Although numerous studies prove that Cognitive Behavioral Therapy (CBT) is effective in chronic pain treatment, psychologists acknowledge they need to learn which components of CBT provide the best outcomes for different people with pain, according to UK-based clinical psychologist Lance McCracken, Ph.D. speaking in a plenary session today at the American Pain Society Annual Scientific Conference.

CBT is the most frequently used psychological intervention for people with chronic pain, but McCracken believes psychologists can identify approaches to improve CBT outcomes. He said new directions for improving CBT for treatment of chronic pain may be found in the psychological flexibility model and Acceptance and Commitment therapy (ACT), in particular.

Psychological flexibility basically is the ability to be more aware, more focused on goals and more engaged. One aspect of psychological flexibility pertinent to chronic pain is called committed action, which involves goal-directed, flexible persistence. For pain management, ACT is an approach based on the psychological flexibility model and focuses on building effective patterns of behavior change rather than symptom reduction.

"Greater psychological flexibility is associated with less pain-related anxiety and avoidance, less depression, less physical and psycho-social disability and other measures of patient function," said McCracken, Professor of Behavioral Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London. "Outcome studies suggest that ACT is effective for enhancing daily functioning and for decreasing psychological distress."

McCracken pointed to results of a 2015 study published by British and Swedish researchers that showed acceptance of pain, one component of psychological flexibility, may be a general mechanism by which CBT treatments achieve improvements in functioning, and more specific targeting of pain-related acceptance may lead to further improvement is CBT outcomes.

Another study, published in 2011, assessed the long-term efficacy of acceptance and commitment therapy in more than 100 people with chronic pain. The evidence showed at three-year follow-up 65 percent of study subjects had reliably improved in at least one key clinical domain, and improvements in acceptance of pain and another process called values-based action were associated with improvements in outcomes measures.

McCracken noted that research is underway to learn how to enhance these results precisely for those who do not show reliable improvements.