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Brief Cognitive Behavioral Therapy For Chronic Pain

Results From a Clinical Demonstration Project in Primary Care Behavioral Health

Beehler, Gregory P. MA, PhD*,†; Murphy, Jennifer L. PhD‡,§; King, Paul R. PhD*,∥; Dollar, Katherine M. PhD; Kearney, Lisa K. PhD, ABPP¶,#; Haslam, Aaron PhD**; Wade, Michael MS; Goldstein, Wade R. MA*

doi: 10.1097/AJP.0000000000000747
Original Articles
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Objectives: Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care.

Methods: A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes.

Results: One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen’s d=0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen’s d=0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes.

Discussion: These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.

*VA Center for Integrated Healthcare, VA Western New York Healthcare System

School of Public Health and Health Professions

Department of Counseling, School, and Educational Psychology, University at Buffalo, The State University of New York, Buffalo

VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY

James A. Haley Veterans’ Hospital

§Department of Neurology, University of South Florida College of Medicine, Tampa, FL

#Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX

**Albuquerque VA Medical Center, Albuquerque, NM

This material is the result of work supported with resources and the use of facilities at the VA Center for Integrated Healthcare at the VA Western New York Healthcare System, Buffalo, NY. The information provided in this study does not represent the views of the Department of Veterans Affairs or the United States Government. The authors declare no conflict of interest.

Reprints: Gregory P. Beehler, MA, PhD, VA Center for Integrated Healthcare (116N), VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215 (e-mail: gregory.beehler@va.gov).

Received January 22, 2019

Received in revised form June 26, 2019

Accepted July 2, 2019

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