title: Cognitive factors influence outcome following multidisciplinary chronic pain treatment: a replication and extension of a cross-lagged panel analysis.
abstract: Reducing maladaptive cognitions is hypothesized to constitute an active therapeutic process in multidisciplinary pain programs featuring cognitive-behavioral interventions. A cross-lagged panel design was used to determine whether: a) early-treatment cognitive changes predicted late-treatment pain, interference, activity and mood changes, but not vice versa; b) three cognitive factors made unique contributions to outcome; c) substantial cognitive changes preceded substantial improvements in outcome. Sixty-five chronic pain patients, participating in a 4-week multidisciplinary program, completed measures of pain helplessness, catastrophizing, pain-related anxiety (process factors), pain severity, interference, activity level and depression (outcomes) at pre-, mid- and posttreatment. Results showed that early-treatment reductions in pain helplessness predicted late-treatment decreases in pain and interference, but not vice versa, and that early-treatment reductions in catastrophizing and pain-related anxiety predicted late-treatment improvements in pain severity, but not vice versa. Findings suggested that the three process factors predicted improvements mostly in common. However, little evidence was found that large early-treatment reductions in process variables preceded extensive improvements in pain. Findings replicate those of a recent report regarding cross-lagged effects, and offer support that cognitive changes may indeed influence late-treatment changes in outcomes.
authors.affiliation: Finch University of Health Sciences, The Chicago Medical School, Psychology Department, Building 51, 3333 Green Bay Road, Chicago, IL 60064, USA. burnsj@finchcms.edu
authors.forename: J W
authors.initials: JW
authors.lastname: Burns
authors.forename: B
authors.initials: B
authors.lastname: Glenn
authors.forename: S
authors.initials: S
authors.lastname: Bruehl
authors.forename: R N
authors.initials: RN
authors.lastname: Harden
authors.forename: K
authors.initials: K
authors.lastname: Lofland
mesh_terms: D000704:Analysis of Variance; D001007:Anxiety / Q000209:etiology; D001294:Attitude to Health; D002908:Chronic Disease; D003072:Cognition Disorders / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology; D059408:Pain Management; D012044:Regression Analysis; D016896:Treatment Outcome