Introduction
... [1]. Chronic pain is used to describe non-cancerous and resistant to treatment that has lasted longer than the period expected to improve [2]. A significant population with chronic pain suffers from depression and social maladaptation and poor quality of life [3]. Low back pain is one of the most common types of chronic pain [4]. ... [5, 6]. Studies on the effects of chronic low back pain on the mental status of patients indicate a higher prevalence of mental disorders among them than the general population [7]. Compare to the general population, the disease is more prevalent among the military [8]. ... [9, 10]. Because psychological disorders may be associated with low back pain and even cause it, will lead to the adoption of appropriate treatment methods and more serious follow-up [11]. ... [12, 13]. In the research of Kiani et al., it has been found that acceptance and commitment therapy and positive cognitive-behavioral therapy are effective on pain self-efficacy in patients with chronic pain [14]. Razavi et al. have also shown that acceptance and commitment therapy leads to increased feelings of hope and pain management in women with chronic pain [15]. Emotion-focused cognitive-behavioral therapy and acceptance and commitment therapy have reduced the symptoms of pain and depression and have increased life satisfaction among patients with chronic low back pain [16]. The role of acceptance and commitment therapy in reducing catastrophizing and disabling pain in women with low back pain has been proven and has been stable during the two-month follow-up period [17].
Aim (s)
This study aimed to compare the two methods of cognitive-behavioral therapy and acceptance and commitment therapy in patients with chronic low back pain to determine the effectiveness of these two methods in increasing pain self-efficacy and quality of life.
Research Type
The present study is a pre-test, post-test, and follow-up experiment with a control group.
Research Society, Place and Time
All patients with chronic low back pain referred to the specialty ward of Al-Zahra Hakimieh Clinic in Tehran, Iran from February 2020 to March 2021 was the statistical population of this study.
Sampling Method and Number
45 subjects were selected by purposive and available sampling method and were randomly divided into two experimental groups and one control group.
Used Devices & Materials
The Demographic Information Questionnaire was used to identify patients with chronic pain. Other tools used in this study were the Pain Self-Efficacy Questionnaire [18] and the WHO Quality of Life Questionnaire. Experimental group A (CBT) and experimental group B (ACT) received weekly group training (Tables 1 and 2) and no training was provided for the control group. Finally, after two months, a follow-up period was performed.
Ethical Permissions
The necessary license has been obtained from the ethics committee of Ahvaz Azad University, Medical Sciences Branch, number IR.IAU.AHVAZ.REC.1399.012.
Statistical Analysis
In this study, data were analyzed using univariate analysis of variance and Bonferroni's post hoc test.
Finding by Text
In this study, 45 patients with chronic low back pain, including 33 men and 12 women participated with a mean age of 14.81±14.09 years. All variables were examined in three groups (two experimental groups and one control group) and three stages of pre-test, post-test, and follow-up (Table 3). The hypothesis of normal distribution of scores in the pretest was confirmed in both experimental and control groups (p>0.05). The results of the Levin test also showed the homogeneity of variances in experimental and control groups before the experimental intervention (in the pre-test stage) (p>0.05). Therefore, the possibility of using analysis of covariance was confirmed. In this study, the pre-tests of pain self-efficacy and quality of life variables were considered as co-variates and their post-test were considered as dependent variables. Since the dependent variables of the study did not form a common focus, univariate or ANOVA analysis of covariance was used. The results showed that the F-ratio of univariate analysis of covariance was significant for the difference of all dependent variables between the experimental groups and the control group (p <0.001). This means that both treatments were effective on the dependent variables of the research separately (Table 4). Therefore, to compare the effectiveness of the two methods of cognitive-behavioral therapy and acceptance and commitment therapy on pain self-efficacy and quality of life, the results of the Bonferroni post hoc test were used (Table 5). In addition, the difference between the mean of cognitive-behavioral therapy group and acceptance and commitment therapy on pain self-sufficiency and quality of life in both post-test and follow-up stages was not significant at the level of 0.05 (p>0.05). Therefore, the effectiveness of the two treatments on pain self-sufficiency and quality of life in these patients was the same.
Main Comparison to the Similar Studies

The findings of this study are consistent with a study aimed at managing pain in inflammatory bowel disease [14]. In this study, it was shown that after the intervention of cognitive-behavioral therapy, the scores of quality of life and self-efficacy of pain improved and depression, anxiety, and catastrophic pain decreased. In the study of Anvari et al., it has been shown that acceptance and commitment therapy has a significant effect on the severity of pain and anxiety and quality of life of patients with chronic low back pain, which is consistent with the results of the present study [19]. Also, according to the findings of Rahimian Booger, cognitive-behavioral therapy is effective in reducing multifaceted pain symptoms among patients with chronic low back pain [9]. By reviewing research related to pain treatment, including the present study, it can be concluded that the best outcome of pain treatment occurs when the various factors involved in pain processing are also considered. ... [20]. Thus, the findings of the present study showed that both cognitive-behavioral therapy and acceptance and commitment therapy were able to change the inefficiency of patients with chronic low back pain to better efficiency and self-efficacy in coping with pain and also improving the quality of life of this group of patients via influencing cognitions, emotions, behaviors and non-adaptive coping skills, as well as by increasing flexibility, the ability to go back to the present, being aware and observing thoughts and emotions [21]. ... [22, 23]. Considering the role of psychological factors on the sense of self-efficacy and quality of life facing chronic low back pain, it can be said that the factors and variables in pain have an interactive and reciprocal role [24]. ... [25].
Limitations
The sampling of this study lasted from February 2020 to March 2021due to the Corona pandemic and related limitations.
Suggestions
Due to the importance of psychological factors and structures in the phenomenon of pain, especially chronic pain, more research is emphasized in this category. It is also recommended to conduct research related to chronic pain with an emphasis on gender segregation in different groups. It is suggested that the effectiveness of these two treatments on other variables affecting the statistical population be compared and evaluated.
Conclusions
The effectiveness of both cognitive-behavioral therapy and acceptance and commitment therapy is effective in increasing pain self-efficacy and quality of life among patients with chronic low back pain, but there is no significant difference between the two therapies.
Clinical & Practical Tips in Police Medicine
According to the results of this study based on the effectiveness of two approaches of cognitive-behavioral therapy and acceptance and commitment therapy, such interventions can be used in medical centers of the police and other armed forces for patients with chronic low back pain.
Acknowledgments
This article is taken from the Ph.D. dissertation on health psychology at the Islamic Azad University, Khorramshahr branch and thanks all the participants in the research, as well as the professors, advisors and consultants, the neurologist and the management of Al-Zahra Hakimiyeh Clinic in Tehran, Iran.
Conflict of Interest
The authors state that there is no conflict of interest in the present study.
Funding Sources
The present study had no financial support

Table 1) Description of cognitive-behavioral therapy sessions

Table 2) Description of treatment sessions based on acceptance and commitment

Table 4) Results of univariate analysis of covariance on each of the dependent variables

P=0.0001


Table 5) Results of Bonferroni post hoc test to compare the difference between the means of
pain self-efficiency in the two stages of post-test and follow-up