title: Self-system therapy for distress associated with persistent low back pain: A randomized clinical trial.
abstract: Persistent low back pain (PLBP) is associated with vulnerability to depression. PLBP frequently requires major changes in occupation and lifestyle, which can lead to a sense of failing to attain one's personal goals (self-discrepancy).
  
  
  
  We conducted a clinical trial to examine the efficacy of self-system therapy (SST), a brief structured therapy for depression based on self-discrepancy theory. A total of 101 patients with PLBP and clinically significant depressive symptoms were randomized either to SST, pain education, or standard care.
  
  
  
  Patients receiving SST showed significantly greater improvement in depressive symptoms. Reduction in self-discrepancy predicted reduction in depressive symptoms only within the SST condition.
  
  
  
  Findings support the utility of SST for individuals facing persistent pain and associated depression.
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.|b Department of Psychology , North Carolina Central University , Durham , NC , USA.
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Waters
authors.affiliation: c Department of Psychology and Neuroscience , Duke University , Durham , NC , USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Strauman
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors.forename: Daphne C
authors.initials: DC
authors.lastname: McKee
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.|d Department of Psychology , East Carolina University , Greenville , NC , USA.
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Campbell
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Shelby
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.|e Department of Anesthesiology , Duke University Medical Center , Durham , NC , USA.|f Department of Psychology , Tuscaloosa VA Medical Center , Tuscaloosa , AL , USA.
authors.forename: Kim E
authors.initials: KE
authors.lastname: Dixon
authors.affiliation: c Department of Psychology and Neuroscience , Duke University , Durham , NC , USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Fras
authors.affiliation: a Department of Psychiatry & Behavioral Sciences , Duke University Medical Center , Durham , NC , USA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000523:psychology*; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods*; D000068356:Self-Control; D013315:Stress, Psychological / Q000628:therapy*
keywords: depression; persistent pain; self-discrepancy; self-regulation; self-system therapy