Acceptance and commitment therapy (ACT) for patients with degenerative spinal disorders and maladaptive psychological processes: an observational study.

Background: Patients living with chronic pain may experience maladaptive psychological processes that include depression, somatization, kinesiophobia, pain catastrophizing, and anxiety. Spine surgery in the setting of maladaptive psychological processes can lead to poor outcomes, but intervention with acceptance and commitment therapy (ACT), which is a specific form of cognitive-behavioral therapy (CBT), may provide benefits. Our objective was to evaluate the preliminary effectiveness of ACT for patients with degenerative spinal disorders awaiting surgery. Methods: We performed a retrospective observational study of data that were collected at a single academic center. Patient reported outcome measures (PROMs) were collected before and after ACT, while awaiting spine surgery: Patient Health Questionnaire 9 item (PHQ-9) for depression, Patient Health Questionnaire 15 item (PHQ-15) for somatization, Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Generalized Anxiety Disorder 7 Item Scale (GAD-7), Post-Traumatic Stress Disorder (PTSD) Checklist, Injustice Experience Questionnaire (IEQ), and Pain Disability Index (PDI). Results: Among the 63 patients, ACT was associated with significant improvements for depression [mean change -3.3, standard deviation (SD) 6.5, P<0.001], somatization (mean change -2.9, SD 4.1, P<0.001), kinesiophobia (mean change -6.1, SD 10.8, P<0.001), catastrophizing (mean change -9.9, SD 14.8, P<0.001), anxiety (mean change -2.1, SD 6.2, P=0.007), injustice (mean change -5.5, SD 8.5, P<0.001), and pain disability (mean change -6.4, SD 17.4, P<0.001), but not PTSD (mean change -3.5, SD 14.3, P=0.06). Conclusions: ACT prior to spine surgery may be associated with significant improvements for many maladaptive psychological processes. These results suggest that implementation of ACT in clinical practice could be appropriate and that further research to understand effects on outcomes after surgery is warranted.