Cognitive Behavioral Therapy (CBT) and Pain Education for People With Chronic Pain: Tests of Treatment Mechanisms

• Published in: Journal of consulting and clinical psychology 2020-11, Vol.88 (11), p.1008-1018
• Main Authors: Burns, John W, Van Dyke, Benjamin P, Newman, Andrea K, Morais, Calia A, Thorn, Beverly E
• Format: Article
• Language: English
• Subjects: Adult; Behavior modification; Biopsychosocial aspects; Catastrophic reactions; Catastrophization; Catastrophizing; Chronic Pain; Chronic Pain - psychology; Chronic Pain - therapy; Clinical trials; Cognition; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive change; Cognitive restructuring; Cognitive therapy; Cognitive-behavioral factors; Education; Female; Human; Humans; Male; Middle Aged; Pain; Patient Education as Topic - methods; Randomized Controlled Trials as Topic; Risk Factors; Self Efficacy; Treatment; Treatment Outcome; Treatment Outcomes
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000612

Objectives: The goals of the study were to determine to what degree changes in pain-related cognition during cognitive behavioral treatment (CBT) and pain education (EDU) represented treatment mechanisms and whether these cognitive changes worked to a larger extent to produce favorable outcomes in CBT than in EDU. Method: Reported here are secondary analyses of a randomized control trial (N = 290) comparing CBT, EDU, and treatment as usual for low-literacy, low-socioeconomic-status people with chronic pain. We excluded the treatment as usual condition from these analyses and included measures collected at a midtreatment epoch. Treatment was 10 weekly group sessions. Results: Linear mixed models revealed nonsignificant differences in pre- to mid- to posttreatment changes in pain catastrophizing and pain self-efficacy between CBT and EDU. The same was true for outcome measures. Cross-lagged analyses revealed significant relationships between pre- to midtreatment changes in catastrophizing and self-efficacy and mid- to posttreatment changes in outcomes. However, relationships between pre- to midtreatment changes in outcomes and mid- to posttreatment changes in catastrophizing and self-efficacy were also significant. Conclusions: Results suggest a complex set of mechanistic relationships. Instead of a unidirectional path from designated mechanism to designated outcome, our results suggest reciprocal influences whereby cognitive changes may beget outcome improvements and vice versa. Results also suggest that cognitive changes do not occur solely in a treatment that uses cognitive restructuring to foster such changes but may occur as a function of providing people with detailed information regarding the biopsychosocial nature of chronic pain. What is the public health significance of this article? This study suggests that changes in pain-related cognition may be a mechanism for psychosocial treatments of chronic pain, even treatments that do not feature explicit cognitive restructuring or coping skills training.