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Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care

  • Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.

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Metadaten
Author: Matthias Feldmann, Hauke Jeldrik Hein, Ulrich Voderholzer, Robert Doerr, Thomas Hoff, Gernot Langs, Philipp Herzog, Tim Kaiser, Winfried Rief, Jenny Riecke, Eva-Lotta Brakemeier
URN:urn:nbn:de:gbv:9-opus-56145
DOI:https://doi.org/10.3389/fpsyt.2021.617871
ISSN:1664-0640
Parent Title (English):Frontiers in Psychiatry
Publisher:Frontiers Media S.A.
Document Type:Article
Language:English
Date of first Publication:2021/08/03
Release Date:2021/10/08
Tag:chronic pain; cognitive behavioral therapy; coping skills; effectiveness; mechanisms of change; multidisciplinary pain treatment; naturalistic
GND Keyword:-
Volume:12
Faculties:Universitätsmedizin / Klinik für Psychiatrie und Psychotherapie
Licence (German):License LogoCreative Commons - Namensnennung