The Effectiveness of Acceptance and Commitment Therapy (ACT) in Reducing Pain Intensity and Enhancing the Sense of Coherence and Psychological Well-being among the Patients with Chronic Low Back Pain

Document Type : Original Article


1 Department of Psychology University of Sistan and Baluchestan, Iran

2 Department of Psychology, University of Sistan and Baluchestan, Iran


Chronic pain is a common, multifactorial problem that requires medical and psychological interventions to be managed. On the other hand, Acceptance and commitment therapy (ACT) is one of the third-wave cognitive-behavioral therapies, which has recently been used to treat the certain psychiatric disorders and to enhance the patients’ psychological status. Therefore, the present study aimed to investigate the effectiveness of acceptance and commitment therapy on reducing pain intensity and improving the sense of coherence and psychological well-being among the patients with chronic low back pain. This quasi-experimental study was performed by a pretest-posttest design with two groups. Also, it had a statistical population including all the patients with chronic low back pain and were present at the neuropsychiatry clinic of Ali ibn Abi Talib Hospital, who were referred to Red Crescent Physiotherapy Clinic in Zahedan from March 2016 to May 2017. Moreover, its sample consisted of 30 patients with chronic low back pain who were selected from all the patients referred to Red Crescent Physiotherapy Clinic in Zahedan, using the targeted sampling method in terms of the inclusion and exclusion criteria. These patients were then assigned into two groups as experimental and control, each one included 15 patients. In addition, the McGill Pain Questionnaire (1997), the Ryff Psychological Well-being Scale (1989), and the Sense of Coherence Scale designed by Flensborg-Madson et al. (2006) were used as data collection tools. To analyze the data, descriptive statistics such as means, standard deviations, and univariate and multivariate covariance analyses were used. The data analysis indicated that, the acceptance and commitment therapy could significantly decrease the pain intensity and its subscales among the patients in the experimental group compared to the control group (p <0.01). Furthermore, acceptance and commitment therapy significantly increased the sense of coherence and psychological well-being as well as their subscales in the experimental group's patients compared to the control group (p <0.01). It can be concluded that, acceptance and commitment therapy was effective on reducing the pain intensity and boosting the sense of coherence and psychological well-being among the patients with chronic low back pain. Therefore, the findings represent new horizons in clinical interventions and can be used as an effective intervention method.


