Acceptance and Commitment Therapy-Based Intervention for Parents Living With Chronic Pain: Feasibility and Acceptability Study

Abstract

Objective:

Chronic pain often clusters in families with up to 50% of parents of youth with chronic pain having chronic pain themselves. Interventions for pediatric chronic pain often involve parents, yet parental chronic pain and stress are rarely addressed. Acceptance and commitment therapy (ACT)-based interventions are efficacious for adult chronic pain, making it a potentially well-suited intervention for parents of youth with chronic pain who also have pain and/or mental health issues. In collaboration with patient partners, we developed and tested feasibility and acceptability of a pilot ACT-based virtual intervention focused on parental chronic pain and mental health.

Method:

Parents of youth with chronic pain who had chronic pain participated in four 1.5-hr weekly sessions delivered virtually. Parents completed pre- and posttreatment measures of pain and mental health symptoms. Feasibility was assessed using session attendance. Parents rated intervention acceptability and provided feedback at the end of the study.

Results:

Six parents (four mothers, M_age = 45.5 years) attended at least three out of four sessions. Parents rated the intervention to be acceptable (M = 56.7/70). Parents highlighted the sense of community and changes they observed in themselves.

Conclusions:

The brief virtual ACT-based intervention for parents living with chronic pain was feasible and acceptable. Future clinical trials are warranted to assess the intervention efficacy to improve parental and youth outcomes.

Implications for Impact Statement

Interventions for pediatric chronic pain often involve parents, yet parental chronic pain and stress are rarely addressed. We developed a brief virtual acceptance and commitment therapy-based intervention for parents of youth with chronic pain who have pain themselves. The intervention was feasible and acceptable.

Get full access to this article

View all access options for this article.

References

Abid Azam

Weinrib

A. Z.

Montbriand

Burns

L. C.

McMillan

Clarke

, & Katz

(2017). Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service. Canadian Journal of Pain, 1(1), 37–49. 10.1080/24740527.2017.1325317

Acri

M. C.

, & Hoagwood

K. E.

(2015). Addressing parental mental health within interventions for children: A review. Research on Social Work Practice, 25(5), 578–586. 10.1177/1049731514546027

Bastien

C. H.

Vallieres

, & Morin

C. M.

(2001). Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307. 10.1016/S1389-9457(00)00065-4

Belton

Hoens

Scott

, & Ardern

C. L.

(2019). Patients as partners in research: It’s the right thing to do. Journal of Orthopaedic & Sports Physical Therapy, 49(9), 623–626. 10.2519/jospt.2019.0106

Beveridge

J. K.

Neville

Wilson

A. C.

, & Noel

(2018). Intergenerational examination of pain and posttraumatic stress disorder symptoms among youth with chronic pain and their parents. Pain Reports, 3(7), Article e667. 10.1097/PR9.0000000000000667

Beveridge

J. K.

Noel

Soltani

Neville

Orr

S. L.

Madigan

, & Birnie

K. A.

(2023). The association between parent mental health and pediatric chronic pain: A systematic review and meta-analysis. Pain. 10.1097/j.pain.0000000000003125

Birnie

K. A.

Dib

, & Ouellette

(2018). Co-building a new landscape in pediatric chronic pain research: Patient partner and researcher perspectives on meaningful patient engagement. Pediatric Pain Letter, 20(3), 21–27.

Birnie

K. A.

Dib

Ouellette

Dib

M. A.

Nelson

Pahtayken

Baerg

Chorney

Forgeron

Lamontagne

Noel

Poulin

, & Stinson

(2019). Partnering for pain: A priority setting partnership to identify patient-oriented research priorities for pediatric chronic pain in Canada. CMAJ Open, 7(4), E654–E664. 10.9778/cmajo.20190060

Birnie

K. A.

Heathcote

L. C.

Bhandari

R. P.

Feinstein

Yoon

I. A.

, & Simons

L. E.

(2020). Parent physical and mental health contributions to interpersonal fear avoidance processes in pediatric chronic pain. Pain, 161(6), 1202–1211. 10.1097/j.pain.0000000000001820

10.

Birnie

K. A.

Pavlova

Neville

Noel

Jordan

Marianayagam

Stinson

Lorenzetti

D. L.

Faulkner

Killackey

Campbell

, & Lalloo

(2021). Rapid evidence and gap map of virtual care solutions across a stepped care continuum for youth with chronic pain and their families in response to the COVID-19 pandemic. Pain, 162(11), 2658–2668. 10.1097/j.pain.0000000000002339

11.

Bjelland

Dahl

A. A.

Haug

T. T.

, & Neckelmann

(2002). The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77. 10.1016/s0022-3999(01)00296-3

12.

Blanch

A. K.

Nicholson

, & Purcell

(1994). Parents with severe mental illness and their children: The need for human services integration. Journal of Mental Health Administration, 21(4), 388–396. 10.1007/bf02521357

13.

Butler

, & Moseley

L. G.

(2021). Explain the pain. NOI Group.

14.

