Skip to main content
SpringerLink
Log in

Incorporating Cognitive-Behavioral Therapy with Occupational Therapy: A Comparative Study with Patients with Low Back Pain

  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

This paper reports on the implementation of a psychoeducational program utilizing cognitive-behavioral principles. The efficacy of this psychoeducational treatment program in modifying dysfunctional attitudes in patients with chronic low back pain was examined using a two-group pretest posttest design with a follow-up at 3 months. Thirty patients (average age = 44,37, SD = 13.71) participated in the study, with 15 in the psychoeducational treatment group and 15 in the placebo control group. These two conditions were added on to an existing eclectic inpatient pain management program. After assessment on the IPAM (The Integrated Psychosocial Assessment Model), scores were reduced to multivariate composite scores on the factors of “illness behavior,” “depressed and negative cognitions,” and “acute pain strategies.” Results of a group × time repeated measures analysis of variance for the three pain factors revealed a significant main effect for group(F(23,1) = 5.00, p > .04), tempered by a significant interaction between group and time on the ‘depressed and negative’ pain factor(F(23,1) = 4.77, p > .04). Patients in the treatment group improved significantly over time and significantly more than the placebo control group patients at posttreatment. Results provide support for the program in increasing patients' feelings of control over their pain and the use of positive coping strategies, while reducing perceived helplessness, depression, disability, and pain intensity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Linton SJ, Kamwendo K. Low back schools: A critical review. Phys Ther 1989; 67: 1365–1383.

    Google Scholar 

  2. Polatin PB, Gatchel RJ, Barnes D, Mayer TG. A psychosociomedical prediction model of response to treatment by chronically disabled workers with low-back pain. Spine 1989; 14: 956–961.

    PubMed  Google Scholar 

  3. Tunks E. Chronic pain and the occupational role. Part I. Eitology issues. In: Tunks E, Bellissimo A, Roy R, eds. Chronic pain: Psychosocial factors in rehabilitation. (end Ed.). Melbourne, FL: Krieger, 1990, pp. 49–58.

    Google Scholar 

  4. Jensen MP, Karoly P. Notes on the survey of pain attitudes: Original (24–item) and revised (35–item) versions. Unpublished manuscript Arizona State University, Tempe, 1987.

  5. Jensen MP, Karoly P, Huger R. The development and preliminary validation of an instrument to assess patients' attitudes towards pain. J Psychosomat Med 1987; 31: 393–400.

    Google Scholar 

  6. Riley JF, Ahern DK, Follick MJ. Chronic pain and functional impairment: Assessing beliefs about their relationship. Arch Phys Med Rehab 1988; 579–582.

  7. Schwartz DP et al. Direct assessment of beliefs and attitudes of chronic pain patients. Arch Phys Med Rehab 1985; 66: 806–809.

    Google Scholar 

  8. Shutty MS et al. Chronic pain patients' beliefs about their pain and treatment outcome. Arch Phys Med Rehab 1990; 71: 128–132.

    Google Scholar 

  9. Strong J, Ashton R, Chant D. The measurement of attitudes towards and beliefs about pain. Pain 1992; 48: 227–236.

    PubMed  Google Scholar 

  10. Williams DA, Robinson ME, Geisser ME. Pain beliefs: Assessment and utility. Clin J Pain 1994; 71–78.

  11. Williams DA, Thorn BE. An empirical assessment of pain beliefs. Pain 1989; 36: 351–358.

    PubMed  Google Scholar 

  12. Slater MA et al. Pain and impairment beliefs in chronic low back pain. Validation of the pain and impairment relationship scale (PAIRS). Pain 1991; 44: 51–56.

    PubMed  Google Scholar 

  13. Strong J Ashton R, Large RG. Function and the patient with chronic low back pain. Clin J Pain 1994; 10: 191–196.

    PubMed  Google Scholar 

  14. Strong J. Chronic pain: The occupational therapist's perspective. Edinburgh: Churchill Livingstone, 1996.

    Google Scholar 

  15. CAOT Position Paper on Occupational Therapy's Role Work Related Therapy. Toronto Ontario: COAT Publications, 1998.

  16. Ogden LD, Wright MC. Work related programs in occupational therapy: A renaissance. Occup Ther Health Care 1992; 2: 109–126.

    Google Scholar 

  17. Burke JP. Moving occupation into treatment: Clinical interpretation of and legitimizing occupational therapy's knowledge. AJOT 1996; 50: 635–638.

