(PS4-81) Addressing Chronic Pelvic Pain in Women Veterans with Acceptance and Commitment Therapy

Abstract Text: Chronic pelvic pain (CPP) is a debilitating medical condition that disproportionately affects one in four women Veterans. Women Veterans experience high rates of psychosocial distress, such as depression and anxiety that exacerbate pain intensity and disability. Acceptance and Commitment Training (ACT) provides a transdiagnostic approach to the treatment of medical conditions associated with psychological distress. We conducted a pilot study to assess the feasibility, acceptability, and preliminary effectiveness of a brief, virtual ACT group treatment compared to a wait-list control for women Veterans with CPP-related distress. We enrolled 20 women Veterans (mean age = 45.55 ± 13.66 years, 95% identified as a Black or Hispanic) who had a CPP diagnosis, experienced pain related distress with moderate to severe pain, and were stable on mood and pain medications for 4 weeks. Exclusion criteria included: cognitive impairment, uncontrolled bipolar or psychotic disorders, acute suicidal ideation, or Veterans receiving psychotherapy or ACT in the past year. Eligible women were administered a baseline survey and were then randomly assigned to ACT group or the wait-list (WL) control group using a 2:1 ratio. Follow-up surveys were administered at treatment completion and 4 weeks post-treatment. ACT participants were invited to complete a qualitive interview about their experiences at 12-weeks. Participants received $30 compensation for each completed survey and interview. Clinical outcomes were CPP-related distress (Pelvic Floor Distress Inventory) and pain acceptance (Chronic Pain Acceptance Questionnaire). Due to small sample size, statistical significance was not computed. We screened 46 women Veterans, of which 20 were eligible to participate. Twenty women were randomized (13 in ACT group, 7 in WL control). Of the 13 ACT participants, 11 attended sessions with 8 completing treatment (attending ≥ 75% of total sessions). Qualitative analyses showed that participants were satisfied with the services with several noting the benefits of social interactions with other participants and knowing they were not alone with their concerns. Women liked the convenience of attending the group virtually and appreciated having a workbook for easy reference and note-taking. Women in the ACT group reported sustained reduction in CPP-related distress from baseline to 8-weeks and 12-weeks assessments (mean differences = 29 and 30 points, respectively) while WL group only showed a reduction at the 12-week assessment (mean differences = 8 and 34 points, respectively). The ACT group reported a sustained improvement in pain acceptance by 12-weeks (mean differences = -2.4 and -4.9) compared to the WL group (mean differences = -4.5 and -0.4). Overall, women Veterans found the brief ACT group satisfactory and beneficial, making it an acceptable intervention. Delivering the ACT group online made it both accessible and well-received by participants. Future directions include conducting a larger randomized efficacy trial.