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Predictors of Treatment Outcome in Contextual Cognitive and Behavioral Therapies for Chronic Pain: A Systematic Review

  • Helen R. Gilpin
    Affiliations
    INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom

    Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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  • Alexandra Keyes
    Affiliations
    Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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  • Daniel R. Stahl
    Affiliations
    Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
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  • Riannon Greig
    Affiliations
    Royal Holloway, University of London, United Kingdom
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  • Lance M. McCracken
    Correspondence
    Address reprint requests to Professor Lance M. McCracken, PhD, Health Psychology Section, Psychology Department, King's College London, Guy's Campus, London SE1 9RT.
    Affiliations
    INPUT Pain Management, Guys and St Thomas NHS Foundation Trust Hospitals, London, United Kingdom

    Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
    Search for articles by this author

      Highlights

      • Predictors of outcomes in contextual cognitive-behavioral therapy appear unclear.
      • Methodological limitations and a lack of theoretical guidance were identified.
      • Baseline emotional functioning may be an important predictor of treatment response.
      • Predictors may vary across different treatment approaches and outcome domains.
      • Taking a theoretically driven approach to examining moderators is recommended.

      Abstract

      There is increasing evidence that contextual forms of cognitive-behavioral therapy (CBT) are effective in the management of chronic pain, yet little is understood about the factors that moderate or predict outcomes in these treatments. This systematic review aimed to identify pretreatment participant characteristics associated with positive treatment responses in contextual CBT for chronic pain. Medline, EMBASE, PsychINFO, and CENTRAL were searched to identify eligible studies. Studies were included if the participants were adults with chronic pain, designs were longitudinal, treatments focused on psychological flexibility or mindfulness, and reported results allowed for examination of moderators or predictors of standard treatment outcomes. Of 991 records initially identified, 20 were eligible for inclusion in the review. Some evidence suggested that baseline emotional functioning predicts treatment response, but the direction of this association varied between studies. Substantive findings were inconsistent and inconclusive, however, methodological limitations were consistent. These included treatment heterogeneity, and a lack of theoretical, a priori guidance in examining potential predictors. Future research should adopt a theoretically based approach to examining moderators in relation to specific treatment methods and therapeutic processes. Considering moderation without first considering mediation is probably a limited strategy.

      Perspective

      In this systematic review we examined evidence for potential predictors or moderators of outcomes in contextual CBT for chronic pain. Substantive findings were inconclusive but important methodological limitations and a lack of theoretical guidance were found. Future research should explicitly plan relevant methods and follow clear theoretical models.

      Key words

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