无忧试验:使用单一案例实验设计对慢性疼痛(iDBT-Pain)进行在线辩证行为治疗技能训练的疗效。
The No Worries Trial: Efficacy of Online Dialectical Behaviour Therapy Skills Training for Chronic Pain (iDBT-Pain) Using a Single Case Experimental Design.
机构信息
Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia.
Department of Psychological Science, University of Missouri-St Louis, Missouri.
出版信息
J Pain. 2022 Apr;23(4):558-576. doi: 10.1016/j.jpain.2021.10.003. Epub 2021 Oct 20.
Emotion dysregulation frequently co-occurs with chronic pain, which in turn leads to heightened emotional and physical suffering. This cycle of association has prompted a recommendation for psychological treatment of chronic pain to target mechanisms for emotion regulation. The current trial addressed this need by investigating a new internet-delivered treatment incorporating emotional skills training from dialectical behavioral therapy (DBT). Using a single-case experimental design that is suited to heterogeneous populations and can demonstrate efficacy with a small sample, three participants with chronic pain were recruited. Participants received four weeks of online DBT skills training (iDBT-Pain intervention) which incorporated one-on-one sessions over Zoom and a web app. Results revealed compelling evidence for the intervention on the primary outcome of emotion dysregulation and were promising for the secondary outcome of pain intensity. Improvement was also identified on pre-and post-measures of depression, coping behaviors, sleep problems, wellbeing, and harm avoidance, indicating that the intervention may positively influence other factors related to chronic pain. Overall, the trial provides preliminary efficacy for the intervention to improve chronic pain. However, we recommend further investigation of the iDBT-Pain intervention, either in single case trials, which when conducted with scientific rigor may be aggregated to derive nomothetic conclusions, or in a group-comparison trial to compare with usual modes of treatment. PERSPECTIVE: This trial advances understanding of emotion-focused treatment for chronic pain and provides evidence for a viable new technological treatment. Importantly, as an internet-delivered approach, the iDBT-Pain intervention is accessible to those with restricted mobility and remote communities where there are often limited psychological services for people with chronic pain.
情绪失调常与慢性疼痛同时发生,而慢性疼痛反过来又会导致情绪和身体上的痛苦加剧。这种关联循环促使人们建议将慢性疼痛的心理治疗针对情绪调节机制。本试验通过研究一种新的互联网提供的治疗方法,纳入了来自辩证行为疗法(DBT)的情绪技能训练,以满足这一需求。该试验采用了一种适合异质人群的单一案例实验设计,即使在小样本的情况下也能证明疗效,共招募了 3 名慢性疼痛患者。参与者接受了四周的在线 DBT 技能训练(iDBT-Pain 干预),其中包括通过 Zoom 进行的一对一课程和一个网络应用程序。结果表明,该干预措施在情绪失调的主要结果上具有令人信服的证据,在疼痛强度的次要结果上也很有希望。在抑郁、应对行为、睡眠问题、幸福感和回避伤害的预先和事后测量中也发现了改善,这表明干预措施可能会对与慢性疼痛相关的其他因素产生积极影响。总体而言,该试验为改善慢性疼痛的干预措施提供了初步的疗效证据。然而,我们建议进一步研究 iDBT-Pain 干预措施,无论是在单一案例试验中,还是在与常规治疗模式进行比较的群组比较试验中,都可以通过严格的科学方法进行汇总,得出普遍的结论。观点:本试验推进了对慢性疼痛的情绪焦点治疗的理解,并为一种可行的新的技术治疗提供了证据。重要的是,作为一种互联网提供的方法,iDBT-Pain 干预措施可以让那些行动不便和远程社区的人获得,这些社区通常缺乏慢性疼痛患者的心理服务。