Treatment mechanism and outcome decoupling effects in cognitive therapy, mindfulness-based stress reduction, and behavior therapy for chronic pain.
Pain February 1, 2025 James Gerhart, John W Burns, Beverly Thorn et al. 3 citations
For chronic low back pain, cognitive therapy, mindfulness-based stress reduction, and behavior therapy all appear to work by progressively weakening the link between pain-related thoughts or pain spikes and later outcomes, rather than by directly changing those mechanisms. In a study of 521 people, associations between treatment mechanism variables and outcomes were strong early in treatment but became nonsignificant by the final third. This decoupling effect was similar across the three active treatments but did not occur in treatment as usual. The findings suggest that by midtreatment, participants may learn that maladaptive thoughts or pain increases need not worsen their subsequent experience.