Predictors of adherence to an internet-based cognitive behavioral therapy program for individuals with chronic pain and comorbid psychological distress

Abstract Background The burden caused by chronic pain is significant, affecting at least 10 percent of the world´s population. While internet-based treatments based on cognitive behavioral therapy (CBT) have been shown to be promising in this area, attrition levels vary significantly. The purpose of this study was to investigate predictor variables for participants’ adherence to an internet-based CBT treatment for individuals with chronic pain as well as to investigate associations between adherence and treatment outcome. Methods Data for this study was retrieved from a randomized controlled trial including 95 individuals with chronic pain who received internet-based CBT. Treatment adherence was studied through three outcome variables: treatment progress, treatment completion and exercise completion. The predictor variables were grouped into four clusters: background variables (age, gender, marital status, level of education, and typical computer usage); the second cluster included health status variables (sick leave, current psychiatric diagnosis, previous psychotherapy for pain, current pharmacological treatment, previous depression, current depression, and current depressive symptoms); the third cluster included pain-related variables (opioid medication, history of pain, and pain symptoms) and the fourth cluster included motivation variables (measured with treatment preference, treatment credibility, compliance to the treatment schedule and contact with the therapists). Results Findings showed that treatment progress was predicted by higher treatment credibility at baseline, whereas participants who were behind schedule in the second week of the program finished fewer treatment modules. When analyzing each cluster of predictor variables separately, current depressive symptoms also predicted fewer completed treatment modules. Among the pain-related variables, higher pain acceptance was the only predictor for completing more treatment modules. Treatment completion (which in this study was defined as having completed at least 75% of treatment modules) was predicted by higher treatment credibility and fewer depressive symptoms at baseline, and was thus similar to the results regarding treatment progress. Finally, all adherence variables predicted the treatment outcome pain interference. Conclusions Low treatment credibility, depressive symptoms and falling behind the treatment schedule early on were the most important predictor variables for low treatment adherence, while a number of demographical and pain-related variables were not related to adherence. The results from this study may help clinicians identify patients who are less likely to complete, and thus benefit from, their pain treatment. Trial registration ClinicalTrials.gov NTC03316846.

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The Effects of Pre-treatment Depressive Symptoms on Quality of Life Across Cognitive Behavioral Therapy for Chronic Pain

Journal of Clinical Psychology in Medical Settings ◽

10.1007/s10880-018-9568-5 ◽

2018 ◽

Vol 26 (1) ◽

pp. 97-105 ◽

Cited By ~ 3

Author(s):

Justin M. Hughes ◽

Eric A. Seemann ◽

J. Michael George ◽

K. Dean Willis

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Pre Treatment

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Peer-delivered Cognitive Behavioral Therapy-based Intervention Reduced Depression and Stress in Community Dwelling Adults With Diabetes and Chronic Pain: A Cluster Randomized Trial

Annals of Behavioral Medicine ◽

10.1093/abm/kaab034 ◽

2021 ◽

Author(s):

Susan J Andreae ◽

Lynn J Andreae ◽

Joshua S Richman ◽

Andrea L Cherrington ◽

Monika M Safford

Keyword(s):

Chronic Pain ◽

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Perceived Stress ◽

Behavioral Therapy ◽

Controlled Trial ◽

Community Dwelling ◽

Cognitive Behavioral ◽

Community Members ◽

Cluster Randomized

Abstract Background Finding effective, accessible treatment options such as professional-delivered cognitive behavioral therapy (CBT) for medically complex individuals is challenging in rural communities. Purpose We examined whether a CBT-based program intended to increase physical activity despite chronic pain in patients with diabetes delivered by community members trained as peer coaches also improved depressive symptoms and perceived stress. Methods Participants in a cluster-randomized controlled trial received a 3-month telephonic lifestyle modification program with integrated CBT elements. Peer coaches assisted participants in developing skills related to adaptive coping, diabetes self-management goal-setting, stress reduction, and cognitive restructuring. Attention controls received general health advice with an equal number of contacts but no CBT elements. Depressive symptoms and stress were assessed using the Centers for Epidemiologic Studies Depression and Perceived Stress scales. Assessments occurred at baseline, 3 months, and 1 year. Results Of 177 participants with follow-up data, 96% were African Americans, 79% women, and 74% reported annual income <$20,000. There was a significant reduction in perceived stress in intervention compared to control participants at 3-months (β = −2.79, p = .002 [95% CI −4.52, −1.07]) and 1 year (β = −2.59, p < .0001 [95% CI −3.30, −1.87]). Similarly, intervention participants reported significant decreases in depressive symptoms at 3-months (β = −2.48, p < .0001 [95% CI −2.48, −2.02]) and at 1 year (β = −1.62, p < .0001 [95% CI −2.37, −0.86]). Conclusions This peer-delivered CBT-based program improved depressive symptoms and stress in individuals with diabetes and chronic pain. Training community members may be a feasible strategy for offering CBT-based interventions in rural and under-resourced communities. Clinical Trial Registration NCT02538055.

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