Matthew S Herbert1,2,3, Anne L Malaktaris1,2,3, Cara Dochat4, Michael L Thomas1,3, Julie Loebach Wetherell2,3, Niloofar Afari1,2,3. 1. Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California. 2. VA San Diego Healthcare System, San Diego, California. 3. Department of Psychiatry, University of California, San Diego, California. 4. San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
Abstract
Objective: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain. Design: Longitudinal. Setting: Veterans Affairs San Diego Healthcare System. Subjects: A total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83). Methods: Linear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up. Results: Participants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels. Conclusions: PTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.
Objective: The aim of this study was to determine whether post-traumatic stress disorder (PTSD) moderates treatment outcomes in Acceptance and Commitment Therapy for chronic pain. Design: Longitudinal. Setting: Veterans Affairs San Diego Healthcare System. Subjects: A total of 126 veterans with chronic pain participating in an Acceptance and Commitment Therapy intervention for chronic pain. A structured clinical interview was used at baseline to designate PTSD-positive (N = 43) and -negative groups (N = 83). Methods: Linear mixed-effects models to determine whether PTSD moderated change in pain interference, pain severity, pain acceptance, depressive symptoms, or pain-related anxiety at post-treatment and six-month follow-up. Results:Participants with co-occurring PTSD reported greater pain interference, pain severity, depressive symptoms, and pain-related anxiety at baseline. PTSD status did not moderate treatment effects post-treatment. Rather, there were significant improvements on all study measures across groups (P < 0.001). PTSD status moderated change in depressive symptoms at six-month follow-up (P < 0.05). Specifically, participants with chronic pain alone demonstrated improvement in depressive symptoms compared with pretreatment levels, whereas participants with PTSD regressed to pretreatment levels. Conclusions: PTSD status did not significantly affect treatment outcomes, with the exception of depressive symptoms at six-month follow-up. Overall, Acceptance and Commitment Therapy for chronic pain appears helpful for improving outcomes among veterans with co-occurring PTSD; however, veterans with co-occurring PTSD may experience fewer long-term gains compared with those with chronic pain alone.
Authors: Amir Abbas Taheri; Ali Akbar Foroughi; Youkhabeh Mohammadian; Seyed Mojtaba Ahmadi; Khatereh Heshmati; Leila Afshar Hezarkhani; Ali Akbar Parvizifard Journal: Diabetes Ther Date: 2020-06-12 Impact factor: 2.945