Examination of mechanism effects in cognitive behavioral therapy and pain education: analyses of weekly assessments.

Autor:	Burns JW; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States., Gerhart J; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States.; Department of Psychology, Central Michigan University, Mt. Pleasant, MI, United States., Van Dyke BP; Department of Psychology, Young Harris College, Young Harris, GA, United States., Morais CA; Pain Research and Intervention Center of Excellence, Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, United States., Newman AK; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States., Thorn B; Department of Psychology, University of Alabama, Tusculoosa, AL, United States.
Jazyk:	angličtina
Zdroj:	Pain [Pain] 2021 Sep 01; Vol. 162 (9), pp. 2446-2455.
DOI:	10.1097/j.pain.0000000000002237
Abstrakt:	Abstract: Psychosocial treatments for chronic pain produce favorable outcomes. However, we still do not know precisely by what mechanisms or techniques these outcomes are wrought. In secondary analyses of a 10-week group intervention study comparing the effects of literacy-adapted cognitive behavioral therapy (CBT) with literacy-adapted pain education (EDU) among patients with chronic pain, low-socioeconomic status, and low literacy, the Learning About My Pain trial, we examined whether pain catastrophizing was a mechanism specific to CBT. Participants (N = 168) completed mechanism and outcome measures weekly for the 10 weeks of group treatment. Analyses revealed that (1) pain catastrophizing was reduced similary across CBT and EDU; (2) lagged analyses indicated that previous week reductions in pain catastrophizing predicted next week reductions in pain intensity and pain interference; (3) cross-lagged analyses indicated that previous week reductions in pain intensity and interference predicted next week reductions in pain catastrophizing; and (4) the relationships between pain catastrophizing and pain intensity and interference were moderated by session progression such that these links were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. Results suggest the existence of reciprocal influences whereby cognitive changes may produce outcome improvements and vice versa. At the same time, results from analyses of changes in slopes between pain catastrophizing and outcomes indicated that CBT and EDU were successful in decoupling pain catastrophizing and subsequent pain intensity and interference as treatment progressed. Results provide further insights into how psychosocial treatments for chronic pain may work. (Copyright © 2021 International Association for the Study of Pain.)
Databáze:	MEDLINE
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