A National Survey of Patient Completion of Cognitive Behavioral Therapy for Chronic Pain: The Role of Therapist Characteristics, Attempt Rates, and Modification

The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). The present study explores therapists' decisions to offer a particular evidence-based psychotherapy (Cognitive-behavioral therapy for chronic pain [CBT-CP]), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (M = 48.8%, SD = 35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t(111) = 4.57, p < .001. Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion. Public Significance Statement Trained therapists reported attempting evidence-based psychotherapy for chronic pain with less than half of their eligible patients. Therapists outside specialty pain clinics and those with higher reported percentages of patients with whom they attempt the therapy reported lower dropout rates. These findings indicate trained therapists should offer information about evidence-based psychotherapies more frequently and engage patients in treatment decisions.