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Design and implementation of online acceptance and commitment therapy with enhanced therapist support for chronic low

Sara Jones Berkeley¹, Sharlene Wedin², Seema M Patidar³

¹Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.

Pain Medicine (Malden, Mass.)

|April 18, 2025

Abstract

Background:

Chronic low back pain (cLBP) typically involves behavior patterns in the development and maintenance of symptoms. Acceptance and Commitment Therapy (ACT) is an evidence-based treatment for chronic pain shown to improve pain-related depression, anxiety, and sleep, as well as pain catastrophizing, pain interference, and levels of reported pain. It has been proven effective when delivered in person or online, but an online therapist-enhanced ACT has not been tested to treat cLBP. This approach may have care delivery advantages while maintaining patient engagement with treatment.

Objective:

Describe the design and implementation of the therapist-supported, online model of ACT that was evaluated in the Biomarking for Evaluating Spine Treatments (BEST) Trial.

Methods:

The BEST Trial is a sequential, multiple assignment randomized trial of 4 treatment modalities (exercise and manual therapy; duloxetine; enhanced self-management of pain; and ACT) to inform a precision medicine approach to the treatment of cLBP. The ACT intervention was delivered over the internet via a custom, web-based software platform. The program had three primary components: (1) interactive online sessions consisting of video, audio and self-assessment; (2) therapist sessions via video visits; and (3) ongoing therapist support outside the video visits through a messaging system.

Discussion:

The ACT intervention addresses the need for mental health care integrated with chronic low back pain treatment. The online ACT treatment program with enhanced therapist support was designed to overcome barriers to multimodal care of CLBP and improve a range of treatment outcomes.

Clinicaltrial.Gov Id:

NCT05396014.

Registration:

The BEST Trial is registered in ClinicalTrials.gov (NCT05396014): https://clinicaltrials.gov/study/NCT05396014.

Keywords:

Acceptance and Commitment Therapy chronic pain telehealth

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