Main Subjects

Ataei, M. R. (2014). The Effectiveness of Group Therapeutic Hope on Predominant Well-Being, Acceptable and Pseudostasis of HIV Patients. Journal Kermanshah University of Medical Sciences, 18(5), 265-74.
Beigi, N. A., Noorgostar, S., Bidari, A., Sadeghi, S., & Shahgholi, L. (2008). Mental health and psychological complications of pain in workers with chronic low back pain in an industrial plant. Payesh Journal, 7(3), 247-252.
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008). The assessment of present-moment awareness and acceptance the Philadelphia mindfulness scale. Assessment, 15(2), 204-223.
Clarke, D., & Goosen, T. (2009). The mediating effects of coping strategies in the relationship between automatic negative thoughts and depression in a clinical sample of diabetes patients. Personality and Individual Differences, 46(4), 460-464
Dworkin, R. H., Turk, D. C., Revicki, D. A., Harding, G., Coyne, K. S., & Peirce-Sandner, S., et al. (2009). Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). PAIN®, 144(1), 35-42.
Flensborg-Madsen, T., Ventegodt, S., & Merrick, J. (2006). "Sense of coherence and physical health.Across - sectional using scale (SOCII). TSW Holistic Health & Medicin, 1, 236-247
Gharaie-Ardekani, S., Azad-Fallah, P., & Tavallaie, A. (2012). The Effectiveness of Acceptance and Commitment Therapy on Pain Experience in Women with Chronic Pain. Journal of Clinical Psycology, 4(14), 39-50.
Hadizadeh-kafash, R., Mahmoudi, A., & Salimi, M. (2017). The Effectiveness of Acceptance Commitment Therapy in Psychological Well-being and Marital Satisfaction. The 4th International Conference on Recent Innovations in Psychology, Counseling and Behavioral Sciences. Tehran: Nikan University.
Hauser, R. M., Springer, K. W., & Pudrovska, T. (2014). Temporal structures of psychological well-being: continuity or change? Presented at the 2005 Meetings of the Gerontological Society of America, Orlando, Florida. Journal of Intellectual Disability Research, 12, 874-882.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1-25.
Hoseyni, M., Abdkhodai, M., & Aghamohammadian Sherbaf, H. (2017). Role of Mediating Sense of Coherence in Relationship between Duration and Number of Physical Complications of Diabetes with Mental Health in Patients with Type 2 Diabetes Mellitus. Journal of Medicine and Life, 23(4), 311-317.
Irandoost, F., Safary, S., Neshatdoost, H. T., & Nadi, M. A. (2015). The effectiveness of Group Acceptance and Commitment Therapy (ACT) on pain related anxiety and depression in women with chronic low back pain. Journal of Behavioral Sciences, 9(1), 1-2.
Johnston, M., Foster, M., Shennan, J., Starkey, N., & Johnson, A. (2010). The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. The Clinical Journal of Pain, 26(5), 393-402
Keogh, E., Bond, F. W., Hanmer, R., & Tilston, J. (2005). Comparing acceptance-and control-based coping instructions on the cold-pressor pain experiences of healthy men and women. European Journal of Pain, 9, 591-598.
Khosravi, M., Sedighi, S., Moradi Alamdari, Sh., & Zendedel, K. (2013). Persian-McGill pain questionnaire translation, adaptation, and reliability in cancer patients: a brief report. Tehran University Medical Journal, 71(1), 53-58.
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American psychologist, 69(2), 178.
McCracken, L. M., Gauntlett-Gilbert, J., & Eccleston, C. (2010). Acceptance of pain in adolescents with chronic pain: validation of an adapted assessment instrument and preliminary correlation analyses. European Journal of Pain, 14(3), 316-20.
McWilliams, L. A., Cox, B. J., & Enns, M. W. (2003). Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain, 106(1-2), 127-33.
Moksnes, U. K., Espnes, G. A., & Lillefjell, M. (2012). Sense of coherence and emotional health in adolescents. Journal of Adolescence, 35(2), 433-441.
Perry, J., VanDenKerkhof, E. G., Wilson, R. & Tripp, D. A. (2017). Development of a Guided Internet-based Psycho-education Intervention Using Cognitive Behavioral Therapy and Self-Management for Individuals with Chronic Pain. Pain Management Nursing, 18(2), 90-101.
Pourhadi, S., Hossein-Zadeh, S., Haji-Ahmadi, M., & Taghipour-Darzi, M. (2014).The Quality of Life in Patients with Nonspecific Chronic Low Back Pain. Archives of Rehabilitation, 14(4), 74-81
Proceska, J., & Norcross, J., C. (2006). Theory of Psychotherapy. Translated by Yahya Seyed Mohammadi, Tehran: Roshd Publications.
Rafiee, S., Sohrabi, F., Shams, J., & Forough, A. (2012). The efficacy of Cognitive Behavioral Therapy in patients with chronic musculoskeletal pain. Pars of Jahrom University of Medical Sciences, 10(2), 73-82.
Roditi, D., & Robinson, M. E. (2011). The role of psychological interventions in the management of patients with chronic pain. Psychology Research and Behavior Management, 4, 41-49.
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069.
Ryff, C. D., & Singer, B. H. (2013). Know thyself and become what you are: A eudaimonic approach to psychological well-being. The Exploration of Happiness (pp. 97-116): Springer.
Sabri-Nazarzadeh, R., & Abdolkhodaei, M. S. (2011). The Relationship of the Sense of Coherence and Psychological Hard Work with Mental Health. The 1st National Conference on Health Psychology. Ahvaz: Islamic Azad University, Ahvaz Branch, March 2012.
Sahin, N., Karahan, A. Y., Devrimsel, G., & Gezer, I. A. (2017). Comparison among pain, depression, and quality of life in cases with failed back surgery syndrome and non-specific chronic back pain. Journal of Physical Therapy Science, 29(5), 891-895.
Sarah, A. K., & Beatriz, P. (2012). Vulnerabilities to depression and sense of coherence among Bedouin Arab and Jewish students: A test of a mediation model. International Journal of Psychology and Counselling, 4(3), 31-40.
Shokri, O. (2001). Gender Differences in Subjective Well-Being and Personality Characteristics, Iranian Journal of Clinical Psychology, 7(3), 208-289
Thorn, B. E. (2017). Cognitive therapy for chronic pain: a step-by-step guide: Guilford Publications.
Vazquez, C., Hervas, G., Rahona, J. J., & Gomez, D. (2009). Psychological well-being and health. Contributions of positive psychology. Annuary of Clinical and Health Psychology, 5, 15-27
Veehof, M. M., Oskam, M., Schreurs, K. M. G., & Bohlmeijer E. T. (2011).Acceptance-based Interventions for the Treatment of Chronic Pain: A Systematic Review and Meta-Analysis. The Journal of International Association for the Study of Pain, 152(3), 533-542.
Vowles, K. E., McNeil, D. W., Gross, R. T., McDaniel, M. L., Mouse, A., & Bates, M. et al. (2007). Effects of pain acceptance and pain control strategies on physical impairment in individuals with chronic low back pain. Behavior Therapy, 38(4), 412-425
Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., & Petkus, A. J., et al. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098-2107.
Wicksell, R. K., Olsson, G. L., & Hayes, S. C. (2010). Psychological flexibility as a mediator of improvement in Acceptance and Commitment Therapy for patients with chronic pain following whiplash. European Journal of Pain, 14(10), 1059. 1051-1059. 1011.
Zaccagnino, M. P., & Nedeljkovic, S. S. (2017). Pain Assessment Tools Pain Medicine (pp. 77-81): Springer.