title: Intersession coping skill practice mediates the relationship between readiness for self-management treatment and goal accomplishment.
abstract: Underlying pain self-management treatments is the expectation that patients must adhere to coping skill practice recommendations to obtain treatment benefits. Recently, a model of motivation for pain treatment has proposed that patients' readiness to adopt a self-management approach serves as a predictor of active participation in treatment, and ultimately, of improved outcomes. This study compared the ability of pain readiness to change, as measured by the Pain Stages of Change Questionnaire (PSOCQ), and self-efficacy (SE) ratings, to predict adherence and goal accomplishment in cognitive-behavioral therapy (CBT) for chronic pain. Further analyses tested the hypothesis that adherence mediated the relationship between readiness to change and goal accomplishment. Data were collected as part of a larger randomized controlled trial of primary care based CBT. Participants were 78 patients recruited from a VA primary care clinic. At pre-treatment Ss completed the PSOCQ to assess readiness to adopt a self-management approach to chronic pain and an SE measure to quantify certainty of achieving up to five behavioral treatment goals. Criteria were means of aggregated intersession adherence ratings and mean post-treatment goal accomplishment ratings. Pre-treatment PSOCQ variables significantly predicted intersession adherence and goal accomplishment. SE did not significantly predict either criterion. The statistical relationship between pre-treatment PSOCQ and behavioral goal accomplishment was significantly attenuated when intersession adherence was taken into account. These data provide support for a motivational model of pain treatment that asserts adherence to therapist recommendations for coping skill practice mediates readiness to change and self-reported goal attainments.
authors.affiliation: VA Connecticut Healthcare System, Psychology Service (116B), 950 Campbell Avenue, West Haven, CT 06516, USA Yale University School of Medicine, West Haven, CT, USA VA Boston Healthcare System and Boston University, Boston, MA, USA Cardinal Health, Philadelphia, PA, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Heapy
authors.forename: John
authors.initials: J
authors.lastname: Otis
authors.forename: Kelly Stein
authors.initials: KS
authors.lastname: Marcus
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Frantsve
authors.forename: Amy E
authors.initials: AE
authors.lastname: Janke
authors.forename: Marc
authors.initials: M
authors.lastname: Shulman
authors.forename: Wendy
authors.initials: W
authors.lastname: Bellmore
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management; D010147:Pain Measurement; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome