Bendelin Nina, Gerdle Björn, Andersson Gerhard
Pain and Rehabilitation Centre and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
J Pain Res. 2018 Sep 4;11:1715-1728. doi: 10.2147/JPR.S157939. eCollection 2018.
Methods for delivering aftercare to help chronic pain patients to continue practice self-management skills after rehabilitation are needed. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to partly fill this gap given its accessibility and emphasis on self-care. Methods for engaging and motivating patients to persist throughout the full length of treatment are needed. The aim of this study was to describe how chronic pain patients work in an ICBT program, through their descriptions of what is important when they initiate behavior change in aftercare and their descriptions of what is important for ongoing practice of self-management skills in aftercare.
Following a multimodal rehabilitation program, 29 chronic pain patients participated in a 20-week-long Internet-delivered aftercare program (ACP) based on acceptance-based cognitive behavioral therapy. Latent content analysis was made on 138 chapters of diary-like texts written by participants in aftercare.
Attitudes regarding pain and body changed during ACP, as did attitudes toward self and the future for some participants. How participants practiced self-management skills was influenced by how they expressed motivation behind treatment goals. Whether they practiced acceptance strategies influenced their continuous self-management practice. Defusion techniques seemed to be helpful in the process of goal setting. Mindfulness strategies seemed to be helpful when setbacks occurred.
Self-motivating goals are described as important both to initiate and in the ongoing practice of self-management skills. Experiencing a helpful effect of acceptance strategies seems to encourage participants to handle obstacles in new ways and to persist throughout treatment. Research on whether tailored therapist guidance might be helpful in stating self-motivating goals and contribute to ongoing practice of self-management skills is needed.
需要提供后续护理的方法，以帮助慢性疼痛患者在康复后继续练习自我管理技能。鉴于互联网认知行为疗法（ICBT）的可及性及其对自我护理的强调，它有可能部分填补这一空白。需要有方法来促使患者参与并激励他们坚持完成整个治疗过程。本研究的目的是通过慢性疼痛患者对康复后启动行为改变时重要因素的描述以及对康复后持续练习自我管理技能时重要因素的描述，来阐述他们在ICBT项目中的表现。
在完成多模式康复项目后，29名慢性疼痛患者参加了一个为期20周的基于接纳的认知行为疗法的互联网后续护理项目（ACP）。对参与者在后续护理中撰写的138篇类似日记的文本章节进行了潜在内容分析。
在ACP期间，患者对疼痛和身体的态度发生了变化，一些参与者对自我和未来的态度也发生了变化。参与者练习自我管理技能的方式受到他们对治疗目标背后动机表达的影响。他们是否采用接纳策略影响了他们持续的自我管理练习。解离技术在目标设定过程中似乎很有帮助。正念策略在遇到挫折时似乎很有帮助。
自我激励目标被认为对于启动和持续练习自我管理技能都很重要。体验到接纳策略的有益效果似乎会鼓励参与者以新的方式应对障碍并坚持完成整个治疗。需要研究量身定制的治疗师指导是否有助于设定自我激励目标并促进自我管理技能的持续练习。
