A randomized controlled trial evaluating the effectiveness of an acceptance and commitment therapy-based bibliotherapy intervention among adults living with chronic pain

Background Chronic pain has a significant impact on the physical and psychological functioning of those living with this condition. It is now recognized that acceptance and commitment therapy (ACT) is an effective intervention in managing chronic pain; however, several barriers limit its accessibility. Aims The current study aimed to evaluate the effectiveness of an 8-week bibliotherapy-type self-administered psychological intervention with minimal therapeutic contact, based on ACT, in the management of chronic pain. Methods This was a randomized controlled trial with three measurement periods (pretest, posttest, and 3 months after the intervention; ClinicalTrials.gov Identifier: NCT03924687). A total of 140 adults with chronic pain were randomly assigned to an ACT self-help condition or a wait-list control condition. Results Two-way repeated measures analysis of variance (ANOVA) models showed statistically significant differences between pretest and posttest in terms of pain-related disability (main variable), depression (secondary variable), pain-related acceptance, and psychological inflexibility (d = 0.46-0.88) in favor of the ACT self-help condition. At the 3-month follow-up, these differences were maintained and nearly 54% of participants reported an overall improvement of their physical and mental health. Conclusion These results suggest that a psychological intervention self-administered through ACT bibliotherapy with minimal therapeutic support can improve the physical and emotional functioning of adults from the community who live with chronic pain. RESUME Contexte: La douleur chronique a des repercussions importantes sur le fonctionnement physique et psychologique des personnes atteintes. Il est maintenant reconnu que la therapie d'acceptation et d'engagement (ACT) est une intervention efficace pour la prise en charge de la douleur chronique; cependant, plusieurs barrieres limitent son accessibilite. Objectifs: La presente etude avait pour but d'evaluer l'efficacite d'une intervention psychologique autoadministree de huit semaines sous forme de bibliotherapie avec contact therapeutique minimal, basee sur l'ACT dans la gestion de la douleur chronique. Methodes: Cet essai controle et randomise comprenait trois temps de mesure (pretest, posttest et trois mois suivant l'intervention) (Code d'identification ClinicalTrials.gov :NCT03924687). Un total de 140 adultes souffrant de douleur chronique a ete assigne aleatoirement dans une condition ACT de type self-help (bibliotherapie) et une condition liste d'attente. Resultats: Un modele d'analyse de variance (ANOVA) a deux facteurs a mesures repetees a demontre des differences statistiquement significatives entre le pretest et le posttest sur l'incapacite liee a la douleur (variable principale), la depression (variable secondaire), l'acceptation et l'inflexibilite psychologique associees a la douleur (d = 0,46 a 0,88) en faveur de la condition ACT de type self-help. Au suivi de trois mois, ces differences se sont maintenues et pres de 54 % des participants ont rapporte une amelioration globale de leur sante physique et mentale. Conclusion: Ces resultats suggerent qu'une intervention psychologique autoadministree par le biais d'une bibliotherapie de type ACT, avec soutien therapeutique minimal, peut ameliorer le fonctionnement physique et emotionnel des adultes souffrant de douleur chronique en provenance de la communaute.