Hasenbring M I, Titze C
Abt. Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Ruhr-Universität Bochum, Universitätsstr. 105, Bochum, Deutschland.
Klinik für Orthopädie, Katholisches Klinikum der Ruhr-Universität Bochum, St. Josef Hospital, Bochum, Deutschland.
Schmerz. 2025 Jul 10. doi: 10.1007/s00482-025-00893-7.
Cognitive behavioral therapy (CBT) is one of the most frequently used and effective procedures in pain psychotherapy. Nevertheless, meta-analyses exhibit significant variability in response to treatment. Graded balance interventions (GBI) are among the CBT measures with a specific indication for pain patients who, according to the avoidance-endurance model (AEM), exhibit dysfunctional pain processing with respect to fear-avoidant or suppressive pain responses.
The article presents the individual treatment approach of GBI, which is aimed at patients with subacute or chronic pain and an AEM-based dysfunctional pattern of pain processing. Based on the goal of enabling those affected to flexibly alternate between short-term relaxation and resumption of the respective activity with simultaneous pain relief, the concrete procedure is outlined as a model, illustrated by a case study and the preliminary empirical evidence is presented.
Based on selected empirical literature and clinical case reports, the approach of a modular form of CBT is presented, which, guided by a self-reported screening on pain processing, opens up an individually targeted psychological procedure that can effectively support medical measures.
Based on a large number of randomized, controlled clinical trials on the efficacy of CBT in patients with chronic pain in different locations, a first randomized long-term study with individually targeted GBI shows superiority over a standardized procedure in terms of reduction of pain intensity, impairment and emotional distress in patients with subacute radicular pain.
The use of GBI opens the way to individualization and thus greater homogenization of the approach, based on contrasting patterns of affective, cognitive and behavioral pain processing. The findings to date provide initial indications of the long-term effectiveness of GBI, although there is still a great need for research with respect to its superiority over generalized CBT and into assumed mechanisms of action.
认知行为疗法（CBT）是疼痛心理治疗中最常用且有效的方法之一。然而，荟萃分析显示治疗反应存在显著差异。分级平衡干预（GBI）是CBT措施之一，专门针对疼痛患者，根据回避 - 耐受模型（AEM），这些患者在恐惧回避或抑制性疼痛反应方面存在疼痛处理功能障碍。
本文介绍了GBI的个体化治疗方法，该方法针对亚急性或慢性疼痛患者以及基于AEM的疼痛处理功能障碍模式。基于使受影响者能够在短期放松和恢复各自活动之间灵活交替并同时缓解疼痛这一目标，具体程序被概述为一个模型，并通过案例研究进行说明，同时展示了初步的实证证据。
基于选定的实证文献和临床病例报告，介绍了一种模块化形式的CBT方法，该方法以自我报告的疼痛处理筛查为指导，开启了一种可有效支持医疗措施的个体化针对性心理程序。
基于大量关于CBT对不同部位慢性疼痛患者疗效的随机对照临床试验，第一项针对GBI的随机长期研究表明，在减轻亚急性根性疼痛患者的疼痛强度、功能障碍和情绪困扰方面，GBI优于标准化程序。
GBI的使用基于情感、认知和行为疼痛处理的对比模式，为个体化治疗开辟了道路，从而使治疗方法更加同质化。尽管对于GBI相对于一般CBT的优越性及其假定的作用机制仍有很大的研究需求，但迄今为止的研究结果为GBI的长期有效性提供了初步迹象。
