DUMC Box 3842

Duke Clinics, 40 Duke Medicine Circle

3rd Floor, Purple Zone, Suite 3700
Durham, NC 27710
Tel: 919-681-7231

© 2014 by ACT at Duke 

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Phone: 919-681-7231

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Acceptance and Commitment Therapy for Chronic Pain

Professionals who work with patients and clients struggling with chronic pain will benefit from this values-based behavior change program for managing the effects of pain. Acceptance and Commitment Therapy for Chronic Pain addresses case formulation and clinical techniques 

for working with pain patients through a combination of practical instruction and a treatment scenario narrative that follows a patient through an ACT-based intervention. An invaluable resource for rehabilitation specialists, psychologists, physicians, nurses, and others

Summary of Study


Acceptance and Commitment Therapy for Fibromyalgia: Results from a Pilot Randomized Controlled Trial.


The aim of this pilot randomized control trial was to examine the preliminary efficacy of individual Acceptance and Commitment Therapy (ACT) for women with fibromyalgia (FM), relative to an education-control. Twenty-seven women with FM were randomly assigned to 8 weeks of individual ACT or education-control. Primary outcomes included self-report of overall disease impact (Fibromyalgia Impact Questionnaire; FIQ), depressive symptomatology (Patient Health Questionnaire-9; PHQ-9), and chronic pain acceptance (Chronic Pain Acceptance Questionnaire; CPAQ), which were measured at baseline, post-intervention, and 12 week follow-up. 


The full sample was predominantly caucasian (77.8%) with a mean age of 48.63 years (SD = 12.96). Nearly 40% of the sample was on some form of disability income, 14.3% had reduced work hours, and 21.4% had stopped working due to FM but had not received disability income. There were no significant differences between treatment conditions on any demographic variable. 


Disease Impact: FIQ scores significantly decreased from baseline to post-intervention irrespective of treatment condition,  F(2, 44) = 6.98, p < .01, with gains maintained at 12 week follow-up. While differences between treatment conditions were not statistically significant, F(1, 22) = 2.57, p = .12, examination of effect sizes indicated that the ACT condition showed a greater reduction in disease impact throughout the duration of the study (baseline Cohen’s d = -.21; post-intervention Cohen’s = -.88; 12 week follow-up Cohen’s d = -.66).


Depressive Symptomatology: A significant time-by-condition interaction was found for PHQ-9 scores, F(2, 46) = 3.24, p < .05. Post hoc comparisons showed that PHQ-9 scores significantly decreased from baseline to post-intervention exclusively in the ACT treatment condition (p < .05), with scores maintained at follow-up. Depression scores did not significantly change at any time point in the education-control (ps = .10). Pairwise comparisons did not show a significant difference in depressive symptomatology between treatment conditions at any of the three time points ps > .10, though effect size calculations suggest that group differences in PHQ-9 scores were increasing at follow-up. More specifically, self-reported depression levels in the ACT condition were higher than those in the education-control at baseline and decreased below the education-control at follow-up (baseline Cohen’s d = .33; post-intervention Cohen’s d = .02 ; 12 week follow-up Cohen’s d = -.56).


Chronic Pain Acceptance: A significant time-by-condition interaction was found for CPAQ scores, F(2, 44) = 3.46, p < .05. Post-hoc comparisons indicated that the ACT condition showed a significant increase in chronic pain acceptance between baseline and post-intervention. The education-control condition did not evidence any significant differences in CPAQ scores across the three time points (ps = .10). Furthermore, while there were not any significance differences in CPAQ scores between treatment conditions at baseline (p = .55, Cohen’s d = .26), the ACT condition demonstrated significantly higher CPAQ scores at post-intervention (p < .05, Cohen’s d = .90) and 12 week follow-up (p < .05, Cohen’s d = 1.02).


Findings indicated that individual ACT may be a useful treatment for women struggling with physical and psychological difficulties associated with FM. The ACT intervention led to significant improvements in disease impact, depression, and pain acceptance post treatment with gains maintained at 12 week follow-up. In comparison, only improvements in disease impact were observed in the education-control. Furthermore, while group differences in disease impact were not statistically significant, effect sizes suggest that greater improvements in functioning were occurring in the ACT condition relative to the education-control. Given the pilot nature of the study, larger trials are needed to determine the effectiveness of ACT for FM. 



Bigatti, S.M., Steiner, J.L., Merwin, R.M., McCracken, L.M., Wagner, C.D., Lydon-Lam, J.R., Brown, L.F., Ang., D.C. & Moskovich, A.M. Acceptance and Commitment Therapy for Fibromyalgia: A Pilot Randomized Controlled Trial.