Baronian Roupen, Leggett Sarah Je
School of Health and Social Care, University of Essex, Essex, UK.
West Suffolk Community Pain Management Service, Suffolk GP Federation, Ipswich, UK.
Br J Pain. 2020 Feb;14(1):57-67. doi: 10.1177/2049463719858119. Epub 2019 Jun 17.
Cognitive analytic therapy (CAT) has diversified in its application to a broad range of presenting difficulties and formats and there has been growing interest in its use in clinical health settings including Pain Management Services. Despite its growing popularity, to date, no studies have examined the application of CAT for chronic pain.
The purpose of this study was to examine the effectiveness of time-limited, individual CAT for adults with chronic pain as delivered in a publicly funded Community Pain Management Service.
This was an observational service evaluation of treatment practice within a routine clinical setting. Participants were 53 adults with chronic pain who completed eight sessions of individual therapy. Individual and group-level outcomes on self-reported distress, pain-related self-efficacy, as well as changes in healthcare utilisation pre- and post-intervention were examined.
Large pre-post effects on wellbeing ( = 1.50) and self-efficacy ( = 1.13) were observed, while effects on healthcare utilisation were medium to large ( = 0.67). Moreover, reliable change and clinical significance analyses demonstrated that results were clinically meaningful. The majority of clients (67.9%) showed reliable improvement following the CAT intervention and 28% achieved both reliable and clinically significant improvements in psychological distress. Approximately 4 of 10 clients (43.5%) showed reliably higher perceived self-efficacy at the end of therapy.
The results of this evaluation suggest that brief CAT is an encouraging intervention for adults with persistent pain. While preliminary, our findings provide support for a brief approach to persistent pain that focuses not on controlling or eliminating pain but on elucidating and revising unhelpful relational patterns that may impinge upon one's pain management. Directions for future research are suggested.
认知分析疗法（CAT）在应用于广泛的就诊困难和形式方面已经多样化，并且其在包括疼痛管理服务在内的临床健康环境中的应用越来越受到关注。尽管其越来越受欢迎，但迄今为止，尚无研究考察CAT在慢性疼痛中的应用。
本研究的目的是考察在由公共资金资助的社区疼痛管理服务中提供的针对慢性疼痛成人的限时个体CAT的有效性。
这是一项在常规临床环境中对治疗实践进行的观察性服务评估。参与者为53名患有慢性疼痛的成年人，他们完成了八次个体治疗。考察了个体和组水平上自我报告的痛苦、与疼痛相关的自我效能感以及干预前后医疗保健利用率的变化。
观察到对幸福感（=1.50）和自我效能感（=1.13）有较大的前后效应，而对医疗保健利用率的效应为中等至较大（=0.67）。此外，可靠变化和临床意义分析表明结果具有临床意义。大多数客户（67.9%）在CAT干预后显示出可靠的改善，28%在心理痛苦方面实现了可靠且具有临床意义的改善。大约十分之四的客户（43.5%）在治疗结束时显示出自我效能感明显更高。
该评估结果表明，简短的CAT对患有持续性疼痛的成年人是一种令人鼓舞的干预措施。虽然是初步的，但我们的研究结果支持一种针对持续性疼痛的简短方法，该方法不侧重于控制或消除疼痛，而是侧重于阐明和修正可能影响个人疼痛管理的无益关系模式。提出了未来研究的方向。
