Cognitive Therapy, Mindfulness Based Stress Reduction, and Behavior Therapy for the Treatment of Chronic Pain: Predictors and Moderators of Treatment Response

Psychosocial interventions for people with chronic pain produce significant improvements in outcomes, but these effects on average are modest with much variability in the benefits conferred on individuals. To enhance the magnitude of treatment effects, characteristics of people that might predict the degree to which they respond more or less well could be identified. People with chronic low back pain (N=521) participated in a randomized controlled trial which compared cognitive therapy (CT), mindfulness-based stress reduction (MBSR), behavior therapy (BT) and treatment as usual (TAU). Hypotheses regarding predictors and/or moderators were based on the Limit, Activate, and Enhance (LA&E) model; developed to predict and explain moderators/predictors of psychosocial pain treatments. Results were: (1) low levels of cognitive/behavioral function at pre-treatment predicted favorable pre- to post-treatment outcomes; (2) favorable expectations of benefit from treatment and sound working alliances predicted favorable pre- to post-treatment outcomes; (3) women benefited more than men. These effects emerged without regard to treatment condition. Of note, high levels of cognitive/behavioral function at pre-treatment predicted favorable outcomes only for people in the TAU condition. Analyses identified a set of psychosocial variables that may act as treatment predictors across CT, MBSR and BT, as hypothesized by the LA&E model if these three treatments operate via similar mechanisms. Findings point toward people who may and who may not benefit fully from the three psychosocial treatments studied here, and so may guide future research on matching people to these kinds of psychosocial approaches or to other (e.g., forced-based interventions) non-psychosocial approaches.