Online Therapist-Supported ACT Program for Chronic Low Back Pain Management

Overview

An online Acceptance and Commitment Therapy (ACT) program with enhanced therapist involvement was developed and implemented for chronic low back pain (cLBP) management within the BEST Trial. This therapist-supported, web-based intervention aims to improve patient engagement and treatment outcomes by integrating mental health care with cLBP treatment.

Background

Chronic low back pain affects a significant portion of the adult population and is a leading cause of disability worldwide. Its complex nature involves musculoskeletal, neurological, psychological, and social factors, making treatment challenging. Acceptance and Commitment Therapy (ACT) is an evidence-based psychological intervention that targets psychological flexibility to help patients better manage chronic pain. The BEST Trial evaluated four treatment modalities, including ACT, to inform precision medicine approaches for cLBP.

Data Highlights

The ACT intervention was delivered via a custom web-based platform featuring interactive online sessions, therapist video visits, and ongoing therapist support through messaging. The program addresses barriers to multimodal care and aims to improve outcomes such as pain-related depression, anxiety, sleep, pain catastrophizing, and pain interference. Prior meta-analyses indicate moderate effects of ACT on daily functioning and psychological outcomes in chronic pain populations.

Key Findings

• ACT focuses on increasing psychological flexibility through six core processes emphasizing openness, awareness, and engagement.
• The online ACT program integrates interactive multimedia sessions with enhanced therapist support via video and messaging.
• ACT differs from traditional CBT by promoting pain acceptance and values-based activities rather than pain control.
• Research shows ACT yields moderate improvements in pain-related outcomes and psychological symptoms with higher patient satisfaction and lower dropout rates compared to CBT.
• The BEST Trial uses a sequential, multiple assignment randomized design to tailor treatments based on patient phenotypic markers and response.

Clinical Implications

This online therapist-supported ACT program offers a scalable, accessible approach to integrate psychological care into chronic low back pain management. Enhanced therapist involvement may improve patient engagement and adherence, potentially leading to better functional and psychological outcomes. Clinicians should consider ACT as a valuable component of multimodal cLBP treatment, especially for patients with complex biopsychosocial needs.

Conclusion

The development and implementation of an online ACT program with increased therapist support represents a promising advancement in chronic low back pain care. This approach may overcome traditional treatment barriers and improve a range of patient-centered outcomes.

References

1. BEST Trial ClinicalTrials.gov NCT05396014 -- Biomarkers for Evaluating Spine Treatments