Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: randomized controlled trial.
Study Goal
The researchers aimed to compare the relative efficacies of cognitive therapy (CT), mindfulness-based stress reduction (MBSR), behavior therapy (BT), and treatment as usual (TAU) in improving pain, physical function, mood, and sleep disturbance in people with chronic low back pain.
Results Summary
The study found that CT, MBSR, and BT produced similar pretreatment to posttreatment improvements in all outcomes, with comparable maintenance of gains at 6-month follow-up. All three active treatments outperformed TAU, with significant differences emerging by session 6.
Population
Adults with chronic low back pain (N = 521).
Effective Dosage
Eight individual sessions (frequency not specified).
Duration
8 weeks (assuming weekly sessions).
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
cognitive therapy (CT) | decrease | pain | people with chronic pain conditions | - | produce reductions | #1 |
cognitive therapy (CT) | increase | physical function | people with chronic pain conditions | - | improvements | #2 |
cognitive therapy (CT) | increase | mood | people with chronic pain conditions | - | improvements | #3 |
cognitive therapy (CT) | increase | sleep disturbance | people with chronic pain conditions | - | improvements | #4 |
mindfulness-based stress reduction (MBSR) | decrease | pain | people with chronic pain conditions | - | produce reductions | #5 |
mindfulness-based stress reduction (MBSR) | increase | physical function | people with chronic pain conditions | - | improvements | #6 |
mindfulness-based stress reduction (MBSR) | increase | mood | people with chronic pain conditions | - | improvements | #7 |
mindfulness-based stress reduction (MBSR) | increase | sleep disturbance | people with chronic pain conditions | - | improvements | #8 |
behavior therapy (BT) | decrease | pain | people with chronic pain conditions | - | produce reductions | #9 |
behavior therapy (BT) | increase | physical function | people with chronic pain conditions | - | improvements | #10 |
behavior therapy (BT) | increase | mood | people with chronic pain conditions | - | improvements | #11 |
behavior therapy (BT) | increase | sleep disturbance | people with chronic pain conditions | - | improvements | #12 |
cognitive therapy (CT) | no change | all outcomes | people with chronic low back pain | - | produced similar pretreatment to posttreatment effects | #13 |
mindfulness-based stress reduction (MBSR) | no change | all outcomes | people with chronic low back pain | - | produced similar pretreatment to posttreatment effects | #14 |
behavior therapy (BT) | no change | all outcomes | people with chronic low back pain | - | produced similar pretreatment to posttreatment effects | #15 |
cognitive therapy (CT) | no change | treatment gains | people with chronic low back pain | - | revealed similar levels of maintenance of treatment gains | #16 |
mindfulness-based stress reduction (MBSR) | no change | treatment gains | people with chronic low back pain | - | revealed similar levels of maintenance of treatment gains | #17 |
behavior therapy (BT) | no change | treatment gains | people with chronic low back pain | - | revealed similar levels of maintenance of treatment gains | #18 |
cognitive therapy (CT) | increase | outcomes | people with chronic low back pain | - | produced greater improvements | #19 |
mindfulness-based stress reduction (MBSR) | increase | outcomes | people with chronic low back pain | - | produced greater improvements | #20 |
behavior therapy (BT) | increase | outcomes | people with chronic low back pain | - | produced greater improvements | #21 |
cognitive therapy (CT) | increase | outcomes | people with chronic low back pain | by session 6 | differed significantly | #22 |
mindfulness-based stress reduction (MBSR) | increase | outcomes | people with chronic low back pain | by session 6 | differed significantly | #23 |
behavior therapy (BT) | increase | outcomes | people with chronic low back pain | by session 6 | differed significantly | #24 |
Trials of cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) suggest that all 3 treatments produce reductions in pain and improvements in physical function, mood, and sleep disturbance in people with chronic pain conditions. Fewer studies have compared the relative efficacies of these treatments. In this randomized controlled study, we compared CT, MBSR, BT, and treatment as usual (TAU) in a sample of people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of outcomes. Consistent with the prior work, we found that CT, MBSR, and BT produced similar pretreatment to posttreatment effects on all outcomes and revealed similar levels of maintenance of treatment gains at 6-month follow-up. All 3 active treatments produced greater improvements than TAU. Weekly assessments allowed us to assess rates of change; ie, how quickly a given treatment produced significant differences, compared with TAU, on a given outcome. The 3 treatments differed significantly from TAU on average by session 6, and this rate of treatment effect was consistent across all treatments. Results suggest the possibility that the specific techniques included in CT, MBSR, and BT may be less important for producing benefits than people participating in any techniques rooted in these evidence-based psychosocial treatments for chronic pain.