Evaluation and implementation of graded in vivo exposure for chronic low back pain in a German outpatient setting: a study protocol of a randomized controlled trial

Riecke, Jenny; Holzapfel, Sebastian; Rief, Winfried; Glombiewski, Julia Anna

doi:10.1186/1745-6215-14-203

Cited by 20 publications

(17 citation statements)

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“…Modifying patients’ expectations through exposure to expectation-violating situations has been discussed as a promising approach in the treatment of anxiety disorders (Craske et al, 2014; Craske, 2015), obsessive compulsive disorders (Craske et al, 2014), and chronic pain (Riecke et al, 2013). We believe that impeding immunization processes (as discussed for MDD in this article) might also be an important mechanism of change in these disorders.…”

Section: Discussionmentioning

confidence: 99%

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

2017

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In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.

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Section: Discussionmentioning

confidence: 99%

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

2017

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“…Several primary and secondary outcomes were assessed at pretreatment (Pre), mid-treatment (Mid), post-treatment (Post) and 6-months follow-up (6 MFU). The treatment methods are specified in the study protocol (Riecke, Holzapfel, Rief, & Glombiewski, 2013) or in the article describing the study's main results (Glombiewski et al, 2018). Concerning primary outcomes, both treatments were effective in reducing disability from Pre-Post and Pre-6 MFU with large effect sizes in both Exposure conditions and with moderate-to-large effect sizes in the CBT condition.…”

Section: Methodsmentioning

confidence: 99%

Exposure and cognitive‐behavioural therapy for chronic back pain: An RCT on treatment processes

Schemer

Schröeder

Ørnbøl

et al. 2018

European Journal of Pain

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Background To improve treatment outcomes, it is essential to understand the processes involved in therapeutic change. The aim of this study was to investigate the processes involved in treatment of individuals with chronic lower back pain (CLBP) and high fear‐avoidance. Graded in vivo exposure (Exposure), a specific treatment, and cognitive‐behavioural therapy (CBT), a general treatment, were compared. Methods Our study used data from a three‐arm randomized controlled trial. The sample comprised 61 CLBP patients (pain duration >3 months; sufficient level of fear‐avoidance). Assessments of session‐by‐session processes were done weekly for a maximum 14 weeks. The primary outcome, functional disability, was assessed at pre‐treatment, post‐treatment and 6‐months follow‐up. First, two‐level models were used to test for treatment‐related similarities and differences in the changes in session‐by‐session measures (i.e., common and unique treatment processes respectively). Second, we analysed treatment processes as predictors of treatment outcome. Results Contrary to our expectations, we found no evidence of unique treatment processes. Our results indicate that Exposure and CBT share some treatment processes. Specifically, patients reported a reduction in fear of movement and improvements in their ability to relax, to distract themselves, to manage their pain, to confront feared movements, to be active and to enjoy things despite their pain. Changes in fear of movement, relaxation, distraction, confrontation, activity and pain‐related self‐efficacy were also related to disability reduction. Conclusions Despite conceptual differences, Exposure and CBT may share common treatment processes. Future research needs to address, however, whether these processes need to be targeted directly or can be supported indirectly. Significance We identified several treatment processes (e.g., reduction of fear of movement, enhancement of self‐efficacy), which were associated with disability reduction during the management of chronic pain and fear‐avoidance. These processes appeared to be equally important for Exposure and CBT. Practitioners should optimize these processes to improve their patients’ functioning.

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“…Interestingly, one recent study, which utilized a daily diary method to examine changes in pain-related fear during graded exposure treatment, observed a 50% decrease in post-treatment fear of pain and movement, as well as reduced long-term self-reported disability [35]. Additional RCTs are currently underway to test the efficacy of varying durations of graded exposure [36], treatments designed to facilitate progressive goal achievement of goals [37], and post-operative CBT for reducing pain-related fear and disability [38]. …”

Section: Pain-related Fear As a Target For Pain Treatmentmentioning

confidence: 99%

Pain-related fear, disability, and the fear-avoidance model of chronic pain

Zale

Ditre

2015

Current Opinion in Psychology

126

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Chronic pain is a significant public health concern that imposes substantial burdens on individuals and healthcare systems, and factors that contribute to the development and maintenance of pain-related disability are of increasing empirical and clinical interest. Consistent with the fear-avoidance model of chronic pain, greater pain-related fear has consistently been associated with more severe disability and may predict the progression of disability over time. Recent evidence indicates that treatments designed to reduce pain-related fear are efficacious for improving disability outcomes, and several clinical trials are currently underway to test tailored intervention content and methods of dissemination. Future research in this area is needed to identify factors (e.g., substance use, comorbid psychopathology) that may influence interrelations between pain-related fear, response to treatment, and disability.

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Evaluation and implementation of graded in vivo exposure for chronic low back pain in a German outpatient setting: a study protocol of a randomized controlled trial

Cited by 20 publications

References 46 publications

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

Exposure and cognitive‐behavioural therapy for chronic back pain: An RCT on treatment processes

Pain-related fear, disability, and the fear-avoidance model of chronic pain

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