title: Does Change Occur for the Reasons We Think It Does? A Test of Specific Therapeutic Operations During Cognitive-Behavioral Treatment of Chronic Pain.
abstract: OBJECTIVE
  To examine the relative validity of 2 conceptual models-Specific, General-by which therapeutic mechanisms in cognitive-behavioral therapy (CBT) for chronic pain achieve favorable outcomes.
  
  
  METHODS
  As part of a clinical trial of enhanced versus standard CBT, people with chronic pain received treatment consisting of 3 pain coping skill modules. In secondary analyses of a subsample (n=56), we examined pretreatment to session 4 (of 10 sessions) changes in Chronic Pain Coping Inventory subscales that corresponded to receipt of one of 3 modules; namely Relaxation, Exercise, and Cognitive Coping modules.
  
  
  RESULTS
  Findings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes.
  
  
  CONCLUSIONS
  Change with CBT may occur both by theory-specified mechanisms and general mechanisms. However, the results provide the most support for a General Mechanism model in which changes on coping skills have spreading effects on the use of other coping skills. Significant relationships between some skill changes and indexes of patient-therapist working alliance and outcome expectations suggest that nonspecific factors also play a role in treatment-related changes in the use of pain coping strategies.
authors.affiliation: *Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL †Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, London, ON, Canada ‡University of Washington Medical Center, Seattle, WA §VA Connecticut Healthcare System, West Haven ∥Yale University School of Medicine, New Haven, CT.
authors.forename: John W
authors.initials: JW
authors.lastname: Burns
authors.forename: Warren R
authors.initials: WR
authors.lastname: Nielson
authors.forename: Mark P
authors.initials: MP
authors.lastname: Jensen
authors.forename: Alicia
authors.initials: A
authors.lastname: Heapy
authors.forename: Rebecca
authors.initials: R
authors.lastname: Czlapinski
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
mesh_terms: D000223:Adaptation, Psychological; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D012063:Relaxation; D016896:Treatment Outcome