Cognitive Behavioral Therapy For Pain Research Articles

Preliminary feasibility and acceptability of an interdisciplinary, single-session, telehealth class for patients with cancer-related pain.

251 Background: Cognitive behavioral therapy for pain (pain-CBT) is the standard of care for pain management. However, few patients with cancer have access to this treatment. We developed a brief (90-minute), single-session, telehealth intervention that combines medical education (e.g., pain, opioids) with pain-CBT modified for patients with cancer. We sought to quantitatively and qualitatively evaluate the preliminary feasibility and acceptability of the class for patients with cancer-related pain. Methods: Adults with chronic, cancer-related pain (≥4/10) who were receiving or recently completed treatment (<3 months) self-enrolled or were recruited from Stephenson Cancer Center (SCC) in Oklahoma between January and June 2023. We excluded patients who did not speak English or who were experiencing cognitive impairment. After consent, patients completed a baseline survey and attended the 90-minute class offered once monthly on Zoom. Following attendance, the E-acceptability survey, with additional free-text feedback, and were invited to participate in a semi-structured qualitative interview. An initial benchmark for feasibility was set at ≥70% attendance. Results: While recruitment is still ongoing, 66 participants have consented; 22 (33%) withdrew due to being too ill, no longer having pain, or being a fraudulent sign-up ( n = 4, 6%). Of the 44 (67%) remaining participants, 27 (61%) have attended the class; remaining participants are scheduled for future attendance. Participants were 68% female, 89% white, 55 ( SD = 13.1) years of age, and diagnosed with various cancer types (gynecologic 32%, gastrointestinal 20%, head/neck 11%, etc.). Eleven participants (25%) lived in rural Oklahoma. Thirty (68%) participants were taking opioids (short-acting=57%, 48% long-acting=48%, both=36%). Average pain intensity (Brief Pain Inventory) was rated as 6.0/10 ( SD = 1.9). Attendees rated their overall satisfaction with the class as 4.50/5. Participants enjoyed the class (4.15/5), reported learning about pain (4.23/5), and found the material useful (4.31/5) and helpful (4.12/5). Attendees found the class enjoyable and informational, with one stating, “this class [gave] me some tools to better manage my pain...and tools to be able to find help if I need it” (65-year-old, F). Conclusions: To date, participants’ attendance in this single-session, interdisciplinary, telehealth cancer pain class was below our feasibility benchmark, with many requesting to attend future sessions or withdrawing due to being too ill or being lost to follow up. However, among those who have attended the class, they reported very high acceptability and satisfaction. Using qualitative interview feedback, we will tailor the intervention (e.g. more cancer-specific examples, provide a recording) to improve accessibility to this scalable, comprehensive cancer pain education class.

Perspectives of patients with advanced cancer on mobile health interventions to support coping with cancer pain.

277 Background: Pain is common among people with advanced cancer. While opioids are important for management, incorporating behavioral and psychological treatments may improve pain outcomes. We systematically evaluated patients' experiences with pain self-management and their perspectives on using a mobile health (mHealth) intervention that integrates cancer pain management support with pain-Cognitive Behavioral Therapy. Methods: This study recruited adult patients from Stephenson Cancer Center in Oklahoma and Dana Farber Cancer Institute in Massachusetts who had an incurable solid or hematologic malignancy, chronic pain related to cancer, and were using opioids. Following a semi-structured interview guide, participants shared feedback on educational web-based content and app-based wireframes from a behavioral pain management mHealth application. Participants were also asked about their experiences self-managing cancer pain and encouraged to reflect on the ideal role of mHealth interventions in their existing care. Interviews were transcribed verbatim and analyzed using a combination of thematic and framework analysis. Results: Patients (n=28; 54% female; mean age=53) experienced substantial challenges related to their pain, including new physical limitations, distress, and side effects from treatments and medications. Patients used physical/behavioral (e.g., using tools/devices, physical activity, modifying routines, opioid therapy) and psychological strategies (e.g., reframing negative thoughts, distraction, pain acceptance, social support) to self-manage chronic cancer-related pain. One notable theme that emerged was that clinicians’ hesitance to prescribe and patients’ hesitance to take opioids represented a significant barrier to adequate pain management. Patient recommendations for how mHealth interventions could best address their needs coalesced around two additional themes, both of which were related to patients’ experience of pain self-management. First, patients felt that content should be directly relevant to the advanced cancer experience. Second, patients wanted convenient access to symptom and medication tracking in addition to informational resources describing how to better cope with pain and communicate with healthcare providers. Conclusions: Many patients felt that for pain management strategies to be successful, medical and psychological pain treatments must be integrated, and contain guidance about appropriate analgesic use. This underscores the importance of coordinating complementary approaches when developing cancer pain management interventions. Given their existing pain self-management strategies and challenges, patients with advanced cancer viewed mHealth interventions that support pain self-management as a promising avenue to provide integrated pain treatment.

