***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular , but to date little is known about neural mechanisms associated with these interventions . Mindfulness-Based Stress Reduction ( MBSR ) , one of the most widely used mindfulness training programs , has been reported to produce positive effects on psychological well-being and to ameliorate symptoms of a number of disorders . Here , we report a controlled longitudinal study to investigate pre-post changes in brain gray matter concentration attributable to participation in an MBSR program . Anatomical magnetic resonance ( MR ) images from 16 healthy , meditation-naïve participants were obtained before and after they underwent the 8-week program . Changes in gray matter concentration were investigated using voxel-based morphometry , and compared with a waiting list control group of 17 individuals . Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus . Whole brain analyses identified increases in the posterior cingulate cortex , the temporo-parietal junction , and the cerebellum in the MBSR group compared with the controls . The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes , emotion regulation , self-referential processing , and perspective taking Introduction Internet-delivered psychological interventions among people with chronic pain have the potential to overcome environmental and economic barriers to the provision of evidence -based psychological treatment in the Irish health service context . While the use of internet-delivered cognitive – behavioural therapy programmes has been consistently shown to have small-to-moderate effects in the management of chronic pain , there is a paucity in the research regarding the effectiveness of an internet-delivered Acceptance and Commitment Therapy ( ACT ) programme among people with chronic pain . The current study will compare the clinical -effectiveness and cost-effectiveness of an online ACT intervention with a waitlist control condition in terms of the management of pain-related functional interference among people with chronic pain . Methods and analysis Participants with non-malignant pain that persists for at least 3 months will be r and omised to one of two study conditions . The experimental group will undergo an eight-session internet-delivered ACT programme over an 8-week period . The control group will be a waiting list group and will be offered the ACT intervention after the 3-month follow-up period . Participants will be assessed preintervention , postintervention and at a 3-month follow-up . The primary outcome will be pain-related functional interference . Secondary outcomes will include : pain intensity , depression , global impression of change , acceptance of chronic pain and quality of life . A qualitative evaluation of the perspectives of the participants regarding the ACT intervention will be completed after the trial . Ethics and dissemination The study will be performed in agreement with the Declaration of Helsinki and is approved by the National University of Irel and Galway Research Ethics Committee ( 12/05/05 ) . The results of the trial will be published according to the CONSORT statement and will be presented at conferences and reported in peer- review ed journals . Trial registration number IS RCT N18166896 Acceptance and Commitment Therapy ( ACT ) training often includes experiential elements aim ed at improving therapist psychological flexibility , yet the effects of ACT training on therapist psychological flexibility have yet to be evaluated . This pilot study examines the effects of experiential phone consultation as an adjunct to a st and ard continuing education workshop on psychological flexibility and burnout among therapists learning ACT . In this study , counselors taking a 2-day ACT workshop  were r and omly assigned to either six 30-min phone consultation sessions ( n = 10 ) or no additional contact ( n = 10 ) . The results show that those in the consultation condition reported higher psychological flexibility at the 3-month follow-up compared to the workshop-only condition . Improvements in ACT knowledge , overall burnout , and personal accomplishment were found in both groups , independent of whether they received phone consultation , and this increase was maintained over time . In conclusion , ACT phone consultation contributed to  counselor psychological flexibility above the workshop alone and appears to be feasible as a means to improve counselor psychological flexibility Fibromyalgia Syndrome ( FMS ) is a chronic pain condition characterized by pain , fatigue , and nonrestorative sleep . The disruptive symptoms of FMS are associated with reductions in quality of life related to family , intimate relationships , and work . The present study was part of a r and omized pilot study of an 8-week Acceptance and Commitment Therapy ( ACT ) intervention compared to education in a sample of 28 women with FMS . The Chronic Pain Values Inventory was administered at baseline , postintervention , and 12 week follow-up . Both groups showed significant improvements in family success , which were maintained at follow-up . Groups showed a differential pattern of success in work . The ACT group demonstrated significant , maintained improvements in success in intimate relationships , while the education group reported no changes over time . Findings suggest that both interventions may lead to improvements in valued living ; however different interventions may be best suited for certain valued domains . The results of this study indicate that FMS patients are able to improve their success in family and intimate relationships and losses in these areas are not necessarily permanent Abstract One way to improve treatment effects of chronic pain is to identify and improve control over mechanisms of therapeutic change . One treatment approach that includes a specific proposed mechanism is acceptance and commitment therapy ( ACT ) with its focus on increasing psychological flexibility ( PF ) . The aim of the present study was to examine the role of PF as a mechanism of change in ACT . This is based on mediation analyses of data from a previously reported r and omized controlled trial , evaluating