Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
Research Group Health Psychology, KU Leuven, Tiensestraat 102, Box 3726, 3000, Leuven, Belgium; Research Group Behavioral Medicine, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Behav Res Ther. 2018 Sep;108:58-67. doi: 10.1016/j.brat.2018.07.002. Epub 2018 Jul 18.
Our aim was to evaluate isolated elements of psychological pain treatments and explore treatment effects on biological stress markers. We employed a single-case experimental design with multiple baselines. Matching pairs of twelve participants (chronic low back pain >6 months; elevated pain-related fear) were randomly assigned to graded in vivo exposure (EXP) or cognitive-behavioral therapy (CBT) in a yoked design. Primary assessments were taken during baseline (7-26 days), treatment (23-44 days) and at 6-months follow-up (11-30 days) including changes in pain symptoms, disability, pain-related fear, acceptance, body confidence, self-efficacy, and positive thoughts. Psycho-educational, behavioral, cognitive, and exposure interventions were compared to baseline. EXP exhibited immediate middle-to-large effects; CBT's small-to-middle effects were delayed. Within the EXP approach, change mainly occurred during exposure but not during psycho-educational sessions. Overall cortisol was lower in EXP than CBT at post-treatment. We recommend integrating exposure elements in the management of CLBP to increase its efficacy. Psycho-educational sessions might not be necessary or should be adapted, e.g. with stronger focus on motivational aspects. Since CBT seemed to produce delayed effects, core CBT interventions such as cognitive restructuring might be added after exposure treatment to sustain therapeutic effects.
我们的目的是评估心理疼痛治疗的孤立元素，并探索其对生物应激标志物的治疗效果。我们采用了具有多个基线的单一案例实验设计。将十二名具有慢性下腰痛（>6 个月；疼痛相关恐惧升高）的参与者配对，并采用对偶设计随机分配到分级活体暴露（EXP）或认知行为疗法（CBT）中。主要评估在基线（7-26 天）、治疗（23-44 天）和 6 个月随访（11-30 天）期间进行，包括疼痛症状、残疾、疼痛相关恐惧、接受度、身体自信、自我效能感和积极思想的变化。比较了心理教育、行为、认知和暴露干预与基线的差异。EXP 立即表现出中到大的效果；CBT 的小到中等效果则延迟出现。在 EXP 方法中，主要在暴露治疗期间发生变化，而不是在心理教育课程中。总体而言，治疗后 EXP 的皮质醇水平低于 CBT。我们建议在 CLBP 的管理中整合暴露元素以提高其疗效。心理教育课程可能不是必需的，或者应该进行调整，例如更加强调动机方面。由于 CBT 似乎产生延迟效果，因此可以在暴露治疗后添加核心 CBT 干预措施，例如认知重构，以维持治疗效果。
