TY - JOUR
T1 - Efficacy of videoconference group Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) for chronic low back pain (CLBP) plus comorbid depressive symptoms
T2 - A Randomized Controlled Trial (IMPACT Study)
AU - Sanabria-Mazo, Juan P
AU - Colomer-Carbonell, Ariadna
AU - Borràs, Xavier
AU - Castaño-Asins, Juan R
AU - McCracken, Lance M
AU - Montero-Marin, Jesus
AU - Pérez-Aranda, Adrián
AU - Edo, Sílvia
AU - Sanz, Antoni
AU - Feliu-Soler, Albert
AU - Luciano, Juan V
N1 - Funding Information:
This study has been funded by the Institute of Health Carlos III (ISCIII; PI19/00112) and has been cofinanced with European Union ERDF funds. We are grateful to the CIBER of Epidemiology and Public Health (CIBERESP CB22/02/00052; ISCIII) for its support. Juan P. Sanabria-Mazo has a PFIS predoctoral contract from the ISCIII (FI20/00034). Ariadna Colomer-Carbonell has a FI predoctoral contract from AGAUR (FI_B/00216). Jesus Montero-Marin has a Miguel Servet contract from the ISCIII (CP21/00080). Adrián Pérez-Aranda has a Sara Borrell contract from the ISCIII (CP20/00181). Albert Feliu-Soler acknowledges the funding from the Serra Hunter program (UAB-LE-8015). All authors declare no conflict of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Publisher Copyright:
© 2023 United States Association for the Study of Pain, Inc.
PY - 2023/8/1
Y1 - 2023/8/1
N2 - This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of Acceptance and Commitment Therapy (ACT) or Behavioral Activation Therapy for Depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at post-treatment (d = 0.64) and at follow-up (d = 0.73). BATD was only superior to TAU at follow-up (d = 0.66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at post-treatment (d = 0.45 and d = 0.59, respectively) and at follow-up (d = 0.59, in both) compared to TAU. Stress was significantly reduced at post treatment by ACT in comparison to TAU (d = 0.69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant NNT values for reduction in pain interference were obtained at post-treatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at post-treatment in psychological flexibility. These findings suggest that new forms of Cognitive Behavioral Therapy (CBT) are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. TRIAL NUMBER: NCT04140838 PERSPECTIVE: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.
AB - This study examined the efficacy of adding a remote, synchronous, group, videoconference-based form of Acceptance and Commitment Therapy (ACT) or Behavioral Activation Therapy for Depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at post-treatment (d = 0.64) and at follow-up (d = 0.73). BATD was only superior to TAU at follow-up (d = 0.66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at post-treatment (d = 0.45 and d = 0.59, respectively) and at follow-up (d = 0.59, in both) compared to TAU. Stress was significantly reduced at post treatment by ACT in comparison to TAU (d = 0.69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant NNT values for reduction in pain interference were obtained at post-treatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at post-treatment in psychological flexibility. These findings suggest that new forms of Cognitive Behavioral Therapy (CBT) are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions. TRIAL NUMBER: NCT04140838 PERSPECTIVE: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.
KW - Chronic low back pain
KW - acceptance and commitment therapy
KW - behavioral activation
KW - depression
KW - eHealth
U2 - 10.1016/j.jpain.2023.04.008
DO - 10.1016/j.jpain.2023.04.008
M3 - Article
C2 - 37105508
SN - 1526-5900
VL - 24
SP - 1522
EP - 1540
JO - Journal of Pain
JF - Journal of Pain
IS - 8
ER -