Practice-based evidence for outpatient, acceptance & commitment therapy for veterans with chronic, non-cancer pain

• Practice-based evidence of ACT vs. CBT for chronic pain among Veterans is lacking.
• Questions remain about disparities between RCT results and practice-based evidence.
• ACT not significantly different from CBT on standard pain outcome measures in study.
• ACT and CBT decreased catastrophizing, illness-focused coping, and global distress.
• Research needed to identify tailoring variable to adapt and/or sequence treatment.

Past research has shown that Acceptance & Commitment Therapy (ACT) compares favorably with Cognitive-Behavioral Therapy (CBT) in the treatment of chronic pain among different populations. However, practice-based evidence comparing ACT and CBT to treat chronic, non-cancer pain solely among a Veteran population is lacking. The current pilot study used a quasi-experimental, single-site, pre-/post-test design. A sample of 96 Veterans participated in the study at a Midwestern Department of Veterans Affairs Medical Center between November 3, 2009–November 4, 2010. Veterans self-selected to participate in either a manualized ACT or CBT for chronic pain group. All participants completed a standard pre- and post-intervention assessment battery. A 2×2 RM MANOVA did not find a significant interaction effect nor a significant main effect for type of intervention. The ACT intervention was not significantly different from the CBT intervention on the standard outcome measures. Findings did suggest that both groups decreased illness-focused coping strategies, catastrophizing behaviors, and global distress levels over time. Further research is needed to help identify a tailoring variable that can provide guidance in developing adaptive and/or sequential treatment strategies.