title: Cognitive mechanisms of change in multidisciplinary treatment of patients with chronic widespread pain: a prospective cohort study.
abstract: OBJECTIVE
  To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of multidisciplinary treatment in patients with chronic widespread pain.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A total of 120 subjects diagnosed with chronic widespread pain, who completed a multidisciplinary pain programme.
  
  
  METHODS
  Data from baseline, 6 months and 18 months follow-up measurements were analysed. Longitudinal relationships were analysed between changes in cognitions and outcome, using generalized estimated equations. Outcome domains included: pain, interference of pain in daily life, depression, and global perceived effect. Cognitive domains included: negative emotional cognitions, active cognitive coping and control and chronicity beliefs.
  
  
  RESULTS
  Improvements in negative emotional cognitions were associated with improvements in all outcome domains, in particular with improvement in interference of pain with daily life and depression (between baseline and 6 months, and 6 and 18 months). Improvements in active cognitive coping were associated with improvements in interference of pain in daily life (between baseline and 6 months). Improvements in control and chronicity beliefs were associated with improvements in pain and depression (between 6 and 18 months).
  
  
  CONCLUSIONS
  Improvement in negative emotional cognitions seems to be a key mechanism of change in multidisciplinary treatment of chronic widespread pain. Improvement in active cognitive coping and improvement in control and chronic timeline beliefs may also constitute mechanisms of change, although the evidence is less strong.
authors: Amsterdam Rehabilitation Research Center, Reade, 1056 AB Amsterdam, The Netherlands. a.d.rooij@reade.nl.
authors: Aleid
authors: A
authors: de Rooij
authors: Michiel R
authors: MR
authors: de Boer
authors: Marike
authors: M
authors: van der Leeden
authors: Leo D
authors: LD
authors: Roorda
authors: Martijn P M
authors: MP
authors: Steultjens
authors: Joost
authors: J
authors: Dekker
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D003071:Cognition; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies