Might psychological flexibility processes and Acceptance and Commitment Therapy (ACT) apply in adults with painful diabetic neuropathy? A cross-sectional survey

Painful diabetic neuropathy (PDN) is a distressing and disabling condition. There is, surprisingly, relatively lithe research into the role of psychological variables related to PDN. The aim of this study was to investigate the association between psychological flexibility, daily functioning, and distress in people with PDN. This cross-sectional study included 225 participants who were recruited from hospital services and online. In correlation analyses, acceptance of pain was shown to be negatively correlated with pain intensity (r = -0.21, p < 0.01), pain distress (r = -0.25, p < 0.01), functional impairment (r = -0.38, p < 0.01), depression severity (r = -0.41, p < 0.01), and depression impact (r = -0.41, p < 0.01). Cognitive fusion correlated positively with pain intensity (r = 0.14, p < 0.05), functional impairment (r = 0.24, p < 0.01), depression severity (r = 0.44, p < 0.01), and depression impact (r = 0.20, p < 0.01). Committed action also correlated negatively with functional impairment (r = -0.22, p < 0.01), depression severity (r = -0.43, p < 0.01), and depression impact (r = -0.21, p < 0.01). In regression analyses, the four variables representing psychological flexibility accounted for significant variance in all the equations except in the case of pain distress. However, in some cases the variance accounted for was less than that accounted for by pain intensity. For example, in the equation for functional impairment, pain intensity accounted for 32.2% of variance, while psychological flexibility accounted for 6.8% of variance. These results suggest that psychological flexibility may play a smaller role, relative to pain intensity, in the context of PDN as compared to the larger populations of chronic, mostly musculoskeletal, pain. The reliability and generalisability of these results need to be established.