Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: How did it work and for whom?

This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB...

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Bibliographic Details
Published in:Journal of behavioral medicine 2021-10, Vol.44 (5), p.704-714
Main Authors: Xie, Haiyi, Guarino, Honoria, Moore, Sarah K., Acosta, Michelle, Budney, Alan J., Rosenblum, Andrew, Marsch, Lisa A., Fong, Chunki
Format: Article
Language:English
Subjects:
Behavior modification
Behavior therapy
Care and treatment
Catastrophic reactions
Chronic pain
Cognition & reasoning
Cognitive ability
Cognitive behavioral therapy
Cognitive therapy
Cognitive-behavioral factors
Demographic aspects
Drug abuse
Drug addiction
Family Medicine
General Practice
Health Psychology
Internet
Intervention
Medicine
Medicine & Public Health
Pain
Patient outcomes
Patients
Severity
Substance abuse
Telemedicine
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Summary:This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU plus a 12-week, web-based CBT intervention (n = 55). Assessments were conducted at weeks 4, 8, and 12, and at 1- and 3-months post intervention. Web-CBT significantly reduced pain catastrophizing, which, in turn, reduced pain interference and pain severity via a pathway of pain catastrophizing. Web-CBT also significantly reduced ADRB both directly and indirectly by reducing pain catastrophizing. For pain interference and pain severity, web-CBT was more effective than TAU for younger patients (≤ age 50). For pain severity, web-CBT was more effective for both younger patients (≤ age 50), and those with a lifetime substance use disorder. Findings suggest that web-CBT’s positive impact on pain outcomes and ADRB are mediated by its effect on pain catastrophizing, and its treatment effects may be most robust for younger patients and those with histories of substance dependence.
ISSN:0160-7715
1573-3521
DOI:10.1007/s10865-021-00219-9