Objective: To examine the relative validity of two conceptual models - Specific, General - by which therapeutic mechanisms in cognitive-behavioral therapy (CBT) for chronic pain achieve favorable outcomes.
Methods: As part of a clinical trial of enhanced versus standard CBT, people with chronic pain received treatment consisting of three pain coping skill modules. In secondary analyses of a subsample (n=56), we examined pre-treatment to Session 4 (out of 10 sessions) changes in Chronic Pain Coping Inventory subscales that corresponded to receipt of one of three modules; namely Relaxation, Exercise, and Cognitive Coping modules.
Results: Findings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes.
Discussion: Change with CBT may occur both by theory-specified mechanisms and general mechanisms. However, the results provide the most support for a General Mechanism model in which changes on coping skills have spreading effects on the use of other coping skills. Significant relationships between some skill changes and indexes of patient-therapist working alliance and outcome expectations suggest that non-specific factors also play a role in treatment-related changes in the use of pain coping strategies.
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