Chronic pain represents a complex phenomenon in which biological and psychological aspects intertwine, influencing each other. Specifically, the impact of the subjective psychological component on what is defined as “total pain” and the need for individualized multidisciplinary treatments seems increasingly evident in the existing literature (McCracken et al, 2013).
Researchers are currently focusing on understanding chronic pain better and developing more effective treatments.
To increase the effectiveness of therapies, crucial measurement tools are needed to help specify which type of treatment works best, for whom it works, and to assess whether intervention models such as ACT (Accepance and Commitment Therapy) are effective.
There are currently numerous studies on chronic pain and psychological flexibility.
Psychological flexibility is considered a basic quality of behavior (Hayes et al., 2012) and a fundamental aspect of the healthy functioning of individuals.
According to the theorists of Acceptance and Committment Therapy, the processes most involved in the patient’s adaptation to chronic pain concern: acceptance, cognitive defusion, actions based on values, awareness of being focused on the present, the Self as an observer and committed action (McCracken and Morley, 2014; McCracken and Vowles, 2014).
Acceptance of pain has emerged as a useful and functional concept to explain, at least partially, psychological disabilities and disorders in patients with chronic pain (Hayes & Duckworth, 2006; McCracken, Vowles & Eccleston, 2004).
“Acceptance” involves “exposure” to pain as it is experienced without attempts to avoid or control it and persist in “healthy” activities even when pain is present.
ACT emphasizes the importance of accepting rather than attempting to control negative thoughts and experiences (Hayes, Strosahl, & Wilson, 1999, 2012).
Today, the primary assessment tool for measuring acceptance in chronic pain patients is the Chronic Pain Acceptance Questionnaire (CPAQ). The Chronic Pain Acceptance Questionnaire is a bi-factorial scale consisting of 8 items. Each item provides 6 responses from “never true” (0) to “always true” (6). Higher scores indicate greater pain acceptance (Vowles et al., 2008).
Committed action is action driven by goals and values. It is persistent in the sense that it can present obstacles or inconveniences and flexible in the sense that it can be interrupted when the action is no longer useful for the person. Two studies investigated the relationship between committed action and chronic pain (McCracken, 2013). In both, committed action was found to be significantly correlated with low levels of depression and improved social functioning, mental health, vitality and general health.
