Treatment mechanism and outcome decoupling effects in cognitive therapy, mindfulness-based stress reduction, and behavior therapy for chronic pain.
Study Goal
The researchers aimed to determine whether cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain improve outcomes by altering or decoupling the relationship between treatment mechanisms and pain-related outcomes over time.
Results Summary
The study found that associations between treatment mechanism variables and outcomes weakened over time, becoming nonsignificant by the last third of treatment, suggesting participants learned to decouple maladaptive pain-related thoughts from their pain experience. These effects were consistent across CT, MBSR, and BT but not observed in treatment as usual (TAU).
Population
Adults with chronic low back pain (N = 521).
Effective Dosage
Eight individual sessions (weekly frequency implied).
Duration
Eight weeks (weekly assessments).
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
cognitive therapy (CT) | decrease | chronic pain | people with chronic low back pain | - | produce improvements | #1 |
mindfulness-based stress reduction (MBSR) | decrease | chronic pain | people with chronic low back pain | - | produce improvements | #2 |
behavior therapy (BT) | decrease | chronic pain | people with chronic low back pain | - | produce improvements | #3 |
cognitive therapy (CT) | increase | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables were strong and significant | #4 |
mindfulness-based stress reduction (MBSR) | increase | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables were strong and significant | #5 |
behavior therapy (BT) | increase | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables were strong and significant | #6 |
cognitive therapy (CT) | decrease | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables weakened over time and became nonsignificant | #7 |
mindfulness-based stress reduction (MBSR) | decrease | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables weakened over time and became nonsignificant | #8 |
behavior therapy (BT) | decrease | associations between mechanism and outcome variables | people with chronic low back pain | - | associations between mechanism and outcome variables weakened over time and became nonsignificant | #9 |
treatment as usual (TAU) | no change | associations between mechanism and outcome variables | people with chronic low back pain | - | effects did not emerge | #10 |
cognitive therapy (CT) | decrease | links between changes in treatment mechanism variables and subsequent changes in outcomes | people with chronic low back pain | - | links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes | #11 |
mindfulness-based stress reduction (MBSR) | decrease | links between changes in treatment mechanism variables and subsequent changes in outcomes | people with chronic low back pain | - | links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes | #12 |
behavior therapy (BT) | decrease | links between changes in treatment mechanism variables and subsequent changes in outcomes | people with chronic low back pain | - | links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes | #13 |
Findings suggest that cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain produce improvements through changes in putative mechanisms. Evidence supporting this notion is largely based on findings showing significant associations between treatment mechanism variables and outcomes. An alternative view is that treatments may work by reducing or decoupling the impact of changes in mechanism variables on changes in outcomes. We examined the degree to which relationships between previous changes in potential treatment mechanisms and subsequent changes in outcomes changed as treatment progressed and vice versa. Cognitive therapy, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of putative treatment mechanisms and outcomes. Lagged analyses revealed mechanism × session number interactions and outcome × session number interactions, such that associations between mechanism and outcome variables were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. These effects were similar across treatment conditions but did not emerge among people undergoing TAU. Results suggest that during the course of CT, MBSR, and BT, the links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes and vice versa. Thus, starting by midtreatment and continuing into late treatment, participants may have learned through participation in the treatments that episodes of maladaptive pain-related thoughts and/or spikes in pain need not have detrimental consequences on their subsequent experience.