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Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial
Orebro Univ, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology.ORCID iD: 0000-0002-9736-8228
Orebro Univ, Sweden.
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2019 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed) Published
Abstract [en]

The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 160, no 8, p. 1708-1718
Keywords [en]
Chronic pain; Emotional problems; Transdiagnostic; Cognitive-behavioral therapy; Internet; Randomized clinical trial; Exposure
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General Practice
Identifiers
URN: urn:nbn:se:liu:diva-160052DOI: 10.1097/j.pain.0000000000001575ISI: 000480764500006PubMedID: 31335641Scopus ID: 2-s2.0-85066118471OAI: oai:DiVA.org:liu-160052DiVA, id: diva2:1349030
Note

Funding Agencies|AFA insurance [140356]; Region Ostergotland [LIO-724821]; Swedish Foundation for Humanities and Social Sciences [P14-0799: 1]

Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-09-10Bibliographically approved

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Gerdle, Björn

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Södermark, MartinHesser, HugoGerdle, Björn
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Division of Community MedicineFaculty of Medicine and Health SciencesPsychologyFaculty of Arts and SciencesDepartment of OtorhinolaryngologyPain and Rehabilitation Center
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