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Scholten S, Schemer L, Herzog P, Haas JW, Heider J, Winter D, Reis D, Glombiewski JA. Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01363-5. [PMID: 38467950 DOI: 10.1007/s10488-024-01363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.
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Affiliation(s)
- Saskia Scholten
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany.
| | - Lea Schemer
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Philipp Herzog
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - Julia W Haas
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Jens Heider
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorina Winter
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorota Reis
- Applied Statistical Modeling, Universität des Saarlandes, Campus, 66123, Saarbrücken, Germany
| | - Julia Anna Glombiewski
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
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2
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Riecke J, Rief W, Lemmer G, Glombiewski JA. Sustainability of cognitive behavioural interventions for chronic back pain: A long-term follow-up. Eur J Pain 2024; 28:83-94. [PMID: 37470301 DOI: 10.1002/ejp.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND There is a significant research gap with respect to the long-term sustainability of psychological treatment effects in chronic pain patients. This study aimed to investigate long-term treatment effects of two psychological treatments: cognitive behavioural therapy (CBT) as a broad-spectrum approach and exposure as a specific intervention for fear-avoidant pain patients. METHODS Patients with chronic low back pain were randomized to CBT or exposure in vivo. Long-term follow-up (LTFU) data were available for 64 patients up to 8 years after treatment, with a response rate of 73%. The primary outcomes were pain-related disability and pain intensity and secondary outcomes were emotional distress, psychological flexibility, catastrophizing and pain-related fear. The data analysis was performed with longitudinal multilevel modelling. RESULTS Multilevel analyses showed improvements in all primary outcomes as well as all secondary outcomes from pre-treatment to LTFU for both treatments. The mean proportion of cases meeting reliable and clinical improved criteria in all primary outcome was 36% (range: 22%-46%) in the exposure group and 50% (range: 33%-60%) in the CBT group. Dropout analyses revealed significantly higher deterioration rates over time. Pre-treatment to LTFU effect sizes of the primary outcomes ranged from 0.54 to 1.59. CONCLUSIONS Our results indicate that the effects of psychological treatments might be stable over several years. Treatment gains for exposure as a stand-alone treatment seem to be of shorter duration than a general CBT intervention. Thus, psychological treatments might offer a promising and sustainable long-term perspective for patients with chronic back pain. SIGNIFICANCE The long-term stability of treatment effects is a highly neglected issue despite its inherent importance in the context of chronic pain. This study is the first to investigate treatment effects of cognitive behavioural therapy and in vivo exposure in chronic back pain sufferers up to 8 years after treatment. The findings contribute to an understanding of the sustainability of psychological cognitive behavioural therapy-based intervention effects.
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Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Gunnar Lemmer
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
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Matheve T, Hodges P, Danneels L. The Role of Back Muscle Dysfunctions in Chronic Low Back Pain: State-of-the-Art and Clinical Implications. J Clin Med 2023; 12:5510. [PMID: 37685576 PMCID: PMC10487902 DOI: 10.3390/jcm12175510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Changes in back muscle function and structure are highly prevalent in patients with chronic low back pain (CLBP). Since large heterogeneity in clinical presentation and back muscle dysfunctions exists within this population, the potential role of back muscle dysfunctions in the persistence of low back pain differs between individuals. Consequently, interventions should be tailored to the individual patient and be based on a thorough clinical examination taking into account the multidimensional nature of CLBP. Considering the complexity of this process, we will provide a state-of-the-art update on back muscle dysfunctions in patients with CLBP and their implications for treatment. To this end, we will first give an overview of (1) dysfunctions in back muscle structure and function, (2) the potential of exercise therapy to address these dysfunctions, and (3) the relationship between changes in back muscle dysfunctions and clinical parameters. In a second part, we will describe a framework for an individualised approach for back muscle training in patients with CLBP.
