James A. Haley Veterans' Hospital.
Veterans Affairs Northern California Health Care System.
Psychol Serv. 2022 Feb;19(1):95-102. doi: 10.1037/ser0000506. Epub 2020 Sep 28.
The U.S. Department of Veterans Affairs (VA) has been training clinicians in its cognitive behavioral therapy for chronic pain (CBT-CP) structured protocol since 2012. The aim of this project was to review patient outcomes to determine the effectiveness of the VA's CBT-CP treatment. From 2012-2018, 1,331 Veterans initiated individual CBT-CP treatment as part of the training program. Patient outcomes were assessed with measures of patient-reported pain intensity, pain catastrophizing, depression, pain interference, and quality of life (physical, psychological, social, and environmental). Mixed models of the effects of time indicated significant changes across pretreatment, midtreatment, and treatment conclusion on all outcomes. There was a large effect size (Cohen's d = 0.78) for pain catastrophizing, and there were medium to large effect sizes ( > 0.60) for worst pain intensity, pain interference, depression, and physical quality of life. Systematic training of therapists and implementation of the VA's CBT-CP protocol yielded significant patient improvements across multiple domains. This offers strong support for the VA's CBT-CP as an effective, safe treatment for Veterans with chronic pain and highlights it as a model to increase the availability of training in standardized, pain-focused, evidence-based, behavioral interventions. The findings suggest that the broad dissemination of such training, including in routine, nonpain specialty settings, would improve patient access to effective, nonpharmacological treatment options in both the public and private sectors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
美国退伍军人事务部(VA)自 2012 年以来一直在培训临床医生使用其慢性疼痛认知行为疗法(CBT-CP)的结构化方案。该项目的目的是审查患者的治疗结果,以确定 VA 的 CBT-CP 治疗的有效性。2012 年至 2018 年间,共有 1331 名退伍军人开始接受个体 CBT-CP 治疗,作为培训计划的一部分。通过评估患者报告的疼痛强度、疼痛灾难化、抑郁、疼痛干扰和生活质量(身体、心理、社会和环境)等指标来评估患者的治疗效果。时间的混合模型表明,所有治疗结果在治疗前、治疗中期和治疗结束时都有显著变化。疼痛灾难化的效果大小较大(Cohen's d = 0.78),而最痛强度、疼痛干扰、抑郁和身体生活质量的效果大小为中到大(> 0.60)。治疗师的系统培训和 VA 的 CBT-CP 方案的实施在多个领域都为患者带来了显著的改善。这为 VA 的 CBT-CP 作为一种有效、安全的慢性疼痛退伍军人治疗方法提供了强有力的支持,并强调了它作为一种增加标准化、以疼痛为重点、循证、行为干预培训可及性的模式。这些发现表明,广泛传播这种培训,包括在常规的非疼痛专科环境中,将改善患者获得有效、非药物治疗选择的机会,无论是在公共部门还是私营部门。(PsycInfo 数据库记录(c)2022 APA,保留所有权利)。