Vlaeyen J W, Haazen I W, Schuerman J A, Kole-Snijders A M, van Eek H
Institute for Rehabilitation Research, Hoensbroek, The Netherlands.
Br J Clin Psychol. 1995 Feb;34(1):95-118. doi: 10.1111/j.2044-8260.1995.tb01443.x.
Seventy-one chronic low back pain patients were assigned to one of three behavioural rehabilitation treatments or a waiting-list condition. The first intervention consisted of an operant treatment, aimed at increasing health behaviours and activity levels and at reducing pain and illness behaviours. In the second intervention, a cognitive treatment, aimed at the reinterpretation of catastrophizing pain cognitions and at enhancing self-control, was combined with an operant treatment. The third intervention consisted of the combination of the operant approach and a respondent treatment. During the respondent treatment, patients were taught to decrease muscle tension levels, using the 'applied relaxation' technique supported by EMG-biofeedback and graded exposure to tension-eliciting situations. A repeated measurements design included observer rating of pain behaviours, observer ratings of mood, self-reported depression, residual health behaviours, pain cognitions and experienced pain intensity. Follow-up assessment occurred at six months and one year after termination of treatment. Results suggest that, for the sample as a whole, improvements are found on measures of pain behaviours, health behaviours, pain cognitions and affective distress and that these improvements are maintained at six months and one year follow-up. During the treatment the three treatment groups improved significantly more than the waiting-list control group on most of the measures. Further, the results of this study provide evidence that the operant-cognitive and operant-respondent conditions are more efficacious in decreasing pain behaviours and in increasing health behaviours and efficacy expectations than operant treatment alone. This differential effect among the conditions is maintained at follow-up. Patients who received the OC and OR treatments catastrophize less than OP patients, and OC patients showed better scores on outcome-efficacy than OR patients. In general, the results suggest that behavioural rehabilitation programmes for chronic low back pain are effective and that the effects of an operant treatment are magnified when self-control techniques are added.
71名慢性腰痛患者被分配到三种行为康复治疗之一或等待名单组。第一种干预措施是操作性治疗，旨在增加健康行为和活动水平，减少疼痛和疾病行为。在第二种干预措施中，一种认知治疗与操作性治疗相结合，认知治疗旨在重新诠释灾难性疼痛认知并增强自我控制能力。第三种干预措施是将操作性方法与反应性治疗相结合。在反应性治疗过程中，患者通过肌电图生物反馈支持的“应用放松”技术和逐渐接触引发紧张的情境，学习降低肌肉紧张水平。重复测量设计包括对疼痛行为的观察者评分、情绪的观察者评分、自我报告的抑郁、残余健康行为、疼痛认知和疼痛强度体验。在治疗结束后6个月和1年进行随访评估。结果表明，对于整个样本，在疼痛行为、健康行为、疼痛认知和情感困扰方面的测量有改善，并且这些改善在6个月和1年随访时得以维持。在治疗期间，三个治疗组在大多数测量指标上的改善明显多于等待名单对照组。此外，本研究结果提供了证据，即操作性-认知和操作性-反应性治疗条件在减少疼痛行为、增加健康行为和疗效期望方面比单独的操作性治疗更有效。这种不同条件之间的差异在随访时得以维持。接受操作性-认知和操作性-反应性治疗的患者比接受操作性治疗的患者更少出现灾难性思维，并且操作性-认知治疗组患者在结果效能方面的得分比操作性-反应性治疗组患者更高。总体而言，结果表明慢性腰痛的行为康复计划是有效的，并且当添加自我控制技术时，操作性治疗的效果会增强。
