Table 1.

Basic Principles of Cognitive Behavioral Therapy, the Stress-Appraisal-Coping Model of Pain, the Acceptance and Commitment Therapy, and the Meaning Making Model

	Cognitive Behavioral Therapy	Stress-Appraisal-Coping Model of Pain1	Acceptance and Commitment Therapy	Meaning Making Model
Basic philosophies	The way a person responds (physiologically, emotionally/affectively, and behaviorally) to a given event (eg, pain) is influenced by her/his thoughts (about the event). A person’s way of thinking and their thoughts) are influenced by her/his (core) beliefs, which are rooted in one’s early life experiences.	The way a person copes with pain and its impact is determined by the transaction between the way s/he appraises pain (and its impact) and her/his (intermediate) beliefs (about pain, one’s control over pain, catastrophizing, other). These appraisals are influenced by the person’s individual characteristics (eg, biological state, personality, core beliefs, social roles).	Accepting thoughts and feelings as they are (instead of fighting against them) makes it easier to focus in achieving one’s most valued goals.	The way a person appraises an event is influenced by the characteristics of the event itself and a person’s core beliefs (about the world, the self, and the self-in-world), goals in life, and sense of purpose. Distress produced by a discrepancy between the way a person appraises an event and the person’s core beliefs, goals, or sense of purpose can be reduced through meaning-centered coping (ie, meaning making processes) altering either the way the person appraises the event, the person’s core beliefs, goals, or sense of purpose.
Cause(s) of (dis)stress or maladjustment	Negative, unrealistic and faulty thinking - cognitive distortions and maladaptive (core) beliefs - leads to distress and maladaptive behavioral responses to events.	Negative, unrealistic and faulty thinking - cognitive distortions and maladaptive (core) beliefs - leads to distress and maladaptive behavioral responses to pain.	Experiential avoidance, cognitive entanglement, and psychological inflexibility contribute to distress and an inability to achieve one’s most valued goals.	A discrepancy between the way a person appraises an event and the person’s core beliefs, goals, or sense of purpose.
Goals/Course of treatment	A person’s maladaptive (and often automatic) thoughts and (intermediate and core) beliefs may be changed/corrected by learning and practicing behavioral and cognitive skills.	A person’s maladaptive appraisals, beliefs, and behavior may be changed/corrected by learning and practicing behavioral and cognitive skills	Teach the person strategies to help them notice and accept their experience as it is – without judgement – making it easier for the person to make decisions and take actions consistent with their valued goals.	Nurture beliefs about personal freedom, strengths, meaning, and purpose in life. Specific strategies may include dereflection (or self-transcendence), self-distancing, paradoxical intention, and Socratic dialogue. An example of a meaning-centered intervention program is logotherapy.
Key concepts	– (Negative) Automatic thoughts and cognitive processes – Cognitive distortions – Intermediate beliefs – Core beliefs/Cognitive structures/Schemas – Emotions/Affect Behavior	– Individual characteristics (biological state, personality, mental health, social roles, core beliefs) – Primary appraisals (threat, harm/loss, challenge) – Secondary appraisals (cognitive errors, beliefs, efficacy) – Coping	– Present vs Past vs Future – Acceptance vs Experiential avoidance – Defusion vs Cognitive fusion – Self as a context vs Self as a content – Committed action vs Inaction Values vs Lack of direction	– Global meaning (core beliefs, global goals, subjective sense of meaning/purpose) – Situational meaning – Appraised event meaning – Meaning making processes (eg, assimilation, accommodation) – Meanings made (eg, sense of having “made sense”, acceptance, perception of growth or positive life changes, changed identity or beliefs or goals, etc.)

Notes: This model corresponds to Beverly Thorn’s (2004) application of the Lazarus and Folkman’s (1984, 1987) Transactional Model of Stress and Coping to chronic pain.