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Psychological approaches to persistent pain: What we know and what we need to learn

Francis Keefe, Kevin Vowles

16 Nov 2023


Recently, there has been growing interest in the psychology of pain.  Psychological approaches to treating persistent pain have evolved considerably over the past decade.  The purpose of this workshop is to provide a balanced, critical appraisal of what is known about psychological treatments for pain and to highlight key needs for future work in this area.  The workshop is divided into two days.  Day 1 highlights the current status of the field by focusing on two widely used psychological treatments for persistent pain: cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT).  For each treatment, we will provide a brief discussion of key concepts and the evidence base.  This will be followed by a series of experiential exercises designed to give participants an opportunity to explore key treatment techniques.  Dr Keefe, an expert in CBT, will be leading the presentation on CBT and Dr Vowles, an expert in ACT, will lead the presentation on ACT.  Day 1 ends with a question and answer session about clinical applications of CBT and ACT.  We will discuss, for example, the similarities and differences between CBT and ACT and under what circumstances one would recommend one vs the other treatment approach.  Day 2 of the workshop focuses on what needs to be learned about psychological treatments for persistent pain.  We have identified a number of key topics in this field, will poll participants to identify those of greatest interest, and then provide interactive presentations on the topics that receive the most votes.  Included in the list of potential topics will be:  a) the need for theory-based interventions that are disseminable, b) the use of eHealth (mobile devices) and hybrid approaches (mobile devices plus a health professional) to delivering treatment, c) the need for a better understanding of ways to optimize treatment effects (i.e., timing and dose of treatment), d) the role of brief and “micro” interventions, e) the need to identify key mediators (mechanisms) of treatment effects, f) the need to explore strategies for maintaining treatment gains, g) the need for involving key stakeholders in treatment development, and h) complex interventions and targeting multiple behaviors.  In the final section of Day 2 we will conduct a second poll that asks participants, based on their own experiences and perspectives, to nominate three or more topics they feel we need to learn more about to advance this field.  We will tally the votes and then facilitate a discussion of the topics of greatest interest.  This final discussion will not only highlight the current status of these topics but also emphasize their implications of the topics we have discussed for clinical practice and public policy.

The event will be equivalent to 5.1/2hrs of CPD.


This workshop will:
• Provide an overview of two widely used psychological treatments for persistent pain, cognitive-behavioural therapy (CBT) and acceptance and commitment therapy (ACT).
• Identify key clinical skills involved in the provision of CBT and ACT.
• Consider both the current state of the field and its most pressing needs in the future.
• Include opportunities for participants to shape the content of the workshop in the discussion around pressing needs for the future.

Learning Objectives

You will learn:
• Key skills in CBT and ACT for persistent pain.
• How to describe these two models in terms of their overlapping and distinctive components.
• The key needs for the treatment of persistent pain.

Training Modalities

Didactic content, experiential components, polls, Q&A.

Key References

Caldwell DS, Rice JR, McKee DC, Shelby RA, Campbell LC, Pells JJ, Sims EL, Queen R, Carson JW, Connelly M, Dixon KE, Lacaille LJ, Huebner JL, Rejeski WJ, and Keefe FJ. (2012) Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain, 153(6), 1199-1209. PMID: 22503223; PMCID: PMC3358356.]

DeBar L, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR, Keefe FJ, Leo MC, McMullen C, Owen-Smith A, Smith DH, Trinacty CM, Vollmer WM. A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users with Chronic Pain: A Randomized Pragmatic Trial. Ann Intern Med. 2022 Jan;175(1):46-55 PMID: 34724405

Eccleston C, Blyth FM, Dear BF, Fisher EA, Keefe FJ, Lynch ME, Palermo TM, Reid MC, de C Williams, AC. Managing patients with chronic pain during the COVID-19 outbreak: considerations for the rapid introduction of remotely supported (eHealth) pain management services. PAIN. 2020 May; 161(5): 889–893. PMID: 32251203. PMCID: PMC7172975

