Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: A single-case experimental design with multiple baselines. (September 2018)

• Record Type: Journal Article
• Authors: Schemer, Lea; Vlaeyen, Johan W.S.; Doerr, Johanna M.; Skoluda, Nadine; Nater, Urs M.; Rief, Winfried; Glombiewski, Julia A.
• Is Part Of: Behaviour research and therapy. Volume 108(2018)
• Page Start: 58
• Page End: 67
• Publication Date: 2018-09
• Subjects: Treatment processes -- Chronic low back pain -- Exposure therapy -- Cognitive-behavioral therapy -- Single-case experimental design -- Biological stress response -- Cortisol -- Alpha-amylase; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2018.07.002
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: Our aim was to evaluate isolated elements of psychological pain treatments and explore treatment effects on biological stress markers. We employed a single-case experimental design with multiple baselines. Matching pairs of twelve participants (chronic low back pain >6 months; elevated pain-related fear) were randomly assigned to graded in vivo exposure (EXP) or cognitive-behavioral therapy (CBT) in a yoked design. Primary assessments were taken during baseline (7–26 days), treatment (23–44 days) and at 6-months follow-up (11–30 days) including changes in pain symptoms, disability, pain-related fear, acceptance, body confidence, self-efficacy, and positive thoughts. Psycho-educational, behavioral, cognitive, and exposure interventions were compared to baseline. EXP exhibited immediate middle-to-large effects; CBT's small-to-middle effects were delayed. Within the EXP approach, change mainly occurred during exposure but not during psycho-educational sessions. Overall cortisol was lower in EXP than CBT at post-treatment. We recommend integrating exposure elements in the management of CLBP to increase its efficacy. Psycho-educational sessions might not be necessary or should be adapted, e.g. with stronger focus on motivational aspects. Since CBT seemed to produce delayed effects, core CBT interventions such as cognitive restructuring might be added after exposure treatment to sustain therapeutic effects. Highlights: We evaluated isolated treatment components of CBT and Exposure for chronic pain. Exposure elements were especially effective in producing middle-to-large effects. Psycho-education or other CBT-specific elements revealed no particular effect. The CBT package revealed small-to-medium delayed treatment effects. Overall cortisol levels were lower in Exposure than CBT at post-treatment.