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Affiliation(s)
- Thomas Matheve
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, UHasselt, 3500 Diepenbeek, Belgium
| | - Paul Hodges
- NHMRC—Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Lieven Danneels
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, 9000 Gent, Belgium;
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Gibbs MT, Morrison NMV, Jones MD, Burgess D, Marshall PW. Reductions in movement-associated fear are dependent upon graded exposure in chronic low back pain: An exploratory analysis of a modified 3-item fear hierarchy. Musculoskeletal Care 2023; 21:25-34. [PMID: 35661387 DOI: 10.1002/msc.1661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the effectiveness of a modified fear hierarchy on measuring improvements in movement-associated fear in chronic low back pain. METHODS A modified 3-item fear hierarchy was created and implemented based on principles of graded exposure. This study was an exploratory analysis of the modified 3-item fear hierarchy from a larger clinical trial data set. Both groups received pain education and exercise, either bodyweight or strength training. Both groups performed item one on the hierarchy, the squat. Only the strength training group performed item 2, the deadlift. Neither group performed item 3, the overhead press. Analysis of Covariance and stepwise linear regression were used to explore results. RESULTS Improvement in movement-associated fear was conditional upon graded exposure. Both groups improved in the squat movement (p ≤ 0.05), which both performed. Only the strength training group improved in the deadlift (p ≤ 0.01), and neither improved in the overhead press (p ≥ 0.05). CONCLUSION Reductions in movement-associated fear are conditional upon graded exposure, based on the use of a novel modified 3-item fear hierarchy. Further research is needed to understand the utility of this tool in a patient-led approach to co-designing a graded exposure-based intervention.
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Affiliation(s)
- Mitchell T Gibbs
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Health Science, Western Sydney University, Penrith, New South Wales, Australia
| | - Natalie M V Morrison
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Matthew D Jones
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain Impact, Neuroscience Research Australia, Adelaide, Queensland, Australia
| | - Danielle Burgess
- Department of Health Science, Torrens University Australia, Adelaide, Queensland, Australia
| | - Paul W Marshall
- School of Health Science, Western Sydney University, Penrith, New South Wales, Australia
- Department of Exercise Science, University of Auckland, Auckland, New Zealand
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Herzog P, Kaiser T, Brakemeier EL. Praxisorientierte Forschung in der Psychotherapie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. In den letzten Jahrzehnten hat sich durch randomisiert-kontrollierte Studien (RCTs) eine breite Evidenzbasis von Psychotherapie mit mittleren bis großen Effekten für verschiedene psychische Störungen gebildet. Neben der Bestimmung dieser Wirksamkeit („Efficacy“) ebneten Studien zur Wirksamkeit unter alltäglichen Routinebedingungen („Effectiveness“) historisch den Weg zur Entwicklung eines praxisorientierten Forschungsparadigmas. Im Beitrag wird argumentiert, dass im Rahmen dieses Paradigmas praxisbasierte Studien eine wertvolle Ergänzung zu RCTs darstellen, da sie existierende Probleme in der Psychotherapieforschung adressieren können. In der gegenwärtigen praxisorientierten Forschung liefern dabei neue Ansätze aus der personalisierten Medizin und Methoden aus der ‚Computational Psychiatry‘ wichtige Anhaltspunkte zur Optimierung von Effekten in der Psychotherapie. Im Kontext der Personalisierung werden bspw. klinische multivariable Prädiktionsmodelle entwickelt, welche durch Rückmeldeschleifen an Praktiker_innen kurzfristig ein evidenzbasiertes Outcome-Monitoring ermöglicht und langfristig das Praxis-Forschungsnetzwerk in Deutschland stärkt. Am Ende des Beitrags werden zukünftige Richtungen für die praxisorientierte Forschung im Sinne des ‘Precision Mental Health Care’ -Paradigmas abgeleitet und diskutiert.
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Affiliation(s)
- Philipp Herzog
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Universität Koblenz-Landau, Deutschland
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Deutschland
| | - Tim Kaiser
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
| | - Eva-Lotta Brakemeier
- Klinische Psychologie und Psychotherapie, Institut für Psychologie, Mathematisch-Naturwissenschaftliche Fakultät, Universität Greifswald, Deutschland
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Philipps-Universität Marburg, Deutschland
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6
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den Hollander M, Smeets RJEM, van Meulenbroek T, van Laake-Geelen CCM, Baadjou VA, Timmers I. Exposure in Vivo as a Treatment Approach to Target Pain-Related Fear: Theory and New Insights From Research and Clinical Practice. Phys Ther 2022; 102:6515749. [PMID: 35084025 DOI: 10.1093/ptj/pzab270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/21/2021] [Accepted: 11/07/2021] [Indexed: 01/07/2023]
Abstract
UNLABELLED Pain-related fear (PRF) can be a significant factor contributing to the development and maintenance of pain-related disability in individuals with persistent pain. One treatment approach to target PRF and related avoidance behavior is exposure in vivo (EXP). EXP has a long history in the field of anxiety, a field that is constantly evolving. This Perspective outlines recent theoretical advancements and how they apply to EXP for PRF, including suggestions for how to optimize inhibitory learning during EXP; reviews mechanistic work from neuroimaging supporting the targeting of PRF in people with chronic pain; and focuses on clinical applications of EXP for PRF, as EXP is moving into new directions regarding who is receiving EXP (eg, EXP in chronic secondary pain) and how treatment is provided (EXP in primary care with a crucial role for physical therapists). Considerations are provided regarding challenges, remaining questions, and promising future perspectives. IMPACT For patients with chronic pain who have elevated pain-related fear (PRF), exposure is the treatment of choice. This Perspective highlights the inhibitory learning approach, summarizes mechanistic work from experimental psychology and neuroimaging regarding PRF in chronic pain, and describes possible clinical applications of EXP in chronic secondary pain as well as in primary care.
