​A recent article by Lance M. Mc Cracken and Stephen Morley published in the Journal of Pain addresses the place of theory and models in psychological research and treatment development in chronic pain. It argued that such models are not merely an academic issue but are highly practical. Such models ought to integrate current findings, precisely guide research and treatment development, and create progress. The dominant psychological approach to chronic pain is cognitive behavioural therapy (CBT). 

A relatively new model within CBT is presented here. This model is called the Psychological Flexibility Model (PF). PF can be defined as the capacity to persist or to change behaviour in a way that 1) includes conscious and open contact with thoughts and feelings, 2) appreciates what the situation affords, and 3) serve’s one’s goals and values. In this model two important sets of influences interacts in how behaviour is coordinated. 

The PF model includes 6 interrelated processes. The essence of the PF model is that it addresses directly the dynamic interplay of two sets of processes: those aimed at reducing avoidance, by applying acceptance and cognitive defusion, and those aimed at increasing engagement, guided by the influences of goals and values.

ACT, Acceptance & Commitment Therapy, is the treatment approach that emerges from this model, and is now the subject of at least 7 RCT’s in areas related to chronic pain treatment and many more follow-up process analyses, uncontrolled studies, pilot studies, and instrument development studies.

Further reading:
McCracken LM, Morley S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. 
Journal of Pain 2014; 15(3):221-34. 

Luc Vanderweeen 
Master of Science in Spinal Manual Therapy, Vrije Universiteit Brussel, 
Pain in Motion Research Group 


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