Confirming the mechanisms behind cognitive-behavioural therapy effectiveness in chronic pain using structural equation modeling in a sample of patients with temporomandibular disorders.

OBJECTIVE

To evaluate whether therapeutic mechanisms assumed to explain the effect of cognitive behavioural therapy (CBT) concerning temporomandibular symptoms are confirmed by structural equation modelling.

METHOD

Patients were randomly assigned to either an experimental group receiving CBT (N = 41) or a standard therapy control group (N = 31). Subjects were assessed before and after intervention using mediator variables hypothesized according to the CBT model, as well as outcome variables and other socio-demographic and clinical measures.

RESULTS

The results confirm that the effect of treatment on pain intensity was partially mediated by distress, catastrophizing, perceived control, distraction, and mental self-control. The self-medication frequency was partially mediated by distraction. Pain interference was partially mediated by distress, distraction, and mental self-control. Reduction in the number of painful points on palpation was partially explained by distress, although in this case, there was a significant direct effect of treatment not mediated by other variables.

CONCLUSIONS

The results could set the principles for the development of more efficient and effective cognitive behavioural interventions for chronic pain.