Digital Acceptance and Commitment Therapy for the Treatment of Chronic Pain: Findings of a Randomized Controlled Efficacy Trial.

Abstract

People with chronic pain are confronted with limited access to established forms of treatment. Acceptance and commitment therapy (ACT) has been found to be an effective extension of cognitive behavioral therapy (CBT) for chronic pain. In this study, we evaluated the ACT-based online therapy program <i>HelloBetter Chronic Pain</i> in a clinical sample of patients with chronic pain in Germany. In a randomized, controlled, and investigator-blinded trial, the program was tested against a treatment-as-usual control group (waiting list). <i>HelloBetter Chronic Pain</i> comprises a sequence of seven units with interactive content and audio, video, and textual elements. Written support was delivered by psychotherapists (in training) based on standardized templates incorporating automated components. 360 patients with a medically confirmed diagnosis of chronic pain were included in the trial. The primary endpoint was the degree of pain interference (on the interference scale of the Multidimensional Pain Inventory) at 12 weeks. The efficacy analysis was based on linear regression models (intention to treat [ITT], multiple imputation). At 12 weeks, the patients in the intervention group exhibited significantly lower pain interference scores (d = 0.69; 95% confidence interval: [0.46; 0.92]) than those in the control group; they also had fewer depressive symptoms (d = 0.40; [0.17; 0.63]) and experienced better health-related quality of life (d = -0.23; [-0.40; -0.06). These effects were still present at 6 and 12 months. <i>HelloBetter Chronic Pain</i> effectively and sustainably reduces impairment by pain to a clinically relevant extent, alleviates symptoms overall, and may contribute to the successful implementation of guideline-based care for patients with chronic pain.