Patient Education Based on Principles of Cognitive Behavioral Therapy for a Patient With Persistent Low Back Pain: A Case Report

Abstract

feelings, and behaviors. [2][3][4][5]15,16,28,[46][47][48] It also indicates that relationships are dynamic. 3,4,15,16,[46][47][48] Therefore, relationships characterized by problematic behaviors and emotions are modifiable by mitigating dysfunctional thought patterns through directed, systematic, and goal-oriented treatments. 6,15,16 Typically, CBT involves self-reflection of thought processes on the part of a patient that is partially guided by analysis of a patient's thinking by a clinician.This evaluative process is necessary to identify hypothetical cause-andeffect relationships between cognition and problems of behavior and emotion. The evaluation is followed by specific, problem-focused, psycho-educational interventions directed toward the dysfunctional thinking patterns that are identified. Psycho-educational interventions are provided within and between treatment sessions. One common intervention to improve carryover between sessions is cognitive homework, which is intended to continue to facilitate the development of adaptive thought processes in the absence of a clinician. 6,39 CBT also has been identified as an effective intervention for patients with disablement due to persistent musculoskeletal symptoms such as pain. 13,14,39,40 C ognitive-behavioral therapy (CBT) refers to a number of patient-counseling strategies that are intended to change dysfunctional thoughts, feelings, and behaviors. 38,52,53 Although there are many forms of CBT strategies and interventions ( TaBLE 1), all are characterized by a joint theoretical basis in behaviorism and cognitive psychology. This theoretical foundation predicts clinically recognizable interrelationships between thoughts, t STUdY dESIGn: Case report.t BaCKGroUnd: Cognitive behavioral therapy (CBT) is an effective intervention for patients with persistent pain. Recent research indicates that physical therapists self-perceive a lack of knowledge, skills, and time to provide this intervention. The purpose of this case report is to describe how specific CBT strategies can be integrated with multimodal physical therapist management of a patient with persistent low back pain.t CaSE dESCrIpTIon: The patient was a 70-year-old female with activity limitations of walking, standing, and forward bending. Oswestry Disability Questionnaire score was 19/50 and Fear-Avoidance Belief Questionnaire physical activity subscale was 23/24. The Low Back Activity Confidence Scale revealed 19%, 100%, and 84% for function, symptom self-regulation, and exercise, respectively. CBT-based patient education was provided in combination with manual therapy and exercise. CBT techniques included cognitive restructuring, goal setting, activity pacing, problem-solving strategies, graded exposure, encouraging exposure to pleasant experiences, and maintenance strategies.t oUTCoMES: The patient was discharged after 7 visits distributed over 21 weeks. Her Oswestry Disability Questionnaire score was reduced 10% and Fear-Avoidance Belief Questionnaire physical activity subscale score reduced 48%. On ...

Factors Associated With Exercise Behavior in People With Parkinson Disease

“…[53][54][55] Cognitive-behavioral training (CBT), although promoted as a potentially useful method for helping patients overcome personal barriers to exercise, has met with limited effectiveness. [55][56][57] According to Rauch et al, "there is no evidence in how physiotherapists manage lack of confidence." 58(p249) In contrast, several studies suggest that self-management approaches targeting self-efficacy show promise for improving exercise adherence.…”

Patellofemoral Pain: Proximal, Distal, and Local Factors—2nd International Research Retreat, August 31–September 2, 2011, Ghent, Belgium

“…255 Henschke et al, 144 in a recent Cochrane Review, concluded there is moderate quality evidence that operant therapy and behavioral therapy are more effective than waiting list or usual care for short term pain relief in patients with chronic low back pain, but no specific type of behavioral therapy is superior than another. In the intermediate to long term, there is no established difference between behavioral therapy and group exercise for management of pain or depressive symptoms in patients with chronic low back pain.…”

Management of a Patient With Chronic Low Back Pain and Multiple Health Conditions Using a Pain Mechanisms–Based Classification Approach

“…17 Alternatively, pain education programs have targeted psychological factors that may be linked to elevated pain processing or a central sensitization response. 48,49,57 Discriminative validity to justify usage of a pain mechanisms-based approach has been demonstrated, 61 but evidence of its effectiveness in physical therapy outcomes is limited. 28 The purpose of this case report was to describe the management of a patient with chronic LBP and multiple health conditions using a pain mechanismsbased approach.…”

“…60 The patient was again educated on the physiology of a pain flare-up with chronic LBP. 45,57 He was also encouraged to continue exercise within tolerance.…”

“…These included cognitive restructuring, activity pacing, attention diversion, problem-solving strategies, goal setting, graded exposure, and maintenance. 57 Education on pain physiology was used initially to address cognitive restructuring of pain perception. 48,57 Given his biomechanical/motor control deficits, we discussed how activity pacing (eg, stop walking before onset of increased pain) was also important in decreasing peripheral nociception.…”