Pain in irritable bowel syndrome: Does anything really help?

Pain relief remains a significant challenge in the management of irritable bowel syndrome (IBS): "Does anything really help relieve the pain in patients with IBS?". Interventions aimed at pain relief in patients with IBS include diet, probiotics or antibiotics, antidepressants, antispasmodics, and drugs targeting specific gastrointestinal receptors such as opioid or histamine receptors. In the systematic review and meta-analysis published in this journal, Lambarth et al. examined the literature on the role of oral and parenteral anti-neuropathic agents in the management of pain in patients with IBS. This review article appraises their assessment of the efficacy of the anti-neuropathic agents amitriptyline, pregabalin, gabapentin, and duloxetine in the relief of abdominal pain or discomfort, and impact on overall IBS severity and quality of life. This commentary provides an update of current evidence on the efficacy of the dietary and pharmacological treatments that are available or in development, as well psychological and cognitive behavioral therapy for pain in IBS. Advances in recent years augur well for efficacious treatments that may expand the therapeutic arsenal for pain in IBS.

Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial

Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.

Analysis of secondary behavioral outcomes in patients undergoing tDCS and CBT for pain and opioid misuse

Abstract One of the limitations of tDCS is the difficulty in localizing currents and subsequent difficulty of predicting behavioral outcomes of a particular electrode placement. This project attempts to address this limitation by analyzing behavioral outcomes on a study population undergoing tDCS over the dorsolateral prefrontal cortex (DLPFC) by analyzing longitudinal change in four other behavioral outcomes associated with the target brain region. A series of repeated measures factorial ANOVAs were run on data taken from 73 participants who were randomized to receive either real (N=44) or sham (N=29) tDCS paired with Cognitive Behavioral Therapy (CBT) weekly for 11 weeks. All analyses were conducted with group assignment as a between subjects factor and time as a within subjects factor, and yielded that the main effect of time was significant for anxiety (F=6.122, p=.016), depression (F=6.762, p=.011), pain catastrophizing (F=30.782, p<0.000), and sleep (F=17.820, p<0.000). However, no significant interaction was found between time and group assignment, suggesting that while the CBT treatment showed significant improvements in these non-target behavioral outcomes, those improvements were not significantly aided by the addition of tDCS. This is despite previous analyses of these data yielding significant improvement of the target variable in the group that received real tDCS over the group that received sham tDCS. Keywords: tDCS, target areas, CBT, pain

Understanding the Impact of Pain Among Latinx Older Adults

Pain is the number one reason for seeking medical attention, and a top contributor to healthcare costs in the United States. Considerable evidence highlights racial/ethnic disparities in pain with Latinx communities being disproportionally affected at higher rates. Compared to other ethnic minority groups, Latinx older adults are more socioeconomically disadvantaged and experience higher rates of disability and frailty (Garcia, Downer, Crowe, & Markides, 2017). Given the rapidly growing population of Latinx, it is anticipated that the incidence of pain and its associated impact will adversely affect the quality of life of many older adults. The public health focus on improving pain management with non-opioid treatment options also highlights the need to provide culturally responsive care for Latinx older adults. However, limited efforts have addressed this important target for intervention. Following the biopsychosocial model of pain, this presentation will provide an overview of biological, psychosocial and cultural factors influencing pain disparities among older adults. Findings from experimental and clinical settings will be discussed. The presenter will also review current evidence highlighting the preference for self-management strategies for pain management among Latinxs, as well as the need to increase accessibility to psychosocial treatments for chronic pain, such as cognitive behavioral therapy for pain (CBT-pain). Furthermore, preliminary findings from a qualitative study will be presented to illustrate the need to offer culturally adapted treatments for pain management (Torres, Thorn, Kapoor, & DeMonte, 2017). Future research is needed to study sociocultural factors influencing pain disparities to help identify modifiable targets for intervention.

