Honors Theses and Capstones

Date of Award

Fall 2022

Project Type

Senior Honors Thesis

College or School



Department of Communication Sciences & Disorders

Program or Major

Communication Sciences & Disorders

Degree Name

Bachelor of Science

First Advisor

Donald A. Robin

Second Advisor

Semra A. Aytur


Chronic pain is a significant and widely prevalent health condition which requires comprehensive care to address the many facets contributing to symptomatology. In 2016, 20% of American adults (about 50 million) reported experiencing chronic pain, of which 7.4% indicated that chronic pain frequently limited their life and participation in activities within the past 3 months (CDC, 2018). As a result, many individuals with chronic pain turn to opioid-based medication for pain relief, but long-term use of opioids actually increases pain sensation (Tobin, 2019). Moreover, opioid medication is unable to target underlying mental health components which emerge as part of chronic pain conditions. Thus, non-pharmacological treatment is needed to relieve the burden of chronic pain and improve cognitive and emotional processing as well as views of self (Skelly et al., 2018). Acceptance and Commitment Therapy (ACT) is a highly effective transdiagnostic intervention used to treat chronic pain by teaching individuals coping skills through mindfulness and behavioral activation (Bai et al., 2020; Dindo et al., 2017). Based on extensive data, ACT is shown to correlate with an increase in psychological flexibility, pain acceptance, and reductions in feelings of pain-related stigma (Aytur et al., 2022; Ding & Zheng, 2022; Meier et al., 2021; Feliu-Soler, 2018). Given the necessity of remote healthcare intervention, especially relevant during the recent pandemic, there is an urgent need to evaluate the efficacy of ACT in a tele-practice delivery model which will broaden the availability of the treatment to reach far larger numbers of patients. As a complement to ACT, recreational therapy (RT) is likely efficacious for treatment of chronic pain and associated symptoms. Similar to the underlying goals of ACT, RT focuses on personal values, improved functioning, quality of life, independence, and recovery (Froutan, 2022). The purpose of this paper is to expand upon a prior pilot study assessing feasibility of a non-pharmacological approach to chronic pain treatment using a tele-practice intervention that combines ACT with RT (TeleACT-RT). Specifically, this paper will evaluate the efficacy of the TeleACT-RT intervention on improving mindfulness in participants with chronic pain. With a focus on the concept of mindfulness, this study aims to extend the previous findings from the TeleACT-RT study by quantifying the impact of ACT on metrics of mindfulness using the Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2004, 2008). Results suggest that TeleACT-RT was associated with a significant increase in mindfulness scores after the intervention, as well as improved scores in numerous other domains (e.g., psychological flexibility, pain acceptance, and social role participation) (Roy, 2022). These findings complemented prior research suggesting that TeleACT-RT was associated with a wide range of improvements in chronic pain. (Roy, 2022). Roy et al. (2022) explored the feasibility of administering this intervention through a 6-week tele-practice TeleACT-RT modality within the context of the COVID-19 pandemic through a pilot-study. Findings from this study revealed positive behavior outcomes, encompassing increased psychological flexibility, pain acceptance, and lower extremity function, while simultaneously showing decreased feelings of pain-related stigma (Roy, 2022). Additionally, participants reported being satisfied with the tele-practice modality of delivery and provided positive feedback regarding their overall quality of life post-treatment with ACT.