Gilpin Helen R, Ratanachatchuchai Soravis, Novelli David, McCracken Lance M, Scott Whitney
INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Br J Pain. 2022 Aug;16(4):420-432. doi: 10.1177/20494637211073012. Epub 2022 Mar 4.
Although cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments.
The aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy.
This was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes.
The ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC = 0.04) was not warranted. Group percentage of participants receiving disability benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes.
Given the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and countertherapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.
尽管慢性疼痛的认知行为疗法以团体形式开展，但针对这些疗法中的团体效应的研究却很少。
本研究旨在调查治疗开始时的团体构成变量与基于接纳与承诺疗法的强化跨学科疼痛治疗后的个体结局之间的关联。
这是对常规收集的观察性数据进行的二次分析。516名患者在治疗前和治疗后完成了一套标准的人口统计学、疼痛相关和社会心理测量。计算组内相关系数（ICC）以检验组内结局的聚集性，多层次模型则探讨团体构成变量与个体水平结局之间的关联。
疼痛强度（0.11）和干扰（0.09）的ICC表明，对于这些结局有必要采用多层次模型，而治疗后抑郁的多层次模型（ICC = 0.04）则没有必要。在控制治疗前个体水平疼痛强度的情况下，接受残疾福利的参与者的团体百分比和治疗前团体平均疼痛强度与治疗后个体水平疼痛强度显著正相关。治疗前团体平均疼痛强度是唯一能在个体水平上显著预测治疗后疼痛干扰的团体变量。社会心理团体构成变量与个体水平结局无显著关联。
鉴于本研究中团体构成变量的预测效用有限，未来的研究应直接评估团体水平的治疗和反治疗过程，以增进对谁能从疼痛团体治疗中获益以及如何获益的理解。由于团体聚集所解释的结局方差相对较小，且组内仍存在显著方差，因此还需要开展研究以进一步了解影响疼痛认知行为治疗结局的个体水平因素。
