title: The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial.
abstract: OBJECTIVE
  Current psychological and behavioral therapies for chronic musculoskeletal pain only modestly reduce pain, disability, and distress. These limited effects may be due to the failure of current therapies: a) to help patients learn that their pain is influenced primarily by central nervous system psychological processes; and b) to enhance awareness and expression of emotions related to psychological trauma or conflict.
  
  
  METHODS
  We developed and conducted a preliminary, uncontrolled test of a novel psychological attribution and emotional awareness and expression therapy that involves an initial individual consultation followed by 4 group sessions. A series of 72 patients with chronic musculoskeletal pain had the intervention and were assessed at baseline, post-treatment, and 6-month follow-up.
  
  
  RESULTS
  Participation and satisfaction were high and attrition was low. Intent-to-treat analyses found significant improvements in hypothesized change processes: psychological attributions for pain, emotional awareness, emotional approach coping, and alexithymia. Pain, interference, depression, and distress showed large effect size improvements at post-treatment, which were maintained or even enhanced at 6 months. Approximately two-thirds of the patients improved at least 30% in pain and other outcomes, and one-third of the patients improved 70%. Changes in attribution and emotional processes predicted outcomes. Higher baseline depressive symptoms predicted greater improvements, and outcomes were comparable for patients with widespread vs. localized pain.
  
  
  CONCLUSIONS
  This novel intervention may lead to greater benefits than available psychological interventions for patients with chronic musculoskeletal pain, but needs controlled testing.
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Burger
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA. Electronic address: mlumley@wayne.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lumley
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Carty
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Deborah V
authors.initials: DV
authors.lastname: Latsch
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Thakur
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Maren E
authors.initials: ME
authors.lastname: Hyde-Nolan
authors.affiliation: Department of Psychology, Wayne State University, Detroit, MI, USA.
authors.forename: Alaa M
authors.initials: AM
authors.lastname: Hijazi
authors.affiliation: Department of Internal Medicine, St. John/Providence Health System, Southfield, MI, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Schubiner
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D001521:Behavior Therapy / Q000379:methods; D003863:Depression / Q000209:etiology; D004522:Educational Status; D004644:Emotions; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology* / Q000628:therapy*; D010147:Pain Measurement; D011602:Psychophysiologic Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Attribution; Chronic pain; Clinical trial; Emotional awareness; Emotional expression; Registered at Clinicaltrials.gov (NCT00861302)