Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial Monica Buhrman a, * , Astrid Skoglund a , Josefin Husell a , Kristina Bergström a , Torsten Gordh b , Timo Hursti a , Nina Bendelin c , Tomas Furmark a , Gerhard Andersson d, e a Department of Psychology, Uppsala University, Uppsala, Sweden b Department of Surgical Sciences, Pain Research, Uppsala University, Sweden c Department of Medical and Health Sciences, Linköping University, Sweden d Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, SE-581 83 Linköping, Sweden e Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden article info Article history: Received 17 May 2012 Received in revised form 2 February 2013 Accepted 12 February 2013 Keywords: Internet-delivered CBT Chronic pain Acceptance and commitment therapy Mindfulness Guided self-help abstract 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 randomized 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 Questionnaire 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. Ó 2013 Elsevier Ltd. All rights reserved. Introduction For many individuals chronic pain has adverse consequences on daily activity, employment, relationships, and emotional func- tioning (Breivik, Collett, Ventafridda, Cohen & Gallcher, 2006). Several studies have investigated the prevalence of chronic pain among adults. Results show that 15e20 percent of adults experi- ence chronic pain. Considering all sources of expenditures, chronic pain has a large financial impact on society (Breivik et al., 2006). Chronic pain is a demoralizing situation that compromises all aspects of the person’s life, including disability and emotional distress. Psychological research has identified the central role of cognitive, behavioural and emotional factors contributing to the perpetuation of chronic pain (Kerns, Sellinger, & Goodin, 2011). Cognitive-behavioural therapy (CBT) delivered in a multidisci- plinary setting has been shown in several controlled studies to be effective in the treatment of chronic pain (e.g. Hoffman, Papas, Chatkoff, & Kerns, 2007; Morley, Eccleston, & Williams, 1999). A common factor for the psychologically oriented interventions for chronic pain is that the focus is on the consequences that pain has on one’s life, rather than on pain intensity, as a way of directly addressing adaptive behavioural change (Kerns et al., 2011). In the so called third generation of cognitive behavioural treat- ments, e.g. acceptance and commitment therapy (ACT), function is emphasized in contrast to form. Behaviour is analysed from a func- tional perspective, i.e. the aim is to understand why a particular behaviour is maintained rather than describing what kind of behaviour a person performs. In order to understand how influence can affect the function of behaviour it is important to alter the social/ verbal context through identification of basic processes that are common across settings (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Hayes, Strosahl, & Wilson, 1999). From this perspective, chronic pain can be viewed as an experiential avoidance disorder. Experiential avoidance has been defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences, which often creates suffering in the long-run (McCracken, Vowles, & Eccleston, 2004; Vowles & McCracken, 2010). Studies have shown that experiential avoidance is associated with higher pain intensity, * Corresponding author. E-mail address: Monica.Buhrman@psyk.uu.se (M. Buhrman). Contents lists available at SciVerse ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.brat.2013.02.010 Behaviour Research and Therapy 51 (2013) 307e315