Elsevier

The Journal of Pain

Volume 18, Issue 10, October 2017, Pages 1153-1164
The Journal of Pain

Critical Review
Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review

https://doi.org/10.1016/j.jpain.2017.04.003Get rights and content
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Highlights

  • Predictors of outcomes in contextual cognitive-behavioral therapy appear unclear.

  • Methodological limitations and a lack of theoretical guidance were identified.

  • Baseline emotional functioning may be an important predictor of treatment response.

  • Predictors may vary across different treatment approaches and outcome domains.

  • Taking a theoretically driven approach to examining moderators is recommended.

Abstract

There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy.

Perspective

In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.

Key words

Chronic pain
acceptance and commitment therapy
mindfulness
psychological flexibility
predictor

Cited by (0)

PROSPERO registration number: CRD42016038795.

The authors have no conflicts of interest to declare.

Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.