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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Article info
Publication history
Published online: April 25, 2017
Footnotes
PROSPERO registration number: CRD42016038795.
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2017 by the American Pain Society.
