Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis

• Published in: Behaviour research and therapy 2003-10, Vol.41 (10), p.1163-1182
• Main Authors: Burns, J.W., Glenn, B., Bruehl, S., Harden, R.N., Lofland, K.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Anxiety - etiology; Attitude to Health; Behavior therapy. Cognitive therapy; Biological and medical sciences; Chronic Disease; Chronic pain; Cognition & reasoning; Cognition Disorders - therapy; Cognitive Behavioral Therapy - methods; Combined Modality Therapy; Cross-legged analysis; Female; Humans; Male; Medical sciences; Middle Aged; Outcome; Pain - psychology; Pain Management; Process; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Regression Analysis; Therapy; Treatment Outcome; Treatments
• ISSN: 0005-7967; 1873-622X
• DOI: 10.1016/S0005-7967(03)00029-9

Reducing maladaptive cognitions is hypothesized to constitute an active therapeutic process in multidisciplinary pain programs featuring cognitive–behavioral interventions. A cross-lagged panel design was used to determine whether: a) early-treatment cognitive changes predicted late-treatment pain, interference, activity and mood changes, but not vice versa; b) three cognitive factors made unique contributions to outcome; c) substantial cognitive changes preceded substantial improvements in outcome. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary program, completed measures of pain helplessness, catastrophizing, pain-related anxiety (process factors), pain severity, interference, activity level and depression (outcomes) at pre-, mid- and posttreatment. Results showed that early-treatment reductions in pain helplessness predicted late-treatment decreases in pain and interference, but not vice versa, and that early-treatment reductions in catastrophizing and pain-related anxiety predicted late-treatment improvements in pain severity, but not vice versa. Findings suggested that the three process factors predicted improvements mostly in common. However, little evidence was found that large early-treatment reductions in process variables preceded extensive improvements in pain. Findings replicate those of a recent report regarding cross-lagged effects, and offer support that cognitive changes may indeed influence late-treatment changes in outcomes.