Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: a single-blind randomized controlled trial

Trials of Cognitive Therapy (CT), Mindfulness-Based Stress Reduction (MBSR), and Behavior Therapy (BT) suggest that all three treatments produce reductions in pain and improvements in physical function, mood and sleep disturbance in people with chronic pain conditions. Fewer studies have compared the relative efficacies of these treatments. In this randomized controlled study, we compared CT, MBSR, BT and treatment as usual (TAU) in a sample of people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of outcomes. Consistent with prior work, we found that CT, MBSR, and BT produced similar pre- to post-treatment effects on all outcomes and revealed similar levels of maintenance of treatment gains at 6-month follow-up. All three active treatments produced greater improvements than TAU. Weekly assessments allowed us to assess rates of change; i.e., how quickly a given treatment produced significant differences, compared to TAU, on a given outcome. The three treatments differed significantly from TAU on average by session 6, and this rate of treatment effect was consistent across all treatments. Results suggest the possibility that the specific techniques included in CT, MBSR, and BT may be less important for producing benefits than people participating in any techniques rooted in these evidence-based psychosocial treatments for chronic pain.


PMID: 34074945 DOI: 10.1097/j.pain.0000000000002357