Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: the contributions of psychological flexibility

Sophia Åkerblom,Lance M. McCracken,Marcelo Rivano Fischer,Sean Perrin

doi:10.1007/s10865-020-00168-9

Abstract

There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will require research to identify patient and treatment variables that help explain outcomes. The first aim of this study was to assess whether pre-treatment scores on measures of psychological (in)flexibility, acceptance, committed action, cognitive (de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological flexibility measures, only pre-treatment scores on the psychological inflexibility scale predicted outcomes; higher scores on this measure were associated with worse outcomes. However, change scores on each of the psychological flexibility measures separately mediated outcomes. The efficacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychological flexibility.

Highlights

IntroductionSystematic and meta-analytic reviews find that multicomponent cognitive behavioral therapy (CBT) is superior to treatment as usual and no treatment (but not other active treatments) for adults with chronic pain arising from various conditions (excluding headaches) (Ehde, Dillworth, & Turner, 2014; Williams, Eccleston, & Morley, 2012)
Systematic and meta-analytic reviews find that multicomponent cognitive behavioral therapy (CBT) is superior to treatment as usual and no treatment for adults with chronic pain arising from various conditions (Ehde, Dillworth, & Turner, 2014; Williams, Eccleston, & Morley, 2012)
We focused on processes from the psychological flexibility model and contrasted these variables to demographic and baseline pain characteristics, an approach used in previous studies of outcome predictors in patients treated for chronic pain

Summary

Introduction

Systematic and meta-analytic reviews find that multicomponent cognitive behavioral therapy (CBT) is superior to treatment as usual and no treatment (but not other active treatments) for adults with chronic pain arising from various conditions (excluding headaches) (Ehde, Dillworth, & Turner, 2014; Williams, Eccleston, & Morley, 2012). There is a general consensus in the literature that improvements in CBT for chronic pain will require research to identify: (a) patient characteristics that predict improvements in key outcomes and (b) therapeutic processes that underlie improvements in these outcomes. The literature on predictors of outcome in CBT for chronic pain is relatively sparse and the findings quite mixed. Variables that reflect emotional functioning appear most often among identified predictors of treatment outcomes (Gilpin et al, 2017).

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