title: National dissemination of cognitive-behavioral therapy for chronic pain in veterans: therapist and patient-level outcomes.
abstract: OBJECTIVE
  This paper assesses the effects of training in and implementation of Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) in the US Department of Veterans Affairs (VA) health care system on therapists' CBT-CP competencies and patients' pain-related outcomes.
  
  
  METHODS
  A total of 71 therapists participated in the VA CBT-CP Training Program. Patients included 148 Veterans treated by therapist training participants. Therapists completed a 3-day workshop followed by 6 months of weekly consultation. Therapy session tapes were rated by expert training consultants using a standardized competency rating form. Patient outcomes were assessed with measures of patient-reported pain intensity, pain-related cognitions, overall distress, depression, pain interference, and quality of life. The therapeutic alliance was also assessed.
  
  
  RESULTS
  Among the 71 therapists who participated in the training program, 60 (85%) completed all training requirements, including competency-based performance criteria. Of the 148 Veteran patients treated, 117 (79%) completed all CBT-CP protocol sessions. Intent-to-treat analyses indicated significant improvements in pain catastrophizing, interference, quality of life, and other domains, as well as on the therapeutic alliance.
  
  
  CONCLUSIONS
  Training in and implementation of CBT-CP in the VA health care system were associated with significant increases in therapist competencies to deliver CBT-CP and improvements in several domains for Veteran patients. Results support the feasibility and effectiveness of broad dissemination of CBT-CP in routine, nonpain specialty settings.
authors.affiliation: *Mental Health Services, US Department of Veterans Affairs Central Office, Washington, DC †Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ‡James A. Haley Veterans' Hospital §University of South Florida, Tampa, FL ∥Alpert Medical School of Brown University, Providence, RI ¶Bay Area Pain and Wellness Center, Los Gatos, CA #VA Connecticut Healthcare System, PRIME Center **Departments of Psychiatry and Neurology, Yale University, New Haven, CT.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Stewart
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Karlin
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Murphy
authors.forename: Susan D
authors.initials: SD
authors.lastname: Raffa
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Miller
authors.forename: John
authors.initials: J
authors.lastname: McKellar
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
mesh_terms: D058443:Catastrophization / Q000628:therapy; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000193:education* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans