2023
DOI: 10.1037/ccp0000801
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Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for people with chronic low back pain: A comparative mechanisms study.

Abstract: Objective: Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. Nonetheless, methodological limitations preclude clear understanding of how psychosocial chronic pain treatments work. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatm… Show more

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Cited by 12 publications
(7 citation statements)
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“…36 It has also been argued that there may be a conceptual overlap between measures of pain self-efficacy and disability, artificially inflating the correlation between the two, but the correlation was in the moderate range for fear-avoidance beliefs and disability, making this an unlikely cause for concern. Moreover, there is accumulating evidence from experimental RCTs demonstrating positive treatment outcomes with CLBP to be mediated through mechanisms common to all treatment models, 8,39 as also reported with chronic pain conditions more broadly. 35 Unlike most previous clinical trials examining the FAM with CLBP, the sample in this study did not consist of only highly fearful-avoidant patients.…”
Section: Pre Treatmentmentioning
confidence: 99%
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“…36 It has also been argued that there may be a conceptual overlap between measures of pain self-efficacy and disability, artificially inflating the correlation between the two, but the correlation was in the moderate range for fear-avoidance beliefs and disability, making this an unlikely cause for concern. Moreover, there is accumulating evidence from experimental RCTs demonstrating positive treatment outcomes with CLBP to be mediated through mechanisms common to all treatment models, 8,39 as also reported with chronic pain conditions more broadly. 35 Unlike most previous clinical trials examining the FAM with CLBP, the sample in this study did not consist of only highly fearful-avoidant patients.…”
Section: Pre Treatmentmentioning
confidence: 99%
“…48 Although outcome studies examine the overall effect of a treatment, process research may help clarify the underlying mechanisms associated with beneficial outcomes; that is, the intermediate variables or "mediators" associated with positive change. Surprisingly, only a handful of RCTs, comparing an active psychological intervention with that of a control condition, have examined mediators of treatment outcome in the context of CLBP, 8,29,40,41 with only 2 based specifically on the FAM. 22,39 However, results indicate that changes in key components of the FAM, including pain catastrophizing 8,22,40,41 and fear of movement, 29,39 are important for reducing disability.…”
Section: Introductionmentioning
confidence: 99%
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“…Mediation, moderation, and time-lagged analyses all offer more advanced approaches to studying the clinical relevance of mechanisms, allowing causal inferences to be made. These methods have a long history of use in psychology [ 62 64 ], but few studies have used them to elucidate SMT mechanisms [ 65 ]. A mediator is a variable measured during treatment that affects (or mediates) the response to treatment [ 66 ].…”
Section: Main Textmentioning
confidence: 99%