Cohn

L. N.

Pechlivanoglou

Lee

Mahant

Orkin

Marson

, & Cohen

(2020). Health outcomes of parents of children with chronic illness: A systematic review and meta-analysis. Journal of Pediatrics, 218, 166–177.e2. 10.1016/j.jpeds.2019.10.068

15.

Coyne

L. W.

McHugh

, & Martinez

E. R.

(2011). Acceptance and commitment therapy (ACT): Advances and applications with children, adolescents, and families. Child and Adolescent Psychiatric Clinics of North America, 20(2), 379–399. 10.1016/j.chc.2011.01.010

16.

Donnelly

T. J.

Palermo

T. M.

, & Newton-John

T. R. O.

(2020). Parent cognitive, behavioural, and affective factors and their relation to child pain and functioning in pediatric chronic pain: A systematic review and meta-analysis. Pain, 161(7), 1401–1419. 10.1097/j.pain.0000000000001833

17.

Dragioti

Wiklund

Alföldi

, & Gerdle

(2015). The Swedish version of the Insomnia Severity Index: Factor structure analysis and psychometric properties in chronic pain patients. Scandinavian Journal of Pain, 9(1), 22–27. 10.1016/j.sjpain.2015.06.001

18.

Fledderus

Oude Voshaar

M. A.

Ten Klooster

P. M.

, & Bohlmeijer

E. T.

(2012). Further evaluation of the psychometric properties of the Acceptance and Action Questionnaire-II. Psychological Assessment, 24(4), 925–936. 10.1037/a0028200

19.

Goubert

Eccleston

Vervoort

Jordan

, & Crombez

(2006). Parental catastrophizing about their child’s pain. The parent version of the Pain Catastrophizing Scale (PCS-P): A preliminary validation. Pain, 123(3), 254–263. 10.1016/j.pain.2006.02.035

20.

Groenewald

C. B.

Essner

B. S.

Wright

Fesinmeyer

M. D.

, & Palermo

T. M.

(2014). The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the US. Journal of Pain, 15(9), 925–933. 10.1016/j.jpain.2014.06.002

21.

Hahn

E. A.

Beaumont

J. L.

Pilkonis

P. A.

Garcia

S. F.

Magasi

DeWalt

D. A.

, & Cella

(2016). The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations. Journal of Clinical Epidemiology, 73, 135–141. 10.1016/j.jclinepi.2015.08.034

22.

Harris

(2008). The happiness trap: How to stop struggling and start living. Trumpeter Books.

23.

Harris

(2009). ACT with love. New Harbinger Publications.

24.

Harris

(2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (2nd ed.). New Harbinger Publications.

25.

Hayes

S. C.

Strosahl

K. D.

, & Wilson

K. G.

(2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

26.

Hoftun

G. B.

Romundstad

P. R.

, & Rygg

(2013). Association of parental chronic pain with chronic pain in the adolescent and young adult: Family linkage data from the HUNT Study. JAMA Pediatrics, 167(1), 61–69. 10.1001/jamapediatrics.2013.422

27.

Killackey

Soltani

Noel

Birnie

K. A.

Choiniere

Page

M. G.

Dassieu

Lacasse

Lalloo

Poulin

Ali

Baerg

Battaglia

Campbell

Mohabir

Nishat

Kelly

Lund

Isaac-Bertrand

, … Stinson

(2023). We survived the pandemic together: The impact of the COVID-19 pandemic on Canadian families living with chronic pain. Canadian Journal of Pain, 7(2), Article 2157251. 10.1080/24740527.2022.2157251

28.

King

Chambers

C. T.

Huguet

MacNevin

R. C.

McGrath

P. J.

Parker

, & MacDonald

A. J.

(2011). The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain, 152(12), 2729–2738. 10.1016/j.pain.2011.07.016

29.

Lau

M. A.

, & McMain

S. F.

(2005). Integrating mindfulness meditation with cognitive and behavioural therapies: The challenge of combining acceptance- and change-based strategies. Canadian Journal of Psychiatry, 50(13), 863–869. 10.1177/070674370505001310

30.

Law

E. F.

Fales

J. L.

Beals-Erickson

S. E.

Failo

Logan

Randall

, & Weiss

(2017). A single-arm feasibility trial of problem-solving skills training for parents of children with idiopathic chronic pain conditions receiving intensive pain rehabilitation. Journal of Pediatric Psychology, 42(4), 422–433. 10.1093/jpepsy/jsw087

31.

Lee

Dick

B. D.

Jordan

, & McMurtry

C. M.

(2021). Psychological interventions for parents of youth with chronic pain: A scoping review. Clinical Journal of Pain, 37(11), 825–844. 10.1097/AJP.0000000000000977

32.

Lee

Edwards

, & McMurtry

C. M.

(2021). A cognitive-behavioral group intervention for parents of youth with chronic pain: Development, feasibility, and preliminary effectiveness. Clinical Practice in Pediatric Psychology, 9(2), 145–155. 10.1037/cpp0000385

33.

