %ath8 Jear -oo+;#p S#rvey in %ath

!oteB Thanks to &evin =o+es Fane Khao;'%rien!oteB Thanks to &evin =o+es Fane Khao;'%rien

! 7 @5 (G of those contacted)! 7 @5 (G of those contacted)

G9> +omenG9> +omen

Pain D#ration M 7


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Meas#resMeas#res 5;


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Pre;T/ 8 Jr -;#p Si ffect Si*e (d)

Pain #$%&

(.!'#

#$'&

(.!'#

O.5: .88

PhysicaDisaiity

$(%(.#

$()(.)#

O.55< .G5

PsychosociaDisaiity $)*(.*# $(*(.'# O.55< .G8

An/iety +#$,)(!.*+#

')$**(.'#

O.55< .68

'#tcome at 8 Jears'#tcome at 8 Jears


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11contin#edcontin#ed

Pre;T/ 8 Jr -;#p Si ffect Si*e (d)

Depression )&$,((."'#

(,$&+(.*#

O.55< .@4

Medica =isits ,$)&(.)*#

)$&,(.!+#

O.55< .:5

Acceptance ,-$#((.#

#%$,,(.*#

O.55< .2 small, > .5 medium, > .8 larged > .2 small, > .5 medium, > .8 large.


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Empact of C%T and ACT Modes inEmpact of C%T and ACT Modes in

Psychooy Trainee TherapistsPsychooy Trainee Therapists

Participants +ere 4I peope seekinParticipants +ere 4I peope seekintreatment for depression or interpersonatreatment for depression or interpersona

proems.proems.

Matched pairs randomy assined to eMatched pairs randomy assined to etreated for


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Therapist TraininTherapist Trainin

C%TC%T


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Primary Cient '#tcomeBPrimary Cient '#tcomeB

?SE of SCL;@5?SE of SCL;@5

?ro#p ffect at

post T/

ffect at

foo+;#pACT .8"*. (small > .2") medium > .5") large > .8"*


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'ther Res#ts'ther Res#ts

Acceptance appeared to e the mostAcceptance appeared to e the most

important process to o#tcome in othimportant process to o#tcome in oth

ro#ps.ro#ps.At the start of treatment therapistsAt the start of treatment therapists

reported ess kno+ede of ACT.reported ess kno+ede of ACT.

Therapists fear and tension d#rinTherapists fear and tension d#rintreatment decreased in C%T #t not intreatment decreased in C%T #t not in

ACT.ACT.


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More Empactf# Treatment inMore Empactf# Treatment in

the -#t#rethe -#t#re

Conte/t#aConte/t#a Ae to e/perientiay manip#ate f#nctionaAe to e/perientiay manip#ate f#nctiona

active inf#ences o#tside of takin andactive inf#ences o#tside of takin andthinkinthinkin

CompassionateCompassionate Ae to inc#de empathy, intimacy, andAe to inc#de empathy, intimacy, and

carincarin Co#raeo#sCo#raeo#s

Ae to radicay contact pain and s#fferin,Ae to radicay contact pain and s#fferin,and to earn to sit +ith it, openy, +itho#tand to earn to sit +ith it, openy, +itho#tresistance, +henever re#ired.resistance, +henever re#ired.


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S#mmary

Psychooica approaches to chronic painare deveopin and no+ inc#de the notionof psychooica fe/iiity

They emphasi*e that s#fferin is norma,

and inc#de acceptance. These approaches re#ire treatment

providers to face discomfort act +ith a+areness and fe/iiity enter carin reationships +ith peope +ith

pain.


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Thank yo#Thank yo#

Documents

McCracken UCL ACT Talk 0609