Effects of a Home-Based Telephone-Supported Physical Activity Program for Older Adult Veterans With Chronic Low Back Pain

Chronic low back pain (CLBP) is highly prevalent in older adults, leading to functional decline. The objective of this study was to evaluate physical activity (PA) only and PA plus cognitive-behavioral therapy for pain (CBT-P) among older adult veterans with CLBP. This study was a pilot randomized trial comparing a 12-week telephone-supported PA-only intervention group (PA group) or PA plus CBT-P intervention group (PA + CBT-P group) and a wait-list control group (WL group). The study setting was the Durham Veterans Affairs Health Care System. The study participants were 60 older adults with CLBP. The PA intervention included stretching, strengthening, and aerobic activities; CBT-P covered activity pacing, relaxation techniques, and cognitive restructuring. Feasibility measures included enrollment and completion metrics; acceptability was measured by completed phone calls. Primary outcomes included the Timed "Up & Go" Test and the PROMIS Health Assessment Questionnaire. Generalized linear mixed models were used to estimate changes within and between groups. Effect sizes were calculated with the Cohen d. Adverse effects were measured by self-report. The mean participant age was 70.3 years; 53% were not white, and 93% were men. Eighty-three percent of participants completed the study, and the mean number of completed phone calls was 10 (of 13). Compared with the results for the WL group, small to medium treatment effects were found for the intervention groups in the Timed "Up & Go" Test (PA group: -2.94 [95% CI=-6.24 to 0.35], effect size=-0.28; PA + CBT-P group: -3.26 [95% CI=-6.69 to 0.18], effect size=-0.31) and the PROMIS Health Assessment Questionnaire (PA group: -6.11 [95% CI=-12.85 to 0.64], effect size=-0.64; PA + CBT-P group: -4.10 [95% CI=-11.69 to 3.48], effect size=-0.43). Small treatment effects favored PA over PA + CBT-P. No adverse effects were noted. This was a pilot study, and a larger study is needed to verify the results. This pilot trial demonstrated that home-based telephone-supported PA interventions were feasible, acceptable, and safe for older adult veterans. The results provide support for a larger trial investigating these interventions.

Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology Class in Chronic Low Back Pain: Study Protocol for a Randomized Controlled Trial

BackgroundThe Institute of Medicine (IOM) reported that chronic pain affects about 100 million U.S. adults, with chronic low back pain (CLBP) cited as the most prevalent type. Pain catastrophizing is a psychological construct shown to predict the development and trajectory of chronic pain and patient response to pain treatments. While effective treatment for pain catastrophizing typically includes eight-session groups of cognitive behavioral therapy (CBT), a single-session targeted treatment class yielded promising results which, if replicated and extended, could prove to efficiently and cost-effectively reduce pain catastrophizing. In this trial, we seek to determine the comparative efficacy of this novel single-session pain catastrophizing class to an eight-session course of pain CBT and a single-session back pain health education class. We will also explore the psychosocial mechanisms and outcomes of pain catastrophizing treatment.MethodsIn this trial we will randomize 231 individuals with CLBP to one of three treatment arms: (1) pain-CBT (eight weekly 2-h group sessions with home exercises and readings); (2) a single 2-h pain catastrophizing class; or (3) a single 2-h back pain health education class (active control). For the primary outcome of pain catastrophizing, the trial is designed as a non-inferiority test between pain-CBT and the single-session pain catastrophizing class, and as a superiority test between the single-session pain catastrophizing class and the health education class. Team researchers masked to treatment assignment will assess outcomes up to six months post treatment.DiscussionIf the single-session targeted pain catastrophizing class is found to be an effective treatment for patients with CLBP, this low cost and low burden treatment could dismantle many of the current barriers and burdens of effective pain care. Further, elucidation of the mechanisms of pain catastrophizing treatments will facilitate future research on the topic as well as further development and refinement of treatments.Trial registrationClinicalTrials.gov, NCT03167086. Registered on 22 May 2017.

Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial

This controlled trial aims to analyze the efficacy of cognitive-behavioral therapy for insomnia and pain (CBT-IP) compared to cognitive-behavioral therapy for pain (CBT-P) and usual medical care (UMC) at improving sleep and other clinical manifestations (pain, fatigue, impaired functioning, and emotional distress) in women with fibromyalgia (FM). One hundred and twenty-six patients with FM were randomly assigned to different treatment groups and 113 completed the treatments (38 in the CBT-IP group, 34 in the CBT-P group and 41 in the UMC group) and a number of self-reports at pre-treatment, post-treatment, and 3 months of follow-up. The CBT-IP group showed significant improvements at post-treatment in several sleep variables (i.e., subjective sleep quality, sleep latency, sleep efficiency, and use of sleeping medication) that were not observed in the CBT-P and UMC groups. The CBT-IP and CBT-P groups reported significant improvements at post-treatment in FM impact and self-efficacy for coping with pain; the CBT-IP group reported improvements at follow-up in pain intensity, and the CBT-P reported improvements at post-treatment in pain catastrophizing and pain acceptance. Clinical improvements are also described. The findings revealed differential responses between groups regarding sleep and other adjustment parameters and the CBT-IP group exhibited the best clinical response pattern overall. More research in the area of FM treatment is needed to enhance the efficacy of the CBT and identify which patients are likely to benefit from each modality of CBT.

Are We Really Ready for Telehealth Cognitive Behavioral Therapy for Pain?

Are We Really Ready for Telehealth Cognitive Behavioral Therapy for Pain?

The effectiveness of cognitive behavioural therapy for pain in childhood and adolescence: a meta-analytic review

A variety of chronic painful conditions are present in the paediatric population. Patients with chronic pain often experience considerable scepticism and avoidance by health care providers. This meta-analytic review aimed to utilise well-designed studies, in examining the effectiveness of cognitive behavioural therapy (CBT) in the treatment of chronic pain in children and adolescents. Nine randomized controlled trial studies examining CBT for chronic pain were reviewed. Outcome measures were child reported pain intensity, pain duration and functional disability. CBT had a large effect on pain intensity for recurrent abdominal pain (RAP), a small effect on headaches, and a medium effect on fibromyalgia. CBT had a medium effect on pain duration across pain types. CBT had a large effect on functional disability for RAP, a small effect on fibromyalgia and a moderate effect on headaches. Findings are limited by the small number of studies and varied control conditions. CBT may be effective in reducing child reported pain symptomology. Future studies using a larger sample and examining the differential impact of varied control conditions are needed.

Mindfulness and cognitive-behavioral interventions for chronic pain: differential effects on daily pain reactivity and stress reactivity.

This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA). One hundred forty-three RA patients were randomized to 1 of the 3 treatment conditions. CBT-P targeted pain-coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; E provided information regarding RA pain and its management. At pre- and posttreatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects. Multilevel models compared groups in the magnitude of within-person change in daily pain and stress reactivity from pre- to posttreatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E. For individuals with RA, M produces the broadest improvements in daily pain and stress reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life.

Who Benefits From CBT for Insomnia in Primary Care? Important Patient Selection and Trial Design Lessons from Longitudinal Results of the Lifestyles Trial

Evaluate long-term effects of group interventions on sleep and pain outcomes in a primary care population of older adults with osteoarthritis pain and sleep disturbance. Double-blind, cluster-randomized controlled trial with 18-mo follow-up. Group Health and University of Washington, Seattle, WA, from 2009 to 2011. Three hundred sixty-seven adults age 60 y and older, with osteoarthritis pain and insomnia symptoms. Six weekly sessions of group cognitive behavioral therapy for insomnia and pain (CBT-PI), pain alone (CBT-P), and education-only control (EOC) delivered in patients' primary care clinics. There were no significant differences between treatment groups in sleep outcomes at 18 mo. This is a change from published significant 9-mo follow-up results for insomnia severity (Insomnia Severity Index) and sleep efficiency. There were no significant treatment differences in pain at either follow-up. Post hoc analyses of participants with greater insomnia and pain severity at baseline (n = 98) showed significant (P = 0.01) 18-mo reductions in pain comparing CBT-PI versus CBT-P (adjusted mean difference [AMD] = -1.29 [95% confidence interval (CI): -2.24,-0.33]). Moderate, albeit nonsignificant, CBT-PI versus EOC treatment effects for insomnia severity (AMD = -1.43 [95% CI: -4.71, 1.86]) and sleep efficiency (AMD = 2.50 [95% CI: -5.04, 10.05]) were also observed. Possible trial design and methodological considerations that may have affected results are discussed. Results suggest patients with higher levels of comorbid pain and insomnia may be most likely to experience sustained benefit from cognitive behavioral therapy interventions over time, and inclusion of insomnia treatment may yield more clinically meaningful improvements than cognitive behavioral therapy for pain alone. clinicaltrials.gov identifier: NCT01142349.

