Estimating the clinical effectiveness of cognitive behavioural therapy in the clinic: Evaluation of a CBT informed pain management programme

Abstract

Randomized controlled trials and meta-analyses provide evidence for the efficacy of cognitive-behaviourally informed treatment (CBT) programmes for chronic pain. The current study aims to provide practice-based evidence for the effectiveness of CBT in routine clinical settings. Over a 10 year period 1013 pain patients were accepted into a 4 week in-patient pain management programme. Data from more than 800 patients was available at pre-treatment and at one month post-treatment and for around 600 patients at pre-treatment and at 9 months follow-up. Measures reported in this analysis were pain experience and interference, psychological distress (depression and anxiety), selfefficacy, catastrophizing, and walking. Change from pre-treatment to post-treatment and follow-up was assessed with conventional statistical tests, the computation of effect sizes and by the reliable change index (RCI) and clinically significant change (CSC) methodology. These analyses provide evidence of statistical improvement at posttreatment and follow-up and the RCI/CSC methodology suggested that between 1 in 3 and 1 in 7 (depending on the outcome measure) achieved clinically significant gains.There was also evidence that a small percentage of patients (1% -2%) reliably deteriorated during the period of treatment. The limitations in the inferences that can be drawn from this study and of the methodology are discussed. A case is made for the application of benchmarking methods using data from RCTs in order to more fully evaluate practice and to generate better quality practice based evidence.2

Tailored cognitive–behavioral therapy and exercise training for high‐risk patients with fibromyalgia

“…The effect sizes of all of the primary outcomes indicated overall relatively large posttreatment and followup effects (in most cases Ͼ0.70) for the TC and overall small effect sizes (in most cases Ͻ0.30) for the WLC for both the pain-avoidance and the pain-persistence groups (Table 2) (33). In addition, the reliable change index indicated a higher proportion of patients with clinically significant improvements on pain, fatigue, functional disability, anxiety, and negative mood scores in the TC relative to the WLC at posttreatment (Table 3) (8,35,36).…”

“…Furthermore, the mean effect sizes for the outcomes of physical and psychological functioning were calculated for each of the groups. Additionally, we calculated a reliable change index for the painavoidance and the pain-persistence groups separately to determine the percentage of patients who showed a clinically relevant improvement (reliable change Ͼ1.64; P Ͻ 0.05), and also the mean percentage for physical and psychological functioning was calculated (8,35,36).…”

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 .…”

Two Psychological Interventions Are Effective in Severely Disabled, Chronic Back Pain Patients: A Randomised Controlled Trial

“…We defined an increase of pain intensity of 30 or more percent [14,28] and answering the transition question with "little worse" or "much worse" as a change for the worse [27].…”