Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis
Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis
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DOI：
10.1016/s0005-7967(03)00029-9
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发表时间：
2003-10-01
影响因子：
4.1
通讯作者：
Lofland, K
中科院分区：
文献类型：
--
作者：
Burns, JW;Glenn, B;Lofland, K
据推测，减少适应不良的认知构成了以认知行为干预为特色的多学科疼痛项目中的积极治疗过程。使用交叉滞后面板设计来确定是否：a）早期治疗认知变化预测后期治疗疼痛、干扰、活动和情绪变化，但反之则不然； b) 三个认知因素对结果有独特的贡献； c) 显着的认知变化先于结果的显着改善。 65 名慢性疼痛患者参加了为期 4 周的多学科项目，在治疗前、治疗中和治疗后完成了疼痛无助感、灾难性、疼痛相关焦虑（过程因素）、疼痛严重程度、干扰、活动水平和抑郁（结果）的测量。结果表明，早期治疗中疼痛无助的减少预示着后期治疗中疼痛和干扰的减少，但反之则不然；早期治疗中灾难性和疼痛相关焦虑的减少预示着后期治疗中疼痛严重程度的改善，但反之则不然。研究结果表明，这三个过程因素预测的改进大多是相同的。然而，几乎没有证据表明早期治疗过程变量的大幅减少会导致疼痛的广泛改善。研究结果重复了最近一份关于交叉滞后效应的报告，并支持认知变化确实可能影响后期治疗结果的变化。 (C) 2003 Elsevier Science Ltd. 保留所有权利。
Reducing maladaptive cognitions is hypothesized to constitute an active therapeutic process in multidisciplinary pain programs featuring cognitive-behavioral interventions. A cross-lagged panel design was used to determine whether: a) early-treatment cognitive changes predicted late-treatment pain, interference, activity and mood changes, but not vice versa; b) three cognitive factors made unique contributions to outcome; c) substantial cognitive changes preceded substantial improvements in outcome. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary program, completed measures of pain helplessness, catastrophizing, pain-related anxiety (process factors), pain severity, interference, activity level and depression (outcomes) at pre-, mid- and posttreatment. Results showed that early-treatment reductions in pain helplessness predicted late-treatment decreases in pain and interference, but not vice versa, and that early-treatment reductions in catastrophizing and pain-related anxiety predicted late-treatment improvements in pain severity, but not vice versa. Findings suggested that the three process factors predicted improvements mostly in common. However, little evidence was found that large early-treatment reductions in process variables preceded extensive improvements in pain. Findings replicate those of a recent report regarding cross-lagged effects, and offer support that cognitive changes may indeed influence late-treatment changes in outcomes. (C) 2003 Elsevier Science Ltd. All rights reserved.