Eccleston C, Keefe FJ, de C Williams AC. Basic and applied psychology in PAIN: where we have been and where we are headed. PAIN. 2021 Dec 1;162(12):2785-2788. PMID: 34294664

Keefe FJ, Jensen MP, Williams ACC, George SZ. The Yin and Yang of Pragmatic Clinical Trials of Behavioral Interventions for Chronic Pain: Balancing Design Features to Maximize Impact. PAIN. 2022 Jul 1;163(7):1215-1219. PMID: 35027519 PMCID: PMC9148368

McCracken, L. M., Yu, L., & Vowles, K. E. (2022). New generation psychological treatments in chronic pain. British Medical Journal, 376, e057212.

Sterling M, Keefe FJ. Physical Rehabilitation Research and Pain Science. PAIN 2021 Nov 1;162(11):2621-2624. PMID: 34652317

Vowles, K.E. (2022). Chronic Pain: Third Wave Case Conceptualizations. In: O'Donohue, W., Masuda, A. (eds) Behavior Therapy. Springer, Cham.

Vowles, K. E., Pielech, M., Edwards, K. A., McEntee, M. L., & Bailey, R. W. (2020). A comparative meta-analysis of unidisciplinary psychology and interdisciplinary treatment otucomes following Acceptance and Commitment Therapy for adults with chronic pain. Journal of Pain, 21, 529-545.

About the presenter

Francis (Frank) Keefe

Dr. Keefe is a Professor in the Department of Psychiatry and Behavioral Sciences, Professor in Anesthesiology, and Professor of Medicine at Duke University School of Medicine. Dr. Keefe is Director of the Duke Pain Prevention and Treatment Research Program, an active NIH funded clinical research program focused on developing new and more effective ways of assessing and treating patients having acute and persistent pain. Dr. Keefe played a key role in the development of clinical pain services and pain research programs at Duke Medical Center. For over 20 years, he directed the Duke Pain Management Program and was a leader in the development of Duke Medical Center's multidisciplinary pain programs (both out-patient and in-patient.) Dr. Keefe has developed and refined a number of treatment protocols for persistent pain conditions (e.g. pain in patients with advanced cancer; or persistent joint pain due to osteoarthritis) including spouse and partner-assisted pain coping skills training interventions. He has conducted a number of randomized clinical trials testing the efficacy of these and other behavioral interventions (e.g. aerobic exercise protocols, yoga based interventions, mindfulness-based interventions, forgiveness-based interventions, loving kindness meditation, and emotional disclosure). Dr. Keefe has published over 450 papers and 4 books on topics ranging from pain coping strategies used by people suffering from persistent pain to the treatment of cancer pain at end of life. Over the past 10 years, he has served Editor in Chief of PAIN, the premier journal for publishing basic and applied pain science. Dr. Keefe has a longstanding interest in mentoring early career professionals who seek to develop, test, and disseminate novel protocols for managing pain, stress, and medical symptoms.

Dr. Kevin Vowles

Kevin has been a key figure in the development and adaptation of Acceptance and Commitment Therapy (ACT) for this complex condition. His work is cited by the American Psychological Association’s Division of Clinical Psychology in their listing of ACT for chronic pain as an intervention with strong research support: the highest possible grading. His work is also cited by the UK’s National Institute for Health and Care Excellence (NICE) in their recommendation of ACT for the treatment of chronic pain. Kevin completed his PhD in clinical psychology at West Virginia University in 2004 and post-doctoral fellowship at the University of Virginia the following year. From 2005 to 2009, he was employed by the Centres for Pain Research and Services at the University of Bath and Royal National Hospital for Rheumatic Diseases. Since 2019, he had held a chair as Professor of Clinical Health Psychology in the School of Psychology at Queen’s University in Belfast. Regarding the numbers, Kevin has published over 110 scientific articles since 2002. His work has been funded by extramural bodies for almost two decades and his current grant portfolio includes about $500,000/£375,000 in annual expenditure.

Who should attend

Any clinician working with people who have chronic pain is welcome to attend, particularly those that have an interest in behavioural change methods.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

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This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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