Mieux vivre avec la douleur chronique grâce à la thérapie d’acceptation et d’engagement

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Cet article vise à présenter les particularités de la thérapie d’acceptation et d’engagement (Acceptance and Commitment Therapy ou « ACT ») dans l’intervention auprès de patients souffrant de douleur chronique. Il décrit le contexte historique du développement des thérapies comportementales et cognitives dans ce domaine et présente les fondements théoriques de l’ACT. Il introduit les composantes d’une intervention basée sur l’acceptation et la pleine conscience en visitant plusieurs concepts du modèle de la flexibilité psychologique. Enfin, il synthétise un certain nombre de données probantes provenant des études expérimentales, corrélationnelles et cliniques qui appuient l’utilisation de l’ACT dans le domaine de la douleur chronique.

Objectives: The purpose of this article is to present the characteristics of the Acceptance and Commitment Therapy (ACT) for the treatment of chronic pain. The historical context of the development of cognitive and behavioural therapy (CBT) for chronic pain will be described and the theoretical aspects of ACT will be introduced. The components of an acceptance and mindfulness based treatment will also be presented by exploring various processes of the psychological flexibility model. Finally, the article will summarize the scientific evidence supporting ACT based on experimental, correlational and clinical studies in the field of chronic pain.Method: The theoretical aspects underlying ACT, as well as its clinical components in the specific domain of chronic pain were described based on major books in this area, such as McCracken (2005) and Dahl et al. (2005). A descriptive literature review was undertaken to explore the data on the efficacy of ACT for the treatment of chronic pain. Psycinfo and Medline, as well as the Association for Contextual Science website were analyzed for relevant articles. The key search terms were: “Acceptance and Commitment Therapy” or “ACT” or “acceptance” or “mindfulness” or “defusion” and “chronic pain” or “pain.” The reference lists of the articles retrieved were also analyzed. The articles that were not in English or French were excluded as well as those that were not specific to ACT and chronic pain. Results: Results show that ACT is a relevant and empirically supported approach that may be used as a complement to CBT strategies in the treatment of chronic pain. There is growing evidence stemming from experimental and correlational studies that support the majority of the ACT processes. Clinical studies undertaken in the field of chronic pain from different backgrounds support the efficacy of ACT for the management of this condition. Conclusion: ACT is a promising and evidence-based approach for the treatment of chronic pain. More research is needed to further validate its theoretical model and further refine our understanding of how ACT could be effective for the management of chronic pain and enhance quality of life for people who suffer from this health condition. For now, ACT is considered to be as effective as traditional cognitive and behavioral therapy for chronic pain.