In plain language
Most studies of psychological therapy report averages across groups, which can hide huge differences in how individual people respond. This study zoomed in on six individuals with chronic low back pain plus depressive symptoms who received remotely delivered, group-based acceptance and commitment therapy (ACT) within a randomized controlled trial, tracking each person day by day.
Participants completed daily ecological momentary assessments over roughly 70 days, plus full questionnaires at baseline, after treatment, and at follow-up. The researchers used single-case experimental design statistics (non-overlap of all pairs, Tau, Tau-U) and idiographic network analysis to map how pain interference, pain intensity, depressed mood, and psychological inflexibility changed and interacted within each person.
ACT helped most participants: five of six improved in pain interference and depressed mood, four reported an overall relevant improvement, but only one showed meaningful change in pain intensity itself. Crucially, each person had a distinct network of relationships among their symptoms and processes, with psychological inflexibility and depressed mood playing central roles. The results argue for personalizing chronic pain treatment rather than assuming one pattern fits everyone.
Key findings
- Moderate improvements were observed in pain interference for five of six participants and in depressed mood for five of six, while pain intensity changed meaningfully in only one participant.
- Psychological inflexibility, the targeted process variable, improved in three of six participants, and four of six reported an overall relevant improvement after treatment.
- Posttreatment analyses showed five of six participants with statistically significant moderate or larger effects; the largest gains were in pain interference (large effects in three participants) and depressed mood (large effects in four participants).
- Idiographic network analysis produced a distinct network structure for every participant, even though all networks used the same four variables over the same 70-day period, so aggregating into one summary network was not advisable.
- Psychological inflexibility and depressed mood emerged as central nodes in the individual networks, consistent with ACT theory about processes of change.
- The findings show that group-level averages can overestimate or obscure individual treatment effects, supporting single-case methods combined with daily ecological momentary assessment for personalizing chronic pain care.
How to cite
APA
Sanabria-Mazo, J. P., Rodríguez-Freire, C., Gallego, A., Feliu-Soler, A., Suso-Ribera, C., García-Palacios, A., Hayes, S. C., Hofmann, S. G., Ciarrochi, J., McCracken, L. M., & Luciano, J. V. (2025). Acceptance and commitment therapy in chronic low back pain and comorbid depression: A single-case study with idiographic network analysis. International Journal of Cognitive Behavioral Therapy, 19, 1–32. https://doi.org/10.1007/s41811-025-00268-x
BibTeX
@article{sanabriamazo2025acceptance,
title = {Acceptance and Commitment Therapy in Chronic Low Back Pain and Comorbid Depression: A Single-Case Study with Idiographic Network Analysis},
author = {Sanabria-Mazo, Juan P. and Rodr{\'i}guez-Freire, Carla and Gallego, Ana and Feliu-Soler, Albert and Suso-Ribera, Carlos and Garc{\'i}a-Palacios, Azucena and Hayes, Steven C. and Hofmann, Stefan G. and Ciarrochi, Joseph and McCracken, Lance M. and Luciano, Juan V.},
journal = {International Journal of Cognitive Behavioral Therapy},
volume = {19},
pages = {1--32},
year = {2025},
doi = {10.1007/s41811-025-00268-x}
}
Related work
- All publications by Joseph Ciarrochi (searchable, with free PDFs)
- Process-Based Therapy & Idionomic Analysis
Author: Joseph Ciarrochi (ORCID 0000-0003-0471-8100). Free copy hosted with permission for scholarly use. Please cite the published version via the DOI above.