title: Can we improve cognitive-behavioral therapy for chronic back pain treatment engagement and adherence? A controlled trial of tailored versus standard therapy.
abstract: OBJECTIVE
  This study evaluated whether tailored cognitive-behavioral therapy (TCBT) that incorporated preferences for learning specific cognitive and/or behavioral skills and used motivational enhancement strategies would improve treatment engagement and participation compared with standard CBT (SCBT). We hypothesized that participants receiving TCBT would show a lower dropout rate, attend more sessions, and report more frequent intersession pain coping skill practice than those receiving SCBT. We also hypothesized that indices of engagement and adherence would correlate with pre- to posttreatment changes in outcome factors.
  
  
  METHODS
  One hundred twenty-eight of 161 consenting persons with chronic back pain who completed baseline measures were allocated to either TCBT or SCBT using a modified randomization procedure. Participants completed daily ratings of pain coping skill practice and goal accomplishment during treatment, as well as measures of pain severity, disability, and other key outcomes at the end of treatment.
  
  
  RESULTS
  No significant differences between treatment groups were noted on measures of treatment engagement or adherence. However, these factors were significantly related to some pre- to posttreatment improvements in outcomes, regardless of treatment condition.
  
  
  CONCLUSIONS
  Participants in this study evidenced a high degree of participation and adherence, but treatment tailored to take into account participant preferences, and that employed motivational enhancement strategies, failed to increase treatment participation over and above SCBT for chronic back pain. Evidence that participation and adherence were associated with positive outcomes supports continued clinical and research efforts focusing on these therapeutic processes.
authors.affiliation: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.affiliation: Psychology Service, Northport VA Medical Center.
authors.forename: Marc
authors.initials: M
authors.lastname: Shulman
authors.affiliation: Department of Rehabilitation Medicine, University of Washington.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.affiliation: Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care London.
authors.forename: Warren R
authors.initials: WR
authors.lastname: Nielson
authors.affiliation: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Czlapinski
authors.affiliation: Physical Medicine and Rehabilitation Service, VA Connecticut Healthcare System.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Dallas
authors.affiliation: Department of Psychology, University of Michigan-Dearborn.
authors.forename: David
authors.initials: D
authors.lastname: Chatkoff
authors.affiliation: Psychology Service, VA Connecticut Healthcare System.
authors.forename: John
authors.initials: J
authors.lastname: Sellinger
authors.affiliation: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System.
authors.forename: Alicia
authors.initials: A
authors.lastname: Heapy
authors.affiliation: Pain Research, Informatics, Multimorbidities and Education (PRIME) Center/Research Service, VA Connecticut Healthcare System.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rosenberger
mesh_terms: D000223:Adaptation, Psychological; D000704:Analysis of Variance; D001416:Back Pain / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003237:Connecticut; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D012720:Severity of Illness Index