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Affiliation(s)
- Marlies den Hollander
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,CIR Revalidatie, location Eindhoven, the Netherlands
| | - Thijs van Meulenbroek
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Charlotte C M van Laake-Geelen
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Vera A Baadjou
- Adelante Centre of Expertise in Rehabilitation and Audiology, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Inge Timmers
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
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7
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Moraes ÉBD, Martins Junior FF, Silva LBD, Garcia JBS, Mattos-Pimenta CAD. Self-efficacy and fear of pain to movement in chronic low back pain: an intervention developed by nurses. Rev Gaucha Enferm 2021; 42:e20200180. [PMID: 34878010 DOI: 10.1590/1983-1447.2021.20200180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the effect of interventions to chronic low back pain developed by nurses in the Program to Increase Self-efficacy and Reduce the Fear of Pain and Avoidance of Movement. METHOD Clinical trial, with 81 patients, carried out in 2016, at the Pain Outpatient Clinic in São Luís, Maranhão, Brazil. The groups received: A (education and exposure), B (education) and C (control). Chi-square, Fisher's Exact, ANOVA and Kruskal Wallis tests were performed. RESULTS Patients in groups A and B improved self-efficacy, anxiety, depression, and disability, compared to group C. The reduction in fear of pain and avoidance of movement was greater in Group A, which also showed a decrease in current pain and overall scores compared to Group B and C. CONCLUSION Education was effective in increasing the Self-Efficacy Belief. For the Belief of Fear of Pain and Avoidance of Movement and pain intensity, the association with exposure showed better results.
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Affiliation(s)
- Érica Brandão de Moraes
- Universidade Federal Fluminense (UFF), Escola de Enfermagem Aurora de Afonso Costa, Departamento de Fundamentos de Enfermagem e Administração. Niterói, Rio de Janeiro, Brasil
| | | | - Larissa Barros da Silva
- Universidade Federal do Maranhão (UFMA), Programa de Pós-graduação em Ciências da Saúde. São Luís, Maranhão, Brasil
| | - João Batista Santos Garcia
- Universidade Federal do Maranhão (UFMA), Faculdade de Medicina, Departamento de Medicina II. São Luís, Maranhão, Brasil
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8
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Day MA, Ward LC, de la Vega R, Ehde DM, Jensen MP. Development of the Pain Responses Scale: A measure informed by the BIS-BAS model of pain. Eur J Pain 2021; 26:505-521. [PMID: 34698421 DOI: 10.1002/ejp.1877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The behavioural inhibition system and activation system (BIS-BAS) model of pain focusses on two clusters of responses to pain-escape/avoidance (BIS) and approach (BAS) behaviours. While the BIS-BAS model emphasizes active responses to pain, deactivation responses such as despondence and relaxation are also common. This study sought to develop self-report scales assessing cognitive, behavioural intentions and affective responses to pain consistent with this extended BIS-BAS framework. We also sought to develop short-forms of the emerging scales. METHODS Confirmatory factor analysis was performed to derive scales from a large item pool administered to a community sample with heterogeneous chronic pain (N = 476). RESULTS The items resulted in 16 scales assessing Thoughts, Affective responses, Behavioural Intentions and Valence-Associated Thoughts, which loaded on to the four theorized types of pain responses-Escape, Approach, Despondence and Relaxation-with the four emerging short-form scales assessing these overarching factors. The internal consistency reliabilities of the long-forms generally ranged from good to excellent (αs ≥ 0.83), with the exception of the Relaxation-Behavioural Intentions scale (α = 0.64). The four short-forms demonstrated at least adequate internal consistency reliability (αs ≥ 0.79). An initial test of the construct validity of the scales in relation to pain-related outcomes is also reported. CONCLUSIONS We anticipate that the Pain Responses Scale (PRS) developed from this research will be useful for assessing mechanisms targeted by many psychosocial pain treatments and will provide a nuanced understanding of the shared versus specific nature of these mechanisms. SIGNIFICANCE The Pain Responses Scale emerging from this research assesses four theorized, overarching responses to pain: Escape, Approach, Giving Up and Relaxation. This measure will afford the capacity to test a reconceptualized BIS-BAS model of pain and inform treatments that are adapted based on this framework.
