MobACT: An Internet-Based Intervention for Chronic Pain Patients

MOBACT: An Internet-Based Guided Self-Help Intervention Based on Acceptance and Commitment Therapy for Chronic Pain

Chronic Pain (CP) is a condition characterized by pain lasting or recurring for more than three months, often accompanied by emotional distress and difficulties in daily functioning. CP represents a major burden for individuals and healthcare systems due to its impact on quality of life, healthcare utilization, and work productivity. Traditional treatments, such as pharmacological and surgical approaches, frequently provide insufficient relief, highlighting the need for complementary interventions.

Among psychological approaches, Acceptance and Commitment Therapy (ACT) has shown promising results for CP management. ACT aims to increase psychological flexibility by helping individuals accept pain as part of their experience while engaging in meaningful, value-based activities. Rather than focusing exclusively on symptom reduction, ACT promotes emotional well-being, functioning, and quality of life. However, access to psychological interventions remains limited because of barriers such as long waiting lists, geographical distance, physical limitations, stigma, and limited availability of trained professionals.

Digital health interventions, particularly internet-delivered self-help programs, may help overcome these barriers by providing flexible, accessible, and cost-effective support. Previous research suggests that ACT can be effectively adapted to online formats, allowing broader dissemination and increased accessibility for individuals with CP.

The present study aims to evaluate the effectiveness of a guided internet-delivered ACT-based self-help intervention for individuals with CP. The intervention seeks to support pain acceptance, improve quality of life, and promote engagement in valued activities. The study will also explore potential psychological mechanisms underlying treatment outcomes and assess the cost-effectiveness of the intervention to evaluate its potential implementation within public healthcare systems.

Chronic Pain (CP) is a persistent condition characterized by emotional distress and functional impairment that is not better explained by another diagnosis. Its multifactorial nature includes biological, psychological, and social components that interact to maintain and exacerbate symptoms. Psychological processes such as pain-related fear, avoidance behaviors, catastrophizing, and reduced engagement in valued activities contribute to disability and diminished quality of life. Pharmacological and surgical treatments alone frequently provide insufficient improvement, underscoring the relevance of psychological interventions.

Acceptance and Commitment Therapy (ACT) is designed to improve psychological flexibility by promoting willingness to experience pain-related distress while pursuing personally meaningful behaviors. ACT-based interventions have shown effectiveness in addressing emotional and behavioral responses to pain, reducing disability, and improving overall functioning. Due to its modularity and transdiagnostic focus, ACT can be adapted for a wide range of CP presentations and is suitable for digital delivery.

Internet-based interventions (IBIs) are increasingly implemented to improve accessibility to psychological treatment. Digital delivery may reduce barriers related to mobility limitations, geographical distance, waiting lists, stigma, and limited availability of trained clinicians. Guided IBIs allow patients to engage with structured therapeutic content at their own pace, while also receiving support from a therapist. Internet-based ACT programs have demonstrated promising effects on pain acceptance, emotional functioning, behavioral flexibility, and pain-related disability.

The present randomized controlled trial aims to evaluate the effectiveness and cost-effectiveness of MobACT, a guided internet-based ACT intervention adapted for the Italian population. The program consists of seven weekly modules addressing core ACT processes, including acceptance, defusion, values clarification, and committed action. The intervention is delivered through the secure, research-oriented iTerapi platform, which provides access to treatment content, therapist communication, and assessment tools. Participants receive weekly notifications when new material is available and reminder messages if modules are not completed.

Participants complete baseline, post-treatment, and follow-up assessments through the platform. During treatment, additional weekly monitoring collects information on sleep quality and changes in pharmacological therapy for pain management. A subset of participants will take part in semi-structured qualitative interviews to explore their subjective treatment experience, usability perceptions, and acceptability of the digital format. Interview data will undergo thematic analysis.

Data management follows strict procedures to ensure confidentiality, integrity, and secure storage. All participant information is de-identified and stored on encrypted servers with access restricted to authorized study personnel. Statistical analyses will compare outcomes between groups and explore potential mediators and moderators of treatment effects. Cost-effectiveness will be evaluated from both healthcare and societal perspectives, accounting for resource utilization, productivity losses, and implementation costs.

The intervention is expected to improve acceptance of chronic pain, psychological flexibility, coping behaviors, sleep quality, and overall quality of life, while reducing pain intensity, interference, catastrophizing, and emotional distress. Insights gained from the trial will contribute to understanding the mechanisms of change in internet-delivered ACT programs and inform the development of scalable psychological interventions for chronic pain.

Inclusion Criteria:

1. Adults aged 18 years or older;
2. A verifiable medical diagnosis of Chronic Pain (duration ≥ 3 months);
3. Internet access;
4. Sufficient computer and internet literacy;
5. Fluent knowledge of the Italian language.

Exclusion Criteria:

1. Current participation in psychological or psychotherapeutic treatments for chronic pain management;

2. High risk of suicide;

3. Cognitive impairments;

4. Presence of certified psychiatric disorders, such as:

   1. Psychotic disorders (e.g., schizophrenia, schizoaffective disorders, etc.);
   2. Bipolar disorder (unstabilized manic or hypomanic episodes);
   3. Severe depressive disorders (e.g., major depression, suicidal intent, or recent suicide attempts);
   4. Severe personality disorders that impair the ability to carry out daily activities (e.g., work, self-care);
   5. Cognitive or neurodegenerative disorders.