Assessment methods in single case design studies of psychological treatments for chronic pain: A scoping review
Open accessAbstract
Single case designs (SCDs) represent an excellent approach for developing and testing treatments, and for generating general knowledge of treatment mechanisms and outcomes. Their ability to generate knowledge, however, will depend on their methods being reliable, valid, clearly described, and replicable. This scoping review aims to map assessment methods in SCD studies of psychological treatments for chronic pain. The particular aims were to review the specific measures used, their modes of administration, their adequacy as measures, and opportunities for improvement. PubMed, PsycINFO, CINAHL and OpenGrey were searched for SCD studies of psychological treatments for chronic pain in adults. Two reviewers independently assessed eligibility, with input from two additional reviewers, and then extracted relevant data from the 55 included studies. The most common outcome domains were “pain”, “physical functioning” and “psychological processes.” Non-behavioral measures were more common than behavioral or physiological measures. Measures were often standardized. Measures in each domain were highly varied, and administration information was lacking. Evidence for adequacy of measures was based on psychometric analyses of aggregated group data for non-behavioral measures and agreement for behavioral and physiological measures, but was frequently not reported. Non-behavioral idiographic measures were often inadequate in that adapted measures were often used but validation was reported for original versions. Outcome domains did not correspond with currently available guidelines for measures employed in clinical trials in pain. A new set of guidelines, that is more suited to psychological treatments and to SCDs, is needed. Researchers should consider following an idiographic framework by using individualized measures more often. When measures are individually applied, it is recommended that their adequacy is not based on nomothetic psychometric approaches. Rather, behavioral assessment principles should be employed. Overall, adequacy reporting, usage of SCD consistent terminology, and information on how measures are administered need improvement.
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This is the first time this design has been applied in online treatment for persistent pain, as far as the authors know.
“This is the first time this design has been applied in online treatment for persistent pain, as far as we know (Lavefjord et al., 2021).”
From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Lavefjord et al., 2021
The References section (page unavailable) lists a 2017 study of internet-delivered treatment for pain patients using a replicated single-case design. That is contrary to the claimed first use if “this design” means a single-case design generally; the citing sentence does not specify a narrower variant. (LLM, conf=0.72)
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Experimental — accuracy not yet measuredIdiographic approaches like single-case experimental designs are increasingly recommended.
“idiographic approaches like single-case experimental designs (SCEDs) are increasingly recommended (Lavefjord et al., 2021;Vlaeyen et al., 2020).”
From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Lavefjord et al., 2021
The Introduction describes single-case designs as idiographic and a useful alternative to group-based designs. Section 4.1 recommends considering idiographic measures more often. The paper does not establish that recommendations for single-case experimental designs are increasing; its explicit recommendation concerns measures used within those designs. (LLM, conf=0.82)
Experimental — accuracy not yet measuredExtant evidence about the smartphone-based application of experiential sampling with chronic pain patients is still limited.
“Despite this, the extant evidence about the smartphone-based application of ES with chronic pain patients is still limited (Lavefjord et al., 2021).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Lavefjord et al., 2021
Section 4.4 reports that none of the reviewed single-case design studies of psychological treatments for chronic pain reported using ecological momentary assessment. Section 4.6.1 identifies smartphones as a future opportunity. This supports limited use in the studies reviewed, but the paper does not establish that evidence for smartphone-based experience sampling