Lance McCracken
Uppsala University, Psychology, Faculty Member
Objectives Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine... more
Objectives Awareness (being present), acceptance, and engagement (committed action) are three dimensions of psychological flexibility. Understanding these in the context of chronic pain may identify treatment targets to help refine individual treatment. Our objective was to test the predictive capacity of three dimensions within the psychological flexibility model on the longitudinal trajectory of pain interference. Methods Patients receiving pain psychology treatment at a pain management center participated in this pragmatic clinical longitudinal study (n=86 with at least three assessments; Mean age=51 years; Gender=60 females, 26 males). Measures included the Five Facet Mindfulness Questionnaire (FFMQ-SF); Chronic Pain Acceptance Questionnaire (CPAQ-8); Psychological Inflexibility in Pain Scale (PIPS-12); and Committed Action Questionnaire (CAQ-8). The dependent variable was the Patient Reported Outcomes Information System (PROMIS) Pain Interference (PI). We used latent growth mod...
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There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain... more
There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures...
Research Interests: Psychology, Applied Psychology, Clinical Psychology, Cognitive Behavioral Therapy, Health Psychology, and 12 moreCognition, Chronic Pain, Behavioral Medicine, Medicine, Acceptance and Commitment Therapy, Cognitive Therapy, Flexibility in engineering design, Psychological Flexibility, Mediator, Psychology and Cognitive Sciences, Predictor, and Medical and Health Sciences
PurposeFatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic... more
PurposeFatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic pain.MethodsThis study included 354 adults attending an interdisciplinary ACT‐oriented treatment for chronic pain. T‐tests and analyses of clinically meaningful change were used to investigate participant improvements in fatigue interference after the treatment. Pearson's correlations and hierarchical regressions were conducted to investigate associations between improvement in fatigue interference and improvements in PF processes. Finally, mixed effects models were used to explore associations between baseline fatigue interference and changes in treatment outcome measures.ResultsParticipants improved in fatigue interference (d = 0.37), pain, some PF processes and daily functioning (d = 0.18–1.08). 39.7% of participants demonstrated clinically meaningfull...
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This study re-investigated data of a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain (ACTonPain). Baseline psychological inflexibility was examined as a moderator of the outcome pain... more
This study re-investigated data of a randomized controlled trial on Internet-based Acceptance and Commitment Therapy for chronic pain (ACTonPain). Baseline psychological inflexibility was examined as a moderator of the outcome pain interference. In the ACTonPain trial, participants with chronic pain were randomized to one of three conditions: guided Internet-based ACT (n = 100), unguided Internet-based ACT (n = 101), and waitlist (n = 101). Moderation analyses were performed with the SPSS macro PROCESS. Pain interference according to the Multidimensional Pain Inventory (MPI) was the primary outcome in this trial, and the potential moderator psychological inflexibility was measured with the Acceptance and Action Questionnaire (AAQ-II). Psychological inflexibility at baseline moderated the outcome between guided Internet-based ACT and waitlist 9-weeks as well as 6-months after randomization. (both p < 0.05). Between unguided Internet-based ACT and waitlist, psychological inflexibil...
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One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change. One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy (ACT)... more
One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change. One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy (ACT) with its focus on increasing psychological flexibility (PF). The aim of the present study was to examine the role of PF as a mechanism of change in ACT. This is based on mediation analyses of data from a previously reported randomized controlled trial, evaluating the effectiveness of an ACT-based online intervention for chronic pain (ACTonPain). We performed secondary analyses on pretreatment, posttreatment, and follow-up data from 302 adults, receiving a guided (n = 100) or unguided (n = 101) version of ACTonPain, or allocated to the waitlist control group (n = 101). Structural equation modelling and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment through pretreatment and posttreatment changes in the...
Research Interests: Psychology, Clinical Psychology, Pain, Chronic Pain, Structural Equation Modeling, and 10 moreMediation, Medicine, Acceptance and Commitment Therapy, Anxiety, Flexibility in engineering design, Psychotherapist, ANXIETY, Guidance and Counseling Intervention Programs, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Physiotherapy, Chronic Pain, Medicine, Physical Therapy, and 11 moreAcceptance and Commitment Therapy, Anxiety, Psychological Intervention, Exercise, Clinical Sciences, Psychological Therapy, Randomized Controlled Trial, Trials, ANXIETY, Psykologi, and Cardiovascular medicine and haematology
Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management... more
Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service. Method: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used. Results: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensi...
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Psychological interventions are increasingly utilising online or mobile phone based platforms to deliver treatment, including that for people with chronic pain. The aims of this study were to develop an adapted form of Acceptance and... more
Psychological interventions are increasingly utilising online or mobile phone based platforms to deliver treatment, including that for people with chronic pain. The aims of this study were to develop an adapted form of Acceptance and Commitment Therapy (ACT) for chronic pain in Singapore and to test the feasibility of elements of this treatment delivered via the internet and email. Methods. Thirty-three participants recruited from a tertiary pain management clinic and via the clinic website participated in this program over a period of five weeks with a 3-month follow-up. Treatment outcomes were assessed at three assessment time points. Results. 90.9% of participants completed the program, with 81.8% reporting high treatment satisfaction. Significant changes in depression, t = 3.08, p = 0.002 (baseline to posttreatment), t = 3.28, p = 0.001 (baseline to follow-up), and pain intensity, t = 2.15, p = 0.03 (baseline to follow-up) were found. Mainly small effect sizes (d = 0.09-0.39) wi...