    PubMed  Google Scholar 

  18. Kielhofner G, Burke JP. A model of human occupation. Part I: Conceptual framework and content. AJOT 1980; 34: 572–581.

    PubMed  Google Scholar 

  19. Gusich RL. Occupational therapy for chronic pain: A clinical application of the model of human occupation. Occup Ther Health Care 1984; 1: 59–73.

    Google Scholar 

  20. Padilla R, Bianchi EM. Occupational therapy for chronic pain: Applying the model of human occupation to clinical practice. Occup Ther Pract 1990; 1: 47–52.

    Google Scholar 

  21. Turk DC, Rudy TE. Neglected topics in the treatment of chronic pain patients—relapse, noncompliance, and adherence enhancement. Pain 1991; 44: 5–28.

    PubMed  Google Scholar 

  22. Ajzen I, Fishbein M. Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychol Bull 1977; 84: 888–918.

    Google Scholar 

  23. Fishbein M, Ajzen I. Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley, 1975.

    Google Scholar 

  24. Turk DC, Rudy TE. A cognitive-behavioral perspective on chronic pain: Beyond the scalpel and the syringe. In Tollison CD, ed. Handbook of chronic pain management. Baltimore: Williams & Wilkins, 1988.

    Google Scholar 

  25. Altmaier EM, Lehmann TR, Russell DW, Weinstein JN, Kao CF. The effectiveness of psychological intervention for the rehabilitation of low back pain: A randomised controlled trial evaluation. Pain 1992; 49: 329–335.

    PubMed  Google Scholar 

  26. Strong J, Ashton R, Stewart A. Chronic low back pain: Toward an integrated psychosocial assessment model. J. Consult Clin Psychol 1994; 62: 1058–1063.

    PubMed  Google Scholar 

  27. Strong J, Large RG, Ashton R, Stewart A. A New Zealand replication of the IPAM clustering model for low back patients. Clin J Pain 1995; 11: 296–306.

    PubMed  Google Scholar 

  28. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: A comparison of six methods. Pain 1986; 27: 117–126.

    PubMed  Google Scholar 

  29. Tait RC, Pollard CA, Margolis RB, Duckro PN, Krause SJ. The Pain Disability Index: Psychometric and validity data. Arch Phys Med Rehab 1987; 68: 438–441.

    Google Scholar 

  30. Tait RC, Chibnail JT, Krause S. The Pain Disability Index: Psychometric properties. Pain 1990; 40: 171–182.

    PubMed  Google Scholar 

  31. Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low back pain patients' relationship to patient characteristics and current adjustment. Pain 1983; 17: 33–44.

    PubMed  Google Scholar 

  32. Jensen MP, Karoly P. Notes on the Survey of Pain Attitudes (SOPA): Original (24–item) and revised (35–item) versions. Tempe: Arizona State University, 1987.

    Google Scholar 

  33. Beck AT, Ward CH, Mendelson M, Mock J, Erbauch J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–571.

    PubMed  Google Scholar 

  34. Pilowsky I, Spence ND. Manual for the Illness Behavior Questionnaire (IBQ) (2nd ed.). Adelaide: University of Adelaide, 1983.

    Google Scholar 

  35. Nicholas MK, Wilson PH, Goyen J. Operant-behavioral and cognitive-behavioral treatment for chronic low back pain. Behav Res Ther 1991; 29: 225–238.

    PubMed  Google Scholar 

  36. Kerns RD, Turk DC, Holzman AD, Rudy TE. Comparison of cognitive-behavioral and behavioral approaches to the outpatient treatment of chronic pain. Clin J Pain 1986; 1: 195–203.

    Google Scholar 

  37. Turk DC. Customizing treatment for chronic pain patients: Who, what and why. Clin J Pain 1990; 6: 255–270.

    PubMed  Google Scholar 

  38. Strong J, Large RG. Coping with chronic pain: An ideographic exploration through focus groups. Int J Psychiat Med 1995; 26: 361–377.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Occupational Therapy, The University of Queensland, Brisbane, Australia

    Jenny Strong

Authors
  1. Jenny Strong
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strong, J. Incorporating Cognitive-Behavioral Therapy with Occupational Therapy: A Comparative Study with Patients with Low Back Pain. J Occup Rehabil 8, 61–71 (1998). https://doi.org/10.1023/A:1023008632131

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023008632131

Search

Navigation