Cognitive–Behavioral Therapy for Hand and Arm Pain

Cognitive–behavioral therapy (CBT) is a psychological treatment that emphasizes the interrelation among thoughts, behaviors, feelings, and sensations. CBT has been proved effective not only for treatment of psychological illness but also for teaching adaptive coping strategies in the context of chronic illnesses, including chronic pain. The present article provides general information on CBT, specific information on CBT for pain, as well as guidelines and strategies for using CBT for hand and arm pain patients, as part of multidisciplinary care models.

Textbook of Psychotherapeutic Treatments

Back to table of contents Previous article Next article Book ReviewFull AccessTextbook of Psychotherapeutic TreatmentsLina Cassandra Vawter M.D.Lina Cassandra Vawter M.D.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1404aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail When I was a second-year resident, I had my first meeting with a patient about whom I had been exhaustively forewarned: she was exceptionally astute, intermittently psychotic, and habitually sadistic. She immediately asked what I knew about interpersonal therapy. I cringed, admitting that I really didn't know much, and spent the rest of the appointment trying to regain some semblance of competency. Surely I had been post-call for that lecture. When I first opened Glen O. Gabbard's Textbook of Psychotherapeutic Treatments, I turned directly to the segment devoted to interpersonal therapy and found four concise chapters: Theory, Techniques, Applications, and Combination With Medication. I read those chapters first, to find out what I could have said. Next I found the section on cognitive-behavioral therapy and found four corresponding, well-written chapters. From the perspective of a fourth-year resident, this book offers an excellent quick but comprehensive orientation (and reorientation) to a variety of psychotherapies, many of which are covered in residency training and some of which are not. Included in Gabbard's book are sections on psychodynamic, cognitive-behavioral, interpersonal, and supportive therapies. These sections are followed by eight shorter sections (one chapter each) covering several permutations of therapeutic assemblage, including family systems theory and practice and couples therapy (including emotionally focused, psychodynamic, and behavioral therapies). Group therapies covered include psychodynamic, family interventions, and cognitive-behavioral therapy for pain. All chapters are peppered with enough references to demonstrate adequately the book's scholarly origins, without creating mental tangents that detract from its readability. The book is certainly approachable for the busy and novice practitioner.The book ends with chapters that initially look a bit miscellaneous but are actually pertinent and interesting chapters on psychotherapy integration, mentalization-based therapy, brain processes informing psychotherapy, and professional boundaries. Dialectical behavioral therapy is unfortunately placed in the midst of this last section, though it certainly merits the status of the other therapies to which four chapters are devoted. For anyone else who is new to the term, "mentalization" refers to a "procedural, mostly non-conscious … intuitive rapid emotional reaction in response to all the social and personal interactions around us," a "process by which we make sense of each other and ourselves." It is linked to borderline personality disorder by attachment theory, with the assumption that the disorder is caused by a reduced capacity for this skill. It is the focus of a relatively new form of therapy for patients with borderline personality disorder and is aptly placed alongside the chapter on dialectical behavioral therapy.The chapter on brain processes presents the most novel and interesting material, effectively providing a compelling case for the study of neurobiological processes by the average practicing therapist and certainly the average psychiatrist. All in all, this book is an excellent reference for residents, therapists, psychologists, and any practicing psychiatrist who wishes to fortify and expand his or her knowledge of psychotherapeutic interventions, their theoretical bases, and current advances in exploration of their neurobiological correlates.The reviewer reports no competing interests.Dr. Vawter is with the Department of Psychiatry, UMass Memorial Health Care, Worcester, Massachusetts. FiguresReferencesCited byDetailsCited ByNone Volume 60Issue 10 October, 2009Pages 1404-1405PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

Textbook of Psychotherapeutic Treatmentsby Glen O. Gabbard, M.D.; American Psychiatric Publishing, 2009, 896 pages, $95.00

