ACT now! Acceptance & commitment therapy processes are associated with chronic low-back pain (CLBP) disability

Abstract

Background: Acceptance and Commitment Therapy (ACT) is a promising theory-based approach to CLPB which emphasises acceptance and committed action towards improved function. We assess the relative contribution of ACT key process measures with depressive symptoms in explaining self-reported disability. Methods: 198 adult patients (59% female, 47.4yrs, SD=14.5) experiencing CLBP >12 weeks duration and scoring ≥3 points on the Roland-Morris-Disability-Questionnaire (RMDQ) completed RMDQ, acceptance (CPAQ-8), committed action (CAQ-8) and depressive symptoms (PHQ-9) measures. Multiple linear regression assessed the variance in self-reported disability and relationship with ACT process variables. Findings: In correlational analysis, higher acceptance (r=-.62, p<.01)) and higher committed action (r=-.26, p<.01) were associated with lower RMDQ scores. Compared with an initial multiple linear regression model (age, sex and depressive symptoms) which explained 29% of the variance in RMDQ scores (F (3,194) = 27.7, p=<.01), a second model, additionally including acceptance and committed action, explained 48% of the variance in RMDQ scores (R2change 19%; (LR Χ2(2) = 64.43, p>Χ2<.01). Higher acceptance scores were associated with lower RMDQ scores (β=-.56, p=<.01). However, higher committed action scores were associated with higher RMDQ scores (β=.16, p=<.01). Discussion: These findings suggest promoting acceptance of CLBP might improve patients’ function. Independently, committed action has a small positive effect with self-reported disability although this effect was lost with acceptance and depressive symptoms in the regression model. We are testing the effectiveness of an ACT-informed intervention in promoting function in CLBP patients and evaluating possible mediators in the PACT trial http://www.controlled-trials.com/ISRCTN95392287.