Skip Navigation LinksHome > Published Ahead-of-Print > Does Change Occur for the Reasons We Think It Does? A Test o...
Clinical Journal of Pain:
doi: 10.1097/AJP.0000000000000141
Original Article: PDF Only

Does Change Occur for the Reasons We Think It Does? A Test of Specific Therapeutic Operations During Cognitive-Behavioral Treatment of Chronic Pain.

Burns, John W. PhD; Nielson, Warren R. PhD; Jensen, Mark P. PhD; Heapy, Alicia PhD; Czlapinski, Rebecca MA; Kerns, Robert D. PhD

Published Ahead-of-Print
Collapse Box


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.

Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.