Die Effektivität von experimentellen Akzeptanzstrategien bei akutem Schmerz

Acceptance and Commitment Therapy (ACT) belongs to the so-called third wave of cognitive behavior therapy. Since a growing body of research has focused on ACT, e.g. in the field of pain research, acceptance strategies have gained increased popularity. Numerous experimental studies compared the effectiveness of acceptance strategies to distraction and suppression strategies with respect to pain tolerance and intensity (Branstetter-Rost et al., 2009; Gutiérrez et al., 2004; Páez-Blarrina, Luciano, Gutiérrez-Martínez, Valdivia, Rodríguez-Valverde, et al., 2008). Contradictory results were obtained regarding superiority of one or the other strategy. The present dissertation project includes three different studies. The first study, through a meta-analytic review, provided an overview of results of experimental studies which compare acceptance to other emotion regulation strategies with respect to different outcomes (Kohl et al., 2012c). Acceptance strategies were superior to other emotion regulation strategies in increasing pain tolerance. No differences between strategies were found with respect to pain intensity. The meta-analytic review also indicated the lack of experimental studies that compare acceptance strategies to strategies that aim at cognitively restructure pain related thoughts. Therefore, the second experimental study investigated the effects of acceptance, cognitive restructuring and distraction on pain tolerance and intensity in healthy participants (Kohl et al., 2012a). A mixed within-between design was employed. The study found that acceptance was more effective in increasing pain tolerance than cognitive restructuring, whereas distraction led to lower pain intensity than acceptance. Most of the studies included in the meta-analytic review were based on a healthy sample of participants, which limits generalizability of findings for clinical populations. Therefore, the third study compared acceptance and cognitive restructuring to a control condition in a sample of fibromyalgia patients (Kohl et al., 2012b). Results indicated that acceptance and cognitive restructuring were superior to the control condition in increasing heat pain tolerance. Cognitive restructuring was also more effective in increasing cold pain tolerance than the control condition. Responder analyses showed that only patients of the two active conditions (acceptance and cognitive restructuring) were able to reduce pain intensity more than 30%. Results of the dissertation project indicate that differences within effectiveness depend on outcome measures and sample type (healthy vs. clinical samples). It is necessary to validate these results with further studies, and to identify possible moderators of therapeutic success, in order to optimize the allocation of patients to one or the other kind of psychotherapy.