Changes in Pain Coping, Catastrophizing, and Coping Efficacy After Cognitive-Behavioral Therapy in Children and Adolescents With Juvenile Fibromyalgia

Abstract

A recent randomized multi-site clinical trial found that cognitive-behavioral therapy (CBT) was significantly more effective than fibromyalgia education (FE) in reducing functional disability in adolescents with juvenile fibromyalgia (JFM). The primary objective of this study was to examine the psychological processes of CBT effectiveness by evaluating changes in pain coping, catastrophizing, and coping efficacy and test these changes as mediators of continued improvements in functional disability and depressive symptoms at 6-month follow-up. One hundred adolescents (11–18 years old) with JFM completed the clinical trial. Coping, catastrophizing, and coping efficacy (Pain Coping Questionnaire) and the outcomes of functional disability (Functional Disability Inventory) and depressive symptoms (Children’s Depression Inventory) were measured at baseline, post-treatment, and 6-month follow-up. Participants in both conditions showed significant improvement in coping, catastrophizing, and efficacy by the end of the study, but significantly greater improvements were found immediately following treatment for those who received CBT. Treatment gains were maintained at follow-up. Baseline to post-treatment changes in coping, catastrophizing, and efficacy were not found to mediate improvements in functional disability or depressive symptoms from post-treatment to follow-up. Future directions for understanding mechanisms of CBT effectiveness in adolescents with chronic pain are discussed.

Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: A randomized control trial

“…It is not rare for CBT to produce improvement through follow-up. Kashikar-Zuck et al (2013) reported this type of improvement in functional disability and depressive symptoms in a CBT group of juveniles with FM, but there is no reason to believe that this effect acts only in an iCBT group and not in a conventional CBT group. It is possible that this small difference in the modality of treatment could produce this phenomenon.…”

Pain-Related Rumination, But Not Magnification or Helplessness, Mediates Race and Sex Differences in Experimental Pain

“…Among the psychosocial approaches to pain, cognitive-behavioral treatments have received the most attention in this literature and 12 have been found to effectively target catastrophizing 51,70 . Nevertheless, the outcome literature on cognitive-behavioral treatments for pain is inconsistent, and these treatments show only modest effect sizes for decreasing maladaptive coping strategies such as catastrophizing 39,50,70 .…”

The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation

“…17 Central to the current study, existing research has shown that anxiety can be mitigated in children with CP through psychological interventions. 18,19 In addition, it has been suggested that treatment addressing emotional factors, such as anxiety, may have additive effects for children with CP. 18 For these reasons, most interdisciplinary models for treating pain underscore the need to address anxiety in this population.…”