The following is a summary of “Treatment mechanism and outcome decoupling effects in cognitive therapy, mindfulness-based stress reduction, and behavior therapy for chronic pain,” published in the August 2024 issue of Pain by Gerhart et al.

Previous studies have found that cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain may improve outcomes through changes in underlying mechanisms. However, there are differing perspectives on whether these changes directly cause improvements or simply decrease the effect of other factors. 

Researchers conducted a retrospective study to examine how the relationships between changes in potential treatment mechanisms and subsequent changes in outcomes developed throughout treatment.

They included 521 individuals with chronic low back pain and compared the effects of CT, MBSR, BT, and treatment as usual (TAU). Participants underwent 8 individual sessions, with weekly assessments of putative treatment mechanisms and outcomes. Lagged analyses were performed, which indicated interactions between mechanism × session number and outcome × session number.

The results showed linkages between mechanism and outcome variables were extremely effective during the first third of treatment but weakened over time, eventually becoming nonsignificant by the last third of therapy. These effects were equal across CT, MBSR, and BT conditions, but they did not appear among participants with TAU.

They concluded that during the course, participants undergoing CT, MBSR, and BT discovered decouple maladaptive pain-related thoughts and spikes in pain from negative outcomes, indicating the treatments could help individuals overcome the fear of pain.

Source: journals.lww.com/pain/abstract/9900/treatment_mechanism_and_outcome_decoupling_effects.696.aspx