Back to table of contents Previous article Next article Book ReviewFull AccessTextbook of Psychotherapeutic TreatmentsLina Cassandra Vawter M.D.Lina Cassandra Vawter M.D.Search for more papers by this authorPublished Online:1 Oct 2009https://doi.org/10.1176/ps.2009.60.10.1404aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail When I was a second-year resident, I had my first meeting with a patient about whom I had been exhaustively forewarned: she was exceptionally astute, intermittently psychotic, and habitually sadistic. She immediately asked what I knew about interpersonal therapy. I cringed, admitting that I really didn't know much, and spent the rest of the appointment trying to regain some semblance of competency. Surely I had been post-call for that lecture. When I first opened Glen O. Gabbard's Textbook of Psychotherapeutic Treatments, I turned directly to the segment devoted to interpersonal therapy and found four concise chapters: Theory, Techniques, Applications, and Combination With Medication. I read those chapters first, to find out what I could have said. Next I found the section on cognitive-behavioral therapy and found four corresponding, well-written chapters. From the perspective of a fourth-year resident, this book offers an excellent quick but comprehensive orientation (and reorientation) to a variety of psychotherapies, many of which are covered in residency training and some of which are not. Included in Gabbard's book are sections on psychodynamic, cognitive-behavioral, interpersonal, and supportive therapies. These sections are followed by eight shorter sections (one chapter each) covering several permutations of therapeutic assemblage, including family systems theory and practice and couples therapy (including emotionally focused, psychodynamic, and behavioral therapies). Group therapies covered include psychodynamic, family interventions, and cognitive-behavioral therapy for pain. All chapters are peppered with enough references to demonstrate adequately the book's scholarly origins, without creating mental tangents that detract from its readability. The book is certainly approachable for the busy and novice practitioner.The book ends with chapters that initially look a bit miscellaneous but are actually pertinent and interesting chapters on psychotherapy integration, mentalization-based therapy, brain processes informing psychotherapy, and professional boundaries. Dialectical behavioral therapy is unfortunately placed in the midst of this last section, though it certainly merits the status of the other therapies to which four chapters are devoted. For anyone else who is new to the term, "mentalization" refers to a "procedural, mostly non-conscious … intuitive rapid emotional reaction in response to all the social and personal interactions around us," a "process by which we make sense of each other and ourselves." It is linked to borderline personality disorder by attachment theory, with the assumption that the disorder is caused by a reduced capacity for this skill. It is the focus of a relatively new form of therapy for patients with borderline personality disorder and is aptly placed alongside the chapter on dialectical behavioral therapy.The chapter on brain processes presents the most novel and interesting material, effectively providing a compelling case for the study of neurobiological processes by the average practicing therapist and certainly the average psychiatrist. All in all, this book is an excellent reference for residents, therapists, psychologists, and any practicing psychiatrist who wishes to fortify and expand his or her knowledge of psychotherapeutic interventions, their theoretical bases, and current advances in exploration of their neurobiological correlates.The reviewer reports no competing interests.Dr. Vawter is with the Department of Psychiatry, UMass Memorial Health Care, Worcester, Massachusetts. FiguresReferencesCited byDetailsCited byNone Volume 60Issue 10 October, 2009Pages 1404-1405PSYCHIATRIC SERVICES October 2009 Volume 60 Number 10 Metrics PDF download History Published online 1 October 2009 Published in print 1 October 2009

Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression.

This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress, pain, and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis (RA). The 144 RA participants were clustered into groups of 6-10 participants and randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E), which served as an attention placebo control. The authors took a multimethod approach, employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 (IL-6), a proinflammatory cytokine. Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. The relative value of the treatments varied as a function of depression history. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.

Cognitive-Behavioral Therapy fOr Clinical Pain Control: A 15-Year Update and its Relationship to Hypnosis

Since Tan's (1982) review of cognitive and cognitive-behavioral methods for pain control was published 15 years ago, sigruficant advances have been made in cognitive-behavioral therapy for pain. The scientific evidence for its efficacy for clinical pain attenuation is now much more substantial and is briefly reviewed. In particular, cognitive-behavioral therapy for chronic pain was recently listed as one of 25 empirically validated or supported psychological treatments available for various disorders. A number of emerging issues are further discussed in light of recent developments and research findings. The relationship of cognitive-behavioral therapy to hypnosis for pain control is briefly addressed, with suggestions for integrating hypnotic and cognitive-behavioral techniques.