Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review

Lavefjord, Amani; Sundström, Felicia; Buhrman, Monica; McCracken, Lance M.

doi:10.1016/j.jcbs.2021.05.005

Cited by 12 publications

(11 citation statements)

References 85 publications

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“…88 Such methods are increasingly used in chronic pain studies 88 but we know from a recent scoping review that EMA is rarely if ever used in treatment outcome studies of psychological treatments for chronic pain so far. 89 These methods are particularly well suited to examining individual processes of change in treatment.…”

Section: Future Developmentsmentioning

confidence: 99%

“…Such methods are more direct in time and situation, can obtain finer grained data that show patterns over time, can be sensitive to context, and avoid biases, such as recall bias, that plague conventional self-report measures 88. Such methods are increasingly used in chronic pain studies88 but we know from a recent scoping review that EMA is rarely if ever used in treatment outcome studies of psychological treatments for chronic pain so far 89. These methods are particularly well suited to examining individual processes of change in treatment.…”

Section: Guidelinesmentioning

confidence: 99%

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New generation psychological treatments in chronic pain

McCracken

Vowles

2022

BMJ

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Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called “third wave” CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.

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Section: Future Developmentsmentioning

confidence: 99%

Section: Guidelinesmentioning

confidence: 99%

New generation psychological treatments in chronic pain

McCracken

Vowles

2022

BMJ

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“…Moreover, generalizability and replicability may be hampered by the single-item measures used. At present, little consensus exists with respect to measurement in SCEDs, which impedes the comparison and generalizability of findings [ 51 ]. As such, SCEDs may study the same or similar outcomes using different measures of outcomes, hampering the generalizability and synthesis of findings.…”

Section: Discussionmentioning

confidence: 99%

“…The present study employed a single-case experimental design (SCED) wherein each participant is treated as an individual study. In doing this, SCEDs provide evidence of the effectiveness of interventions, drawing on substantially fewer participants than nomothetic approaches (such as RCTs) [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. The specific SCED employed was randomized multiple baseline designs with the temporal staggering and randomized onset of intervention.…”

Section: Methodsmentioning

confidence: 99%

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies

Lavelle

Storan

Murthy

et al. 2022

JCM

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Psychological intervention targeting distress is now considered an integral component of inflammatory bowel disease (IBD) management. However, significant barriers to access exist which necessitate the development of effective, economic, and accessible brief and remote interventions. Acceptance and commitment therapy (ACT) is a therapy with demonstrated acceptability and a growing evidence base for the treatment of distress in IBD populations. The present paper trialled two brief ACT interventions via randomized multiple baseline designs. Study 1 trialled a single-session ACT intervention (delivered face-to-face and lasting approximately two hours) targeting stress and experiential avoidance, respectively. Participants were seven people with an IBD diagnosis who presented with moderate to extremely severe stress (five females, two males; M age = 39.57, SD = 5.74). The findings of study 1 indicate that a single-session ACT intervention represented an insufficient dosage to reduce stress and experiential avoidance. Study 2 investigated a brief telehealth ACT intervention (delivered via a video conferencing platform and lasting approximately four hours) targeting stress and increased psychological flexibility. Participants (N = 12 people with an IBD diagnosis and mild to extremely severe stress) completed baselines lasting from 21 to 66 days before receiving a two-session ACT telehealth intervention supplemented by a workbook and phone consultation. Approximately half of participants experienced reduced stress, increased engagement in valued action, and increased functioning. Despite shortcomings such as missing data and the context of COVID-19, the present findings suggest that brief ACT interventions in this population may be effective and economic, though further research and replications are necessary.

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“…The optimisation studies implement a sequential replicated and randomised SCED to gain detailed insight into within-person behavioural changes, and to develop and test the DAHLIA intervention, which has been recommended in the context of CP. 55 In SCEDs, each case functions as their own control and changes are evaluated comparing levels of the outcome variables across different phases (eg, baseline phase ‘A’ and treatment phase ‘B’). 56 The methodology aims to demonstrate cause–effect relationships between the treatment (independent variable) and the target behaviour (dependent variable).…”

Section: Methods and Analysismentioning

confidence: 99%

Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project

et al. 2022

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IntroductionChronic pain affects about 20%–40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.Methods and analysisThe project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4–6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.Ethics and disseminationThe study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.Trial registration numberNCT05066087.

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Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review

Cited by 12 publications

References 85 publications

New generation psychological treatments in chronic pain

New generation psychological treatments in chronic pain

Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies

Development, evaluation and implementation of a digital behavioural health treatment for chronic pain: study protocol of the multiphase DAHLIA project

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