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Acceptance and commitment therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process referred to as "self-as-context" (SAC). This study investigates whether ACT is associated with an... more
Acceptance and commitment therapy (ACT) is based on the psychological flexibility model, which includes a therapeutic process referred to as "self-as-context" (SAC). This study investigates whether ACT is associated with an effect on SAC and whether this effect is linked to treatment outcomes in people with chronic pain. Four hundred twelve adults referred to a pain management center participated in the study. Participants completed measures of treatment processes (SAC, pain acceptance) and outcomes (pain-related interference, work and social adjustment, depression) before treatment, upon completion of treatment, and at 9-month follow-up. Paired sample t-tests and analyses of meaningful change were conducted to examine changes in processes and outcomes. Regression analyses with residualized change scores from process and outcome variables, and bivariate growth curve modeling were used to examine the association between change in SAC and change in outcomes. Participants sig...
Research Interests: Pain, Chronic Pain, Treatment Outcome, Medicine, Acceptance and Commitment Therapy, and 14 moreExecutive Function, Pain Management, Humans, Female, Male, Pain Perception, Regression Analysis, Follow-up studies, Middle Aged, Self Concept, Pain Measurement, Surveys and Questionnaires, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT... more
Acceptance and commitment therapy (ACT) is one of the so called "third-wave" cognitive behavioral therapies. It has been increasingly applied to chronic pain, and there is accumulating evidence to support its effectiveness. ACT is based on a model of general human functioning called the psychological flexibility (PF) model. Most facets of the PF model have been examined in chronic pain. However, a potential key facet related to "self" appears underappreciated. Indeed, a positive or healthy sense of self seems essential to our well-being, and there have been numerous studies of the self in chronic pain. At the same time, these studies are not currently well organized or easy to summarize. This lack of clarity and integration creates barriers to progress in this area of research. PF with its explicit inclusion of self-related therapeutic processes within a broad, integrative, theoretical model may help. The current review summarizes the PF model in the context of c...
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Acceptance may be an important therapeutic process in sleep medicine, but valid psychometric instruments measuring acceptance related to sleep difficulties are lacking. The purpose of this study was to develop a measure of acceptance in... more
Acceptance may be an important therapeutic process in sleep medicine, but valid psychometric instruments measuring acceptance related to sleep difficulties are lacking. The purpose of this study was to develop a measure of acceptance in insomnia, and to examine its factor structure as well as construct validity. In a cross-sectional design, a principal component analysis for item reduction was conducted on a first sample (A) and a confirmatory factor analysis on a second sample (B). Construct validity was tested on a combined sample (C). Questionnaire items were derived from a measure of acceptance in chronic pain, and data were gathered through screening or available from pretreatment assessments in four insomnia treatment trials, administered online, via bibliotherapy and in primary care. Adults with insomnia: 372 in sample A and 215 in sample B. Sample C (n = 820) included sample A and B with another 233 participants added. Construct validity was assessed through relations with e...
Research Interests: Primary Health Care, Chronic Pain, Bibliotherapy, Medicine, Acceptance and Commitment Therapy, and 15 moreInsomnia, Biological Sciences, Humans, Female, Confirmatory factor analysis, Construct Validity, Male, Experiential Avoidance, Clinical Neurology, Acceptance, Middle Aged, Adult, Cross Sectional Studies, Internet, and Medical and Health Sciences
Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts... more
Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants attended a five-week outpatient multidisciplinary program with self-report data collected at assessment, post-treatment, and at 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to three outcomes: pain interference, pain inte...
Research Interests: Clinical Psychology, Cognitive Behavioral Therapy, Pain, Depression, Cognition, and 15 moreChronic Pain, Mediation, Adolescent, Medicine, Acceptance and Commitment Therapy, Distress, Humans, Female, Cognitive Therapy, Male, Middle Aged, Adult, Mediator, Pain Measurement, and Medical and Health Sciences
Research Interests: Pain, Depression, Chronic Pain, Clinical Trial, Treatment Outcome, and 14 moreMedicine, Physical Therapy, Acceptance and Commitment Therapy, Humans, Fibromyalgia, Female, Male, Aged, Middle Aged, Adult, Randomized Controlled Trial, Pilot Projects, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Cognitive Behavioral Therapy, Pain, Chronic Pain, Theory, and 15 moreMedicine, Acceptance and Commitment Therapy, Pain Management, Low back pain, Humans, Cognitive Therapy, Self Help, Learning Theory, Experiential Avoidance, Randomized Controlled Trial, Psychological Flexibility, Psychological Models, Chronic musculoskeletal pain, Psychology and Cognitive Sciences, and Medical and Health Sciences
ABSTRACT
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Chronic pain is a frequent human experience. Prevalence estimates typically indicate that between 15 and 21 percent of adults experience chronic pain, although some prevalence estimates are substantially higher than this, at 46.5 percent... more
Chronic pain is a frequent human experience. Prevalence estimates typically indicate that between 15 and 21 percent of adults experience chronic pain, although some prevalence estimates are substantially higher than this, at 46.5 percent (Breivik, Collett, Ventafridda, Cohen, & Gallacher, 2006; Elliott, Smith, Penny, Smith, & Chambers, 1999). For many individuals, chronic pain has significant adverse impacts on daily activity, employment, relationships, and emotional functioning (Breivik et al., 2006). It also leads to significant ...