McCracken

L. M.

, & Vowles

K. E.

(2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology, 27(2), 215–220. 10.1037/0278-6133.27.2.215

34.

McCracken

L. M.

, & Vowles

K. E.

(2022). New generation psychological treatments in chronic pain. BMJ, 376, Article e057212. 10.1136/bmj-2021-057212

35.

Milosevic

Levy

H. C.

Alcolado

G. M.

, & Radomsky

A. S.

(2015). The Treatment Acceptability/Adherence Scale: Moving beyond the assessment of treatment effectiveness. Cognitive Behaviour Therapy, 44(6), 456–469. 10.1080/16506073.2015.1053407

36.

Morin

C. M.

Belleville

Belanger

, & Ivers

(2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 34(5), 601–608. 10.1093/sleep/34.5.601

37.

Neff

K. D.

(2012). The science of self-compassion. In Germer

C. K.

& Siegel

R. D.

(Eds.), Wisdom and compassion in psychotherapy: Deepening mindfulness in clinical practice (pp. 79–92). The Guilford Press.

38.

Neuendorf

(2018). Content analysis and thematic analysis. In Brough

(Ed.), Advanced research methods for applied psychology (pp. 211–223). Routledge.

39.

Office of the Auditor General of Canada . (2023). Connectivity in rural and remote areas. https://www.oag-bvg.gc.ca/internet/English/att__e_44225.html

40.

Olthuis

Wilson

Goodman

Wojtowics

Graham

Vallely

, & Chambers

C. T.

(2010). Be the boss of your pain (treatment manual). IWK Health Centre.

41.

Palermo

T. M.

Valrie

C. R.

, & Karlson

C. W.

(2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69(2), 142–152. 10.1037/a0035216

42.

Peolsson

Hydén

L. C.

, & Sätterlund Larsson

(2000). Living with chronic pain: A dynamic learning process. Scandinavian Journal of Occupational Therapy, 7(3), 114–125. 10.1080/110381200300006069

43.

Phares

Lopez

Fields

Kamboukos

, & Duhig

A. M.

(2005). Are fathers involved in pediatric psychology research and treatment? Journal of Pediatric Psychology, 30(8), 631–643. 10.1093/jpepsy/jsi050

44.

Polk

K. L.

, & Schoendorff

(2014). The ACT matrix. Context Press.

45.

Stoddard

J. A.

, & Afari

(2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

46.

Stolper

van Doesum

, & Steketee

(2022). Integrated family approach in mental health care by professionals from adult and child mental health services: A qualitative study. Frontiers in Psychiatry, 13, Article 781556. 10.3389/fpsyt.2022.781556

47.

Stone

A. L.

Bruehl

Smith

C. A.

Garber

, & Walker

L. S.

(2018). Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain. Pain, 159(2), 298–305. 10.1097/j.pain.0000000000001085

48.

Stone

A. L.

, & Wilson

A. C.

(2016). Transmission of risk from parents with chronic pain to offspring: An integrative conceptual model. Pain, 157(12), 2628–2639. 10.1097/j.pain.0000000000000637

49.

Sullivan

M. J.

Bishop

S. R.

, & Pivik

(1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment, 7(4), 524–532. 10.1037/1040-3590.7.4.524

50.

Thorsell Cederberg

Weineland Strandskov

Dahl

, & Ljungman

(2017). Parents’ relationship to pain during children’s cancer treatment—A preliminary validation of the Pain Flexibility Scale for Parents. Journal of Pain Research, 10, 507–514. 10.2147/JPR.S127019

51.

Van Slyke

D. A.

, & Walker

L. S.

(2006). Mothers’ responses to children’s pain. Clinical Journal of Pain, 22(4), 387–391. 10.1097/01.ajp.0000205257.80044.01

52.

Veehof

M. M.

Trompetter

H. R.

Bohlmeijer

E. T.

, & Schreurs

K. M.

(2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31. 10.1080/16506073.2015.1098724

53.

Weathers

F. W.

Litz

B. T.

Keane

T. M.

Palmieri

P. A.

Marx

B. P.

, & Schnurr

P. P.

(2013). The PTSD Checklist for DSM-5 (PCL-5). National Center for PTSD. https://www.ptsd.va.gov

54.

Wilson

A. C.

, & Fales

J. L.

(2015). Parenting in the context of chronic pain: A controlled study of parents with chronic pain. Clinical Journal of Pain, 31(8), 689–698. 10.1097/AJP.0000000000000157

55.

Wilson

K. G.

(2008). Mindfulness for two: An acceptance and commitment therapy approach to mindfulness in psychotherapy. New Harbinger Publications.

56.

Woidneck

M. R.

Pratt

K. M.

Gundy

J. M.

Nelson

C. R.

, & Twohig

M. P.

(2012). Exploring cultural competence in acceptance and commitment therapy outcomes. Professional Psychology: Research and Practice, 43(3), 227–233. 10.1037/a0026235

57.

Zettle

R. D.

(2007). ACT for depression: A clinician’s guide to using acceptance and commitment therapy in treating depression. New Harbinger Publications.