Yoga vs Acceptance and Commitment Therapy for Chronic Pain

Overseen By Peter Bayley, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Palo Alto Veterans Institute for Research

Disqualifiers: Back surgery, Unstable illness, Yoga, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

Duration: 12 weeks

274 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores two methods to help veterans manage chronic muscle and joint pain: online yoga and Acceptance and Commitment Therapy (ACT), a type of talk therapy. The goal is to determine which method more effectively reduces pain. The trial seeks veterans who have experienced chronic pain for over six months and have not recently started new pain treatments. Participants must have a stable internet connection at home and should not have practiced yoga in the past year. As an unphased trial, this study offers veterans a unique opportunity to explore innovative pain management techniques.

Will I have to stop taking my current medications?

The trial requires that you have a stable medication regimen for at least 4 weeks before joining, so you should not start new pain treatments or medications in the month before the study. However, it does not specify that you need to stop your current medications.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

A previous study found yoga effective and safe for managing chronic pain. A 2017 analysis of over 2,500 participants showed that mindfulness meditation, a key part of yoga, reduced chronic pain. Another study focused on yoga for back and neck pain and found it more effective than regular daily care.

Acceptance and Commitment Therapy (ACT) is also safe for chronic pain. Research shows that ACT helps people function better despite their pain. Reviews of multiple studies have shown that ACT effectively helps people manage chronic pain.

Both yoga and ACT are generally well-tolerated, with no major safety concerns reported in these studies. Participants usually handle these therapies well, making them promising options for those dealing with chronic pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using Yoga and Acceptance and Commitment Therapy (ACT) for chronic pain because they offer non-pharmaceutical approaches that target both the mind and body. Unlike typical pain treatments that often rely on medications like NSAIDs or opioids, Yoga combines physical postures, meditation, and breathing exercises to enhance physical flexibility and mental relaxation. ACT, on the other hand, is a form of behavioral therapy that helps patients accept their pain and commit to living life in accordance with their values, which can lead to better emotional resilience. These treatments aim to provide holistic pain management with fewer side effects and a focus on improving quality of life.

What evidence suggests that this trial's treatments could be effective for chronic pain?

This trial will compare the effectiveness of two treatments for chronic pain: online yoga and Acceptance and Commitment Therapy (ACT). Research has shown that both yoga and ACT can help treat chronic pain. Participants in the online yoga arm will engage in postures, meditation, and breathing exercises, which studies have found can effectively reduce chronic low back pain. Meanwhile, those in the ACT arm will receive behavioral medicine, which has improved outcomes for people with chronic pain, such as increasing physical activity and reducing the need for doctor visits related to pain. Randomized trials and systematic reviews consistently support ACT's positive effects on functioning with pain. Both treatments offer promising options for those dealing with chronic pain. ^{2 4 6 7 8}

Who Is on the Research Team?

Peter Bayley, PhD

Principal Investigator

Palo Alto Veterans Institute for Research

Are You a Good Fit for This Trial?

This trial is for veterans experiencing long-term musculoskeletal pain. Participants should be comfortable with using online tools as both treatments are delivered virtually.

Inclusion Criteria

I haven't started any new pain treatments or medications in the last month.

Wireless internet connection at home

Minimum pain intensity at screening ≥4 on a 0-10 using the Defense and Veterans Pain Rating Scale (DVPRS)

Exclusion Criteria

Attended or practiced yoga ≥ 1 x in the past 12 months

My pain level is either less than 4 or more than 9 out of 10.

Participation in another clinical trial, unless given prior authorization from both our research team and that of the other study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either online yoga instruction or Acceptance and Commitment Therapy once a week for 12 weeks in an online group class

12 weeks

12 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with check-ins to record any adverse events

6 months

What Are the Treatments Tested in This Trial?

Interventions

• Acceptance and Commitment Therapy (ACT)
• Yoga

Trial Overview The study aims to determine if online yoga classes or Acceptance and Commitment Therapy (ACT) is more effective in reducing chronic musculoskeletal pain among veterans.

How Is the Trial Designed?

Group I: Online Yoga Experimental Treatment 1 Intervention

Postures, meditation, breathing exercises

Group II: Acceptance and Commitment Therapy Active Control 1 Intervention

Behavioral medicine

Who Is Running the Clinical Trial?

Palo Alto Veterans Institute for Research

Lead Sponsor

Trials

58

Recruited

8,800+

Published Research Related to This Trial

The study involved 82 patients who underwent orthopedic surgery, and those receiving an automated mobile messaging intervention based on Acceptance and Commitment Therapy (ACT) used 36.5% fewer opioid tablets compared to the control group, indicating a significant reduction in opioid consumption (P=0.004).

Patients in the ACT intervention group reported lower pain intensity scores after two weeks post-surgery (mean score of 45.9) compared to the control group (mean score of 49.7), suggesting that ACT may help in managing pain, although the difference may not be clinically significant (P=0.04).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Anthony, CA., Rojas, EO., Keffala, V., et al.[2020]

The ACTsmart intervention, a smartphone-delivered acceptance and commitment therapy, showed significant improvements in pain interference among 34 adults with chronic pain after 8 weeks of treatment, with a large effect size (d = -1.01).

All secondary outcomes, including psychological flexibility and quality of life, also improved significantly and these benefits were maintained for up to 12 months, suggesting that ACTsmart is an effective and accessible treatment option for chronic pain.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain-A Pilot Trial. Gentili, C., Zetterqvist, V., Rickardsson, J., et al.[2023]

A pilot study involving 28 adolescents aged 13-17 showed that an 8-week internet-delivered Acceptance and Commitment Therapy (ACT) significantly improved pain interference in adolescents (effect size d = 1.09) and pain reactivity in parents (effect size d = 0.70).

