Does Change Occur for the Reasons We Think It Does? A Test of Specific Therapeutic Operations During Cognitive-Behavioral Treatment of Chronic Pain
Does Change Occur for the Reasons We Think It Does? A Test of Specific Therapeutic Operations During Cognitive-Behavioral Treatment of Chronic Pain
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DOI：
10.1097/ajp.0000000000000141
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发表时间：
2015-07-01
影响因子：
2.9
通讯作者：
Kerns, Robert D.
中科院分区：
文献类型：
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作者：
Burns, John W.;Nielson, Warren R.;Kerns, Robert D.
目的：探讨认知行为疗法（CBT）治疗慢性疼痛的两个概念模型的相对效度。方法：作为增强CBT与标准CBT的临床试验的一部分，慢性疼痛患者接受了由3个疼痛应对技能模块组成的治疗。在对一个子样本（n=56）的二次分析中，我们检查了第4阶段（10个阶段中）预处理前慢性疼痛应对量表的变化，这些变化与接受3个模块中的一个相对应；即放松，锻炼和认知应对模块。结果：研究结果表明：(1)接受放松模块的参与者在放松技能方面比其他组有显著提高，在其他应对技能方面也有显著提高；(2)接受运动和认知应对模块的参与者在运动使用和认知应对方面表现出混合改善，分别没有比其他组改善更多；(3)第三阶段的医患合作测量和患者对治疗效果的期望与应对技能的变化显著相关。讨论：CBT的改变可能通过理论规定的机制和一般机制发生。然而，研究结果最支持一般机制模型，即应对技能的变化对其他应对技能的使用具有扩散效应。一些技能变化、医患合作指标和结果预期之间存在显著的相关关系，表明非特异性因素也在治疗相关的疼痛应对策略使用变化中起作用。
Objective:To examine the relative validity of 2 conceptual modelsSpecific, Generalby which therapeutic mechanisms in cognitive-behavioral therapy (CBT) for chronic pain achieve favorable outcomes.Methods:As part of a clinical trial of enhanced versus standard CBT, people with chronic pain received treatment consisting of 3 pain coping skill modules. In secondary analyses of a subsample (n=56), we examined pretreatment to session 4 (of 10 sessions) changes in Chronic Pain Coping Inventory subscales that corresponded to receipt of one of 3 modules; namely Relaxation, Exercise, and Cognitive Coping modules.Results:Findings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes.Discussion:Change with CBT may occur both by theory-specified mechanisms and general mechanisms. However, the results provide the most support for a General Mechanism model in which changes on coping skills have spreading effects on the use of other coping skills. Significant relationships between some skill changes and indexes of patient-therapist working alliance and outcome expectations suggest that nonspecific factors also play a role in treatment-related changes in the use of pain coping strategies.