Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review

Abstract

In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.

A theoretically guided approach to identifying predictors of treatment outcome in Contextual Cognitive Behavioural Therapy for chronic pain

“…The PHQ‐9 has been well validated within chronic health condition populations (Kroenke et al., ) and has been shown to be able to distinguish between those with and without a depressive disorder in older adults with chronic health conditions (Lamers et al., ). The reason that a specific depression measure was included in addition to the mental health subscale of the SF‐36 was that our recent systematic review of contextual CBT for chronic pain (Gilpin et al., ) specifically highlighted depression as a potentially important predictor of outcome. We therefore planned to investigate baseline depression as a predictor in our study and selected a specific depression measure (the PHQ‐9) so that this could be investigated as a predictor of more general mental health outcomes (as measured by the mental health subscale of the SF‐36).…”

“…As we have previously recommended (Gilpin et al., ), the selection of potential predictors to include in the model was based on the key processes of the psychological flexibility model and therefore included baseline scores on the CFQ, CAQ, AAQ‐II, CPAQ and the decentring subscale of the EQ. The model also included other demographic or pain‐related variables considered potentially relevant.…”

“…Methods for identifying predictors of psychological treatment outcomes in chronic pain have been limited in a number of ways, including assuming linear relations with treatment effects, dichotomizing continuous variables using cut points and/or investigating the role of single factors considered alone (e.g., Altman & Royston, ; Royston, Altman, & Sauerbrei, ; Sauerbrei & Royston, ; Turk, ; Turk & Rudy, ). We have recently proposed that a further fundamental difficulty in the search for meaningful predictors may be the lack of theoretical grounding in the selection of potential predictors, or moderators, of treatment outcome (Gilpin, Keyes, Stahl, Greig, & McCracken, ). A moderator is a variable that affects the strength of the relationship between a treatment type and clinical outcome.…”

Current status of acceptance and commitment therapy for chronic pain: a narrative review

“…As the only systematic review for predictors in contextual cognitive and behavioral therapies for chronic pain show, important methodological limitations exist in this area of research, and for most predictors the evidence is inconclusive because of the small number of studies investigating each predictor or inconsistent findings between several studies. 72 Thus, only limited progress has been made in understanding which specific patient-level characteristics make someone with chronic pain a particularly good or poor candidate for ACT. Optimistically, ACT benefits diverse chronic pain patients across a range of sociodemographic factors, and at least in one study, ACT outperforms CBT for older adults.…”

Psychological approaches to chronic pain management: where are we coming from and where might we go?

“…While there were early attempts to identify subgroups of people with chronic pain who might respond differentially to interdisciplinary treatments (8,9), research in this area has not advanced as far as we could have hoped in the intervening years. In fact, findings of a lack of significant moderators or predictors of treatment outcome, or the identification of only weak or inconsistent ones, seems the norm in the many studies that have attempted to address this treatment matching problem (10)(11)(12). Of course one strategy for producing better treatment effects, that are more lasting, for more people, is to address this question of "what works for whom?"…”