Acceptance and Commitment Therapy for chronic pain: A diary study of treatment process in relation to reliable change in disability

Kevin E Vowles*, Brandi C Fink, Lindsey L Cohen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)
24 Downloads (Pure)


In chronic pain treatment, a primary goal is reduced disability. It is often assumed that a central process by which disability reduction occurs is pain reduction. Conversely, approaches such as Acceptance and Commitment Therapy (ACT) posit that pain reduction is not necessary for reduced disability. Instead, disability reduction occurs when responses to pain are changed, such that as unsuccessful struggles for pain control decreases and engagement in personally-valued activities increases. Treatment outcome studies have supported ACT's effectiveness; however, less work has examined how within-treatment patterns of change relate to treatment success or failure (i.e., decreased or sustained disability). The present study, therefore, sought to examine this issue. Specifically, struggles for pain control and engagement in valued activities were recorded weekly in 21 patients who completed a four week interdisciplinary ACT intervention for chronic pain. It was hypothesized that the presence or absence of reliable change in disability at a three month follow-up would be predicted by within treatment patterns of change in the weekly data. At follow-up, 47.6% of patients evidenced reliable disability reduction. The expected pattern of change occurred in 81.0% of patients-specifically, when pain control attempts decreased and engagement in valued activities increased, reliably reduced disability typically occurred, while the absence of this pattern was typically associated with a lack of reliable change. Further, changes in pain intensity, also assessed weekly, were unrelated to reliable change. Overall, these results provide additional support for the ACT model and further suggest some possible requirements for treatment success.

Original languageEnglish
Pages (from-to)74-80
Number of pages7
JournalJournal of Contextual Behavioral Science
Issue number2
Publication statusPublished - 18 Apr 2014
Externally publishedYes


  • Acceptance and Commitment Therapy
  • Change processes
  • Chronic pain

ASJC Scopus subject areas

  • Organizational Behavior and Human Resource Management
  • Ecology, Evolution, Behavior and Systematics
  • Behavioral Neuroscience
  • Applied Psychology
  • Health(social science)


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