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Kevin E. Vowles, Ph.D.University of New Mexico
Association for Contextual Behavioral ScienceJune 2014
Mechanisms in Chronic Pain Treatment
Willingness
and Engagementin what matters
to experience pain and discomfort
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One assumes the following
• Treatment success very rarely looks like this:
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In brief, the ACT model assumes that “just accepting it” is insufficient.
Behavior that demonstrates “acceptance” is behavior done in the pursuit of something deemed to be of greater importance than pain.
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Does it work?
“To meet this standard, well-designed studies conducted by independent investigators must converge to support a treatment’s efficacy.”
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What about success from failure?
• Requires that we define success in a way that is quantifiable.
• If we define success, it could allow us to determine change in processes required for success.
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• Interdisciplinary program of ACT
• Intended for highly disabled or distressed individuals who are either not appropriate for lesser intensive treatments or for whom these treatments have already failed
• Duration: ~6.5 hrs daily for 4 weeks, 2 days/wk
The treatment program:
*Outcomes detailed in: Vowles, Witkiewitz, Sowden, & Ashworth, 2014, Journal of Pain
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Pain
Unwillingness
Valued Engagement
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• Success criteria: Reliable Change (RC) in disability at follow-up
(Sickness Impact Profile reduction of > 0.12; possible range from 0 to 1.0)
• Change criteria: + 2 or +33% (whichever was greater).
• Participants21 treatment consecutive treatment completers, who also provided weekly diary data and 3 month follow-up information.
Vowles, Fink, & Cohen, in press; Journal of Contextual Behavioral Science
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Questions• Does treatment success require (is it
consistently associated) with a:
• decrease in Unwillingness AND increase in Engagement?
• decrease in Pain Intensity?
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week 1 week 2 week 3 week 40
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Pain
Patient 1
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PainUnwill-ingness
Patient 1
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Pain UnwillingnessValues Engagement
Patient 1
3 mo. Outcomes:Disability: Reliably improvedMed Visits in prev 3 months : From 5 to 0
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week 1 week 2 week 3 week 40
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PainUnwillingnessValues Engagement
Patient 2
3 mo. Outcomes:Disability: Reliably improvedMed Visits in prev 3 months : From 15 to 2
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PainUnwillingnessValues Engagement
Patient 3
3 mo. Outcomes:Disability: Not reliably improvedMed Visits in prev 3 months : From 0 to 0
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Overall findings
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• 10 of 21 patients (47.6%) evidenced reliable change on the SIP.
Average change:No RC: -.03 (+ .04)Yes RC improved: -.17 (+ .06)
-0.35
-0.3
-0.25
-0.2
-0.15
-0.1
-0.05
0
0.05
MinimumChange
MaximumChange
Reliable Change on the SIP
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Evaluation of Change Requirements
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Change in Pain?
Decreased Pain
Same Pain Worse Pain
RC Improved 2 (9.5%) 7 (33.3%) 1 (4.8%)
No RC 5 (23.8%) 6 (28.6%) --
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Conclusions• These preliminary findings suggest some
potential prerequisites for treatment success within ACT.
• If the results are borne out, it may allow us the opportunity to:• more clearly target them within our interventions• communicate their importance to patients and
providers• and, ideally, strengthen our outcomes.
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Thanks for your attention.
Acknowledgements and thanks:
• UK• Julie Ashworth• Chris Eccleston• Gail Sowden• Lance McCracken
• Sweden• Rikard Wicksell
• USA• Robert Bailey• Lindsey Cohen• Brandi Fink• Mindy McEntee• Katie Witkiewitz
Questions? [email protected]