***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: Acceptance and commitment therapy ( ACT ) interventions for persons with chronic pain have recently received empirical support . ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions , sensations , and thoughts . The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain . A total of 76 patients with chronic pain were included in the study and r and omized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum . Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness . Measurements were provided with the primary outcome variable Chronic Pain Acceptance Question naire which was in favour of the treatment group . Reductions were found on other measures of pain-related distress , anxiety and depressive symptoms . A six month follow-up showed maintenance of improvements . We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain Objective The aim of this study was to compare 2 self-help-based interventions ; a coping-oriented approach , applied relaxation ( AR ) and an acceptance-oriented approach , acceptance and commitment therapy ( ACT ) , for persons with chronic pain . Method This study is a r and omized control trial ( N=90 ) with a mixed between-within participants design with repeated measures . Interventions in both conditions comprised an initial face-to-face session , a 7-week manual-based self-help intervention including weekly therapist telephone support and a concluding face-to-face session . Outcome measures included satisfaction with life , depression , anxiety , acceptance of chronic pain , level of function , and pain intensity . Effects were measured at preintervention and postintervention and at 6 and 12 months after the end of intervention . Results The results show that the ACT condition increased their level of acceptance significantly compared with the AR condition . There was also a marginally significant interaction effect regarding satisfaction with life in which the ACT condition had improved in comparison to the AR condition . Further , the ACT condition reported a higher level of function and decreased pain intensity compared with the AR condition . Both conditions improved significantly regarding depression and anxiety . Conclusions A manual-based self-help intervention with weekly therapist support in an ACT format adds value to the treatment repertoire for persons suffering with chronic pain 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 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 of this type of treatment . However , the number of studies addressing these issues is still relatively scarce . Furthermore , the arrival of varieties of CBT with seemingly different process targets increases the need for such information . The present study explored the processes of change in a previously reported successful r and omized controlled trial evaluating the effectiveness of an exposure-based form of behavioral and cognitive therapy , Acceptance and Commitment Therapy ( ACT ) , on improvement in pain-related disability and  life satisfaction for patients suffering from whiplash-associated disorder ( WAD ) . Several process variables relevant to theories underlying traditional CBT were included : pain , distress , kinesiophobia , self-efficacy , and the process primarily targeted by ACT : psychological inflexibility . Mediation analyses were performed using a non-parametric cross-product of the coefficients approach . Results illustrated that pain intensity , anxiety , depression , kinesiophobia , and self-efficacy did not have significant mediating effects on the dependent variables . In contrast , significant indirect effects were seen for psychological inflexibility on pain-related disability ( pre- to post-change scores ) and life satisfaction ( pre- to post ; pre- to 4-month follow-up change scores ) . Although tentative , these results support the mediating role of psychological inflexibility in ACT-oriented interventions aim ed at improving functioning and life satisfaction in people with chronic pain Background Acceptance and commitment therapy has shown to be effective in chronic pain rehabilitation , and acceptance has been shown to be a key process of change . The influence of treatment dose on acceptance is not clear , and in particular , the effectiveness of a non-intensive treatment ( < 20 h ) in a tertiary pain clinic is required . Purpose The purpose of the study was to assess the effectiveness of a low-intensity , acceptance and commitment therapy ( ACT ) group program for chronic pain . The study sought to compare , at both groups and individual patient levels , changes in acceptance with changes observed in previous ACT studies . Methods Seventy-one individuals with chronic pain commenced a 9-week ACT-based group program at an outpatient chronic pain service . In addition to acceptance , outcomes included the following : pain catastrophizing , depression , anxiety , quality of life , and pain-related anxiety . To compare the current findings with previous research , effect sizes from seven studies were aggregated using the r and om-effects model to calculate benchmarks . Reliable change indices ( RCIs ) were applied to assess change on an individual patient-level . Results The ACT intervention achieved a statistically significant increase in acceptance and medium effect size ( d = 0.54 ) at a group level . Change in acceptance was of a similar magnitude to that found in previous ACT studies that examined interventions with similar treatment hours ( < 20 h ) . Results across other outcome measures demonstrated small to medium effect sizes ( d = 0.01 to 0.48 , mean = 0.26 ) . Reliable improvement in acceptance occurred in approximately one-third ( 37.2 , 90 % CI ) of patients . Approximately three-quarters ( 74.3 , 90 % CI ) demonstrated reliable change in at least one of the outcome measures . Conclusions The low-intensity , group-based ACT intervention was effective at a group level and showed a similar magnitude of change in acceptance to previous ACT studies employing low-intensity interventions . Three-quarters of patients reported reliable change on at least one outcome measure Background Low Back Pain ( LBP ) remains a common and costly problem . Psychological obstacles to recovery have been identified , but psychological and behavioural interventions have produced only moderate improvements . Review s of trials have suggested that the interventions lack clear theoretical basis , are often compromised by low dose , lack of fidelity , and delivery by non-experts . In addition , interventions do not directly target known risk mechanisms . We identified a theory driven intervention ( Contexual Cognitive Behavioural Therapy , CCBT ) that directly targets an evidence -based risk mechanism ( avoidance and ensured dose and delivery were optimised . This feasibility study was design ed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients , and to test recruitment , delivery of the intervention and response rates prior to moving to a full definitive trial . Methods A r and omised controlled feasibility trial with patients r and omised to receive CCBT or physiotherapy . CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions . Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based .  Patients were eligible to take part if they had back pain for more than 3 months , and scored above a threshold indicating fear avoidance , catastrophic beliefs and distress . Results 89 patients were recruited .  Uptake rates were above those predicted . Scores for credibility and acceptability of the interventions met the set criteria . Response rates at three and six months fell short of the 75 % target . Problems associated with poor response rates were identified and successfully resolved , rates increased to 77 % at 3 months , and 68 % at 6 months . Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity . Numbers were too small for formal analysis . Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy ( increase of 7.9 versus 5.1 ) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group , these findings should be interpreted with caution . Conclusions CCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery . Trial registration IS RCT N43733490 , registered 15/12/2010 OBJECTIVE Recent studies support the efficacy of Acceptance and Commitment Therapy ( ACT ) with people with chronic pain . In addition , Selective Optimization with Compensation strategies ( SOC ) can help the elderly with chronic pain to accept their chronic condition and increase functional autonomy . Our aim was to analyze the efficacy of an ACT treatment program combined with training in SOC strategies for elderly people with chronic pain living in nursing homes . METHODS 101 participants ( mean age = 82.26 ; SD = 10.00 ; 78.6 % female ) were r and omized to the  intervention  condition ( ACT-SOC ) or to a minimal support group ( MS ) . Complete data are available for 53 participants  ( ACT-SOC : n = 27 ; MS : n = 26 ) . Assessment s of functional performance , pain intensity , pain acceptance , SOC strategies , emotional well being and catastrophizing beliefs were done preintervention and postintervention . RESULTS Significant time by intervention changes ( P = 0.05 ) were found in acceptance , pain related anxiety , compensation strategies , and pain interference in walking ability . Simple effects changes were found in acceptance ( P = 0.01 ) , selection strategies ( P = 0.05 ) , catastrophizing beliefs ( P = 0.03 ) , depressive symptoms ( P = 0.05 ) , pain anxiety ( P = 0.01 ) and pain interference in mood and walking ability ( P = 0.03 ) in the ACT-SOC group . No significant changes were found in the MS group . CONCLUSIONS These results suggest that an ACT intervention combined with training in SOC strategies could help older people with pain to improve their emotional well being and their functional capability In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore 
    Output:
    
Discussion This collaborative meta- analysis of individual participant data from r and omized controlled trials of ACT for chronic pain versus control conditions will demonstrate how the known benefits of ACT for chronic pain vary across different subtypes of the chronic pain population .