Exposure and cognitive‐behavioural therapy for chronic back pain: An RCT on treatment processes
Abstract
Background To improve treatment outcomes, it is essential to understand the processes involved in therapeutic change. The aim of this study was to investigate the processes involved in treatment of individuals with chronic lower back pain (CLBP) and high fear-avoidance. Graded in vivo exposure (Exposure), a specific treatment, and cognitive-behavioural therapy (CBT), a general treatment, were compared. Methods Our study used data from a three-arm randomized controlled trial. The sample comprised 61 CLBP patients (pain duration >3 months; sufficient level of fear-avoidance). Assessments of session-by-session processes were done weekly for a maximum 14 weeks. The primary outcome, functional disability, was assessed at pre-treatment, post-treatment and 6-months follow-up. First, two-level models were used to test for treatment-related similarities and differences in the changes in session-by-session measures (i.e., common and unique treatment processes respectively). Second, we analysed treatment processes as predictors of treatment outcome. Results Contrary to our expectations, we found no evidence of unique treatment processes. Our results indicate that Exposure and CBT share some treatment processes. Specifically, patients reported a reduction in fear of movement and improvements in their ability to relax, to distract themselves, to manage their pain, to confront feared movements, to be active and to enjoy things despite their pain. Changes in fear of movement, relaxation, di…
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Prior RCTs of GET in adults utilized monodisciplinary treatment controls of CBT, Graded Activity, PT, or manual therapy, in contrast to a multidisciplinary treatment control.
“we identified that prior RCTs utilized monodiscliplinary treatment controls of CBT[49], Graded Activity[73], PT[16], or manual therapy[1], in contrast to a multidisciplinary treatment control.”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [49]
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- Authors
- Schemer, L., Schroeder, A., Ørnbøl, E., & Glombiewski, J. A.
- Affiliations
- Philipps University of Marburg (DE)
- Aarhus University Hospital (DK)
- Corresponding author
- Schemer, Lea
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2018-11-04
- Volume
- 23
- Issue
- 3
- Pages
- 526-538
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2897198644
- Cited by
- 28
- References
- 21
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 9 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 1
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (DFG‐GL 607)
- Philipps-Universität Marburg
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- chronic low back pain, cognitive behavioral therapy, treatment process, fear-avoidance beliefs, kinesiophobia, self-efficacy, functional disability, pain management, relaxation, distraction
- MeSH terms
- Adult, Avoidance Learning, Fear, Female, Humans, Male, Middle Aged, Movement, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Self Efficacy, Chronic Pain
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