the effectiveness of an ACT-based online intervention for chronic pain ( ACTonPain ) . We performed secondary analyses on pretreatment , posttreatment , and follow-up data from 302 adults , receiving a guided ( n = 100 ) or unguided ( n = 101 ) version of ACTonPain , or allocated to the waitlist control group ( n = 101 ) . Structural equation modelling and a bias-corrected bootstrap approach were applied to examine the indirect effects of the treatment through pretreatment and posttreatment changes in the latent construct reflecting PF . The latent construct consisted of data from the Chronic Pain Acceptance Question naire and the Acceptance and Action Question naire . The outcomes were pretreatment to follow-up changes in pain interference , anxiety , depression , pain , and mental and physical health . Structural equation modelling analyses revealed that changes in PF significantly mediated pretreatment to follow-up changes in all outcomes in the intervention groups compared with waitlist ( st and ardized estimates ranged from I0.16I to I0.69I ) . Global model fit yielded modest but acceptable results . Findings are consistent with the theoretical framework behind ACT and contribute to growing evidence , supporting a focus on PF to optimize treatment effects Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters In this study , 67 participants ( 95 % female ) with fibromyalgia ( FM ) were r and omly assigned to an online acceptance and commitment therapy ( online ACT ) and treatment as usual ( TAU ; ACT + TAU ) protocol or a TAU control condition . Online ACT + TAU participants were asked to complete 7 modules over an 8-week period . Assessment s were completed at pre-treatment , post-treatment , and 3-month follow-up periods and included measures of FM impact ( primary outcome ) , depression , pain , sleep , 6-minute walk , sit to st and , pain acceptance ( primary process variable ) , mindfulness , cognitive fusion , valued living , kinesiophobia , and pain catastrophizing . The results indicated that online ACT + TAU participants significantly improved in FM impact , relative to TAU ( P < .001 ) , with large between condition effect sizes at post-treatment ( 1.26 ) and follow-up ( 1.59 ) . Increases in pain acceptance significantly mediated these improvements ( P = .005 ) . Significant improvements in favor of online ACT + TAU were also found on measures of depression ( P = .02 ) , pain ( P = .01 ) , and kinesiophobia ( P = .001 ) . Although preliminary , this study highlights the potential for online ACT to be an efficacious , accessible , and cost-effective treatment for people with FM and other chronic pain conditions . PERSPECTIVE Online ACT reduced FM impact relative to a TAU control condition in this r and omized controlled trial . Reductions in FM impact were mediated by improvements in pain acceptance . Online ACT appears to be a promising intervention for FM The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy ( GACT ) in patients with fibromyalgia ( FM ) compared with patients receiving recommended pharmacological treatment ( RPT ) or on a waiting list ( WL ) . The data were derived from a previously published study , a r and omized controlled trial that focused on clinical outcomes . Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory , respectively . Analyses included quality -adjusted life years , direct and indirect cost differences , and incremental cost effectiveness ratios . A total of 156 FM patients were r and omized ( 51 GACT , 52 RPT , 53 WL ) . GACT was related to significantly less direct costs over the 6-month study period compared with both control arms ( GACT € 824.2 ± 1,062.7 vs RPT € 1,730.7 ± 1,656.8 vs WL € 2,462.7 ± 2,822.0 ) . Lower direct costs  for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications . The incremental cost effectiveness ratios were dominant in the completers ' analysis and remained robust in the sensitivity analyses . In conclusion , acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM . PERSPECTIVE Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group . From government as well as health care perspectives , this study shows that a GACT  is more cost effective than pharmacological treatment in management of FM Abstract Cognitive behavioral therapy ( CBT ) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain . Mindfulness-based stress reduction ( MBSR ) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance . However , little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT . In a r and omized controlled trial comparing MBSR , CBT , and usual care ( UC ) for adults aged 20 to 70 years with chronic low back pain ( N = 342 ) , we examined ( 1 ) baseline relationships among measures of catastrophizing , self-efficacy , acceptance , and mindfulness and ( 2 ) changes on these measures in the 3 treatment groups . At baseline , catastrophizing was associated negatively with self-efficacy , acceptance , and 3 aspects of mindfulness ( nonreactivity , nonjudging , and acting with awareness ; all P values < 0.01 ) . Acceptance was associated positively with self-efficacy ( P < 0.01 ) and mindfulness ( P values < 0.05 ) measures . Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC ( omnibus P = 0.002 ) . Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks ( omnibus P = 0.001 ) . In both the entire r and omized sample and the sub sample of participants who attended ≥6 of the 8 MBSR or CBT sessions , differences between MBSR and CBT at up to 52 weeks were few , small in size , and of question able clinical meaningfulness . The results indicate overlap across measures of catastrophizing , self-efficacy , acceptance , and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain Cognitive behavior therapy ( CBT ) has made important contributions to chronic pain management , but the process by which it is effective is not clear . Recently , strong arguments have been raised concerning the need for theory driven research to e.g. identify mechanisms of change in CBT and enhance the effectiveness 
    Output:
    
There is also promising support for the cost-effectiveness of ACT ;  however , the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery .