Make friends with your pain monster : internet-delivered acceptance- and value-based exposure in chronic pain : model and treatment

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