Despite some challenges in recruitment and compliance, the study indicates that internet-delivered ACT could be a feasible and effective treatment option for managing chronic pain in adolescents and their parents, warranting further research with larger randomized trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-Delivered Acceptance and Commitment Therapy for Adolescents with Chronic Pain and Their Parents: A Nonrandomized Pilot Trial. Zetterqvist, V., Gentili, C., Rickardsson, J., et al.[2021]

A systematic review of 20 articles found that online Acceptance and Commitment Therapy (ACT) interventions for chronic pain are effective, particularly in studies that included randomized controlled trials (RCTs).

Most interventions were designed according to ACT principles and often included guidance, but many studies lacked detailed information on how design choices were made to enhance user engagement and adherence, which are important for maximizing effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online Acceptance and Commitment Therapy (ACT) interventions for chronic pain: A systematic literature review. van de Graaf, DL., Trompetter, HR., Smeets, T., et al.[2022]

A study involving 481 potential participants with chronic pain showed that Acceptance and Commitment Therapy (ACT) is feasible to implement in general practice, with 73 participants allocated to either ACT plus usual care or usual care alone.

The majority of participants (70.3%) attended most ACT sessions and rated the treatment as credible, indicating that ACT could be a promising and acceptable option for managing chronic pain in primary care settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A feasibility study of brief group-based acceptance and commitment therapy for chronic pain in general practice: recruitment, attendance, and patient views. McCracken, LM., Sato, A., Wainwright, D., et al.[2022]

In a study of 415 participants undergoing an ACT-based pain management program, three distinct psychological flexibility (PF) profiles were identified: low PF, low openness, and high awareness and action, indicating that individuals with chronic pain have varied psychological characteristics.

Despite these differences in baseline PF profiles, all subgroups showed similar responses to ACT treatment, suggesting that ACT may be effective across different psychological profiles, but further research is needed to tailor treatments to individual needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of outcomes following interdisciplinary acceptance and commitment therapy for chronic pain: Profiling psychological flexibility. Yu, L., McCracken, LM., Scott, W.[2022]

This systematic review and meta-analysis aims to evaluate the effectiveness of acceptance and commitment therapy (ACT) in improving functioning for individuals with chronic pain, utilizing randomized controlled trials as the basis for analysis.

The study will identify the most effective methods for implementing ACT, potentially leading to better management strategies for chronic pain, which is a widespread issue affecting many people's daily lives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy for chronic pain conditions on functioning: A systematic review protocol. Du, S., Dong, J., Jin, S., et al.[2021]

Acceptance and Commitment Therapy (ACT) has shown effectiveness in improving outcomes for patients with chronic pain and may also benefit those with mild to moderate depression, making it a valuable tool for general practitioners.

ACT employs mindfulness and acceptance strategies to help patients align their behaviors with their values, and it has shown preliminary benefits in various conditions, including obsessive-compulsive disorder and emotional issues after gastric band surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acceptance and commitment therapy - pathways for general practitioners. Smout, M.[2012]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6174685/

Current status of acceptance and commitment therapy for ... Overall, these reviews indicate that ACT can effectively lead to improved health outcomes. In 2014, Hann and McCracken systematically reviewed assessment ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S1526590023005394

Acceptance and Commitment Therapy for Chronic Pain: An ... Overall, however, randomized clinical trials and systematic reviews show that ACT can improve outcomes related to chronic pain (eg, pain-related functioning).

3. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0301226

Acceptance and commitment therapy for patients with chronic ... Post-treatment data highlight the efficacy of ACT in moderating pain-related outcomes. Clinical nurses are encouraged to incorporate ACT ...

4. integrativepainscienceinstitute.com integrativepainscienceinstitute.com/acceptance-and-commitment-therapy-act-for-chronic-pain/

Acceptance and Commitment Therapy (ACT) for Chronic ... Positive outcomes of ACT include an increase in physical and social activity and a decrease in pain-related medical visits. Acceptance of pain is also linked to ...

5. apa.org apa.org/pubs/journals/releases/amp-a0035623.pdf

Acceptance and Commitment Therapy and Mindfulness for ... Results from both of these studies failed to support the necessity of the skills trained in traditional CBT for chronic pain. In fact, they suggest that when ...

6. pesi.com pesi.com/item/2-day-acceptance-commitment-therapy-act-chronic-pain-start-finish-training-clinicians-132063?srsltid=AfmBOorNSuJdqEIESYqXQVzhXQFEUgBJNU6mRYQVG4riAeiJkTQQdV91

2 Day: Acceptance and Commitment Therapy (ACT) for ... 2 Day Acceptance and Commitment Therapy (ACT) for Chronic Pain. A Start to Finish Training for Clinicians. Speaker: Jennifer Caspari, PhD; Duration: 12 Hours ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11092929/

a systematic review and meta-analysis - PMC - PubMed Central This systematic review and meta-analysis will examine the efficacy and safety of acceptance and commitment therapy for FM, using the primary outcomes of pain ...

8. bmcprimcare.biomedcentral.com bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01690-2

Addressing chronic pain with Focused Acceptance and ... Findings support that FACT-CP was acceptable for patients with chronic pain and feasible for delivery in a primary care setting by a BHC.