Make friends with your pain monster : internet-delivered acceptance- and value-based exposure in chronic pain : model and treatment
Author: Rickardsson, Jenny
Date: 2020-05-08
Location: Hörsal Rockefeller, Avdelningen för psykologi, Nobels väg 9, Karolinska Institutet, Solna
Time: 09.00
Department: Inst för klinisk neurovetenskap / Dept of Clinical Neuroscience
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Thesis (1.347Mb)
Abstract
Background: Chronic pain is a complex and common condition, often affecting functioning across a wide range of outcomes as pain interferes with daily activities. The understanding of mechanisms for development and maintenance is however limited, with chronic pain syndromes being the result of a complex matrix of biopsychosocial factors reciprocally impacting each other. Medical treatments are often insufficient in reducing suffering and increasing functioning. Acceptance and Commitment Therapy (ACT) targets psychological flexibility – the ability to continue towards a valued direction in life, despite inner distress and obstacles – and is a promising treatment approach. Access to ACT treatment is limited, and internet-delivery could improve access and reach.
Aim: The purpose of this thesis was to develop a feasible and effective internet-delivered ACT intervention for adults with chronic pain, and increase our understanding of potential mechanisms in pain-related disability and treatment.
Methods: Four studies were conducted. In study I we used a cross-sectional design to evaluate validity aspects of the Valuing Questionnaire (VQ). In study II, also using a cross- sectional design, psychological flexibility was examined as a potential resilience factor for persons with chronic pain. Study III investigated the feasibility and potential efficacy of iACT – a novel internet-delivered treatment in a microlearning format – for clinical and self- referred adults with chronic pain. An open pilot design was used. In study IV a randomized controlled trial design was used to compare the efficacy of iACT to a waitlist control group. Primary outcome was pain interference, secondary outcomes were psychological inflexibility, value orientation, quality of life (QoL), pain intensity, anxiety, insomnia and depressive symptoms.
Results: VQ had adequate model fit and internal consistency, and also contributed to the variance in pain interference, depressive symptoms and QoL. In study II, PF was found to be a candidate for a modifiable resilience factor in chronic pain. In study III results indicated that the iACT treatment was feasible and preliminary efficacious for both clinical and self- referred patients. In study IV, participants in the iACT arm showed improvements compared to the WLC across all nine outcomes investigated.
Conclusions: Values can be effectively assessed with the brief self-rating questionnaire VQ. Psychological flexibility may be a modifiable resilience factor for the development and maintenance of chronic pain. A micro-learning format of ACT via the internet can be both feasible and efficacious as to increase functioning across a wide range of outcomes for chronic pain patients. The studies in this thesis provides a groundwork for future scientific investigations of some of the psychological mechanisms relevant for chronic pain.
Aim: The purpose of this thesis was to develop a feasible and effective internet-delivered ACT intervention for adults with chronic pain, and increase our understanding of potential mechanisms in pain-related disability and treatment.
Methods: Four studies were conducted. In study I we used a cross-sectional design to evaluate validity aspects of the Valuing Questionnaire (VQ). In study II, also using a cross- sectional design, psychological flexibility was examined as a potential resilience factor for persons with chronic pain. Study III investigated the feasibility and potential efficacy of iACT – a novel internet-delivered treatment in a microlearning format – for clinical and self- referred adults with chronic pain. An open pilot design was used. In study IV a randomized controlled trial design was used to compare the efficacy of iACT to a waitlist control group. Primary outcome was pain interference, secondary outcomes were psychological inflexibility, value orientation, quality of life (QoL), pain intensity, anxiety, insomnia and depressive symptoms.
Results: VQ had adequate model fit and internal consistency, and also contributed to the variance in pain interference, depressive symptoms and QoL. In study II, PF was found to be a candidate for a modifiable resilience factor in chronic pain. In study III results indicated that the iACT treatment was feasible and preliminary efficacious for both clinical and self- referred patients. In study IV, participants in the iACT arm showed improvements compared to the WLC across all nine outcomes investigated.
Conclusions: Values can be effectively assessed with the brief self-rating questionnaire VQ. Psychological flexibility may be a modifiable resilience factor for the development and maintenance of chronic pain. A micro-learning format of ACT via the internet can be both feasible and efficacious as to increase functioning across a wide range of outcomes for chronic pain patients. The studies in this thesis provides a groundwork for future scientific investigations of some of the psychological mechanisms relevant for chronic pain.
List of papers:
I. Rickardsson J., Zetterqvist V., Kemani M.K., Holmström L., Andersson E., Wicksell R.K. (2019). Assessing values – Psychometric properties of the Swedish version of the Valuing Questionnaire in adults with chronic pain. Journal of Contextual Behavioral Science. 14:40-49.
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II. Gentili C., Rickardsson J., Zetterqvist V., Simons L.E., Lekander M., Wicksell R.K. (2019). Psychological Flexibility as a Resilience Factor in Individuals With Chronic Pain. Frontiers in Psychology. 10:2016.
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Pubmed
View record in Web of Science®
III. Rickardsson, J., Zetterqvist, V., Gentili, C., Andersson, E., Holmström, L., Lekander, M., Persson, M., Persson, J., Ljótsson, B., Wicksell, R. K. (2020). Internet-delivered Acceptance and Commitment Therapy (iACT) for chronic pain – feasibility and preliminary effects in clinical and self-referred patients. mHealth. 6:27.
Fulltext (DOI)
Pubmed
IV. Rickardsson, J., Gentili, C., Holmström, L., Zetterqvist, V., Andersson, E., Persson, J., Lekander, M., Ljótsson, B., Wicksell, R. K. iACT – internet- delivered Acceptance and Commitment Therapy as microlearning for chronic pain - A randomized controlled study with one-year follow-up. [Manuscript]
I. Rickardsson J., Zetterqvist V., Kemani M.K., Holmström L., Andersson E., Wicksell R.K. (2019). Assessing values – Psychometric properties of the Swedish version of the Valuing Questionnaire in adults with chronic pain. Journal of Contextual Behavioral Science. 14:40-49.
Fulltext (DOI)
View record in Web of Science®
II. Gentili C., Rickardsson J., Zetterqvist V., Simons L.E., Lekander M., Wicksell R.K. (2019). Psychological Flexibility as a Resilience Factor in Individuals With Chronic Pain. Frontiers in Psychology. 10:2016.
Fulltext (DOI)
Pubmed
View record in Web of Science®
III. Rickardsson, J., Zetterqvist, V., Gentili, C., Andersson, E., Holmström, L., Lekander, M., Persson, M., Persson, J., Ljótsson, B., Wicksell, R. K. (2020). Internet-delivered Acceptance and Commitment Therapy (iACT) for chronic pain – feasibility and preliminary effects in clinical and self-referred patients. mHealth. 6:27.
Fulltext (DOI)
Pubmed
IV. Rickardsson, J., Gentili, C., Holmström, L., Zetterqvist, V., Andersson, E., Persson, J., Lekander, M., Ljótsson, B., Wicksell, R. K. iACT – internet- delivered Acceptance and Commitment Therapy as microlearning for chronic pain - A randomized controlled study with one-year follow-up. [Manuscript]
Institution: Karolinska Institutet
Supervisor: Wicksell, Rikard
Co-supervisor: Holmström, Linda; Zetterqvist, Vendela; Andersson, Erik; Lekander, Mats
Issue date: 2020-04-17
Rights:
Publication year: 2020
ISBN: 978-91-7831-765-3
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