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Affiliation(s)
- Melissa A Day
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - L Charles Ward
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Feldmann M, Hein HJ, Voderholzer U, Doerr R, Hoff T, Langs G, Herzog P, Kaiser T, Rief W, Riecke J, Brakemeier EL. Cognitive Change and Relaxation as Key Mechanisms of Treatment Outcome in Chronic Pain: Evidence From Routine Care. Front Psychiatry 2021; 12:617871. [PMID: 34413794 PMCID: PMC8368979 DOI: 10.3389/fpsyt.2021.617871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/05/2021] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Matthias Feldmann
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Hauke Jeldrik Hein
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Robert Doerr
- Schoen Clinic Berchtesgadener Land, Schönau am Königsee, Germany
| | - Thomas Hoff
- Schoen Clinic Bad Bramstedt, Bad Bramstedt, Germany
| | - Gernot Langs
- Schoen Clinic Bad Bramstedt, Bad Bramstedt, Germany
| | - Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Tim Kaiser
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
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10
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Lavefjord A, Sundström FT, Buhrman M, McCracken LM. Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Optimizing Long-term Outcomes of Exposure for Chronic Primary Pain from the Lens of Learning Theory. THE JOURNAL OF PAIN 2021; 22:1315-1327. [PMID: 34029684 DOI: 10.1016/j.jpain.2021.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
Abstract
Exposure in vivo is a theory-driven and widely used treatment to tackle functional disability in people with chronic primary pain. Exposure is quite effective; yet, in line with exposure outcomes for anxiety disorders, a number of patients may not profit from it, or relapse. In this focus article, we critically reflect on the current exposure protocols in chronic primary pain, and provide recommendations on how to optimize them. We propose several adaptations that are expected to strengthen inhibitory learning and/or retrieval of the extinction memory, thus likely decreasing relapse. We summarize the limited, but emerging experimental data in the pain domain, and draw parallels with experimental evidence in the anxiety literature. Our reflections and suggestions pertain to the use of the fear hierarchy, reassurance, positive psychology interventions, exposure with a range of stimuli and within different contexts, and the use of safety behaviors during treatment, as well as associating the fear-inducing stimuli with novel outcomes. In addition, we reflect on the importance of specifically tackling (the return of) pain-related avoidance behavior with techniques such as disentangling fear from avoidance and reinforcing approach behaviors. Finally, we discuss challenges in the clinical application of exposure to improve functioning in chronic primary pain and possible avenues for future research. Perspectives: Inspired by recent advances in learning theory and its applications on the treatment of anxiety disorders, we reflect on the delivery of exposure treatment for chronic primary pain and propose strategies to improve its long-term outcomes.
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Kangas M, Kallesoe KH, Rask CU. Functional Somatic Syndromes (FSS) in Children and Adolescents. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Unspecific somatic health complaints and symptoms are common in children and adolescents, varying on a continuum of severity. When persistent and impairing, they are often referred to as functional somatic syndromes (FSS). The overarching objective of this paper is to provide an overview of the pediatric literature in relation to conceptual, assessment, and treatment issues for youth presenting with FSS. Clinical recommendations are outlined including addressing potential feasibility and barrier issues for families presenting to medical and mental health services. Assessment and treatment issues are further discussed in context of two recent psychotherapy trials conducted with children and older age adolescents (aged from 7 to 19 years). Finally, we address ongoing research gaps in this field with view to strengthen the evidence base in the assessment and treatment of youth presenting with FSS.
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Affiliation(s)
- Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Karen Hansen Kallesoe
- Research Clinic for Functional Disorders and Psychosomatic, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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McCracken LM. Necessary components of psychological treatment for chronic pain: More packages for groups or process-based therapy for individuals? Eur J Pain 2020; 24:1001-1002. [PMID: 32227418 DOI: 10.1002/ejp.1568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lance M McCracken
- Division of Clinical Psychology, Psychology Department, Uppsala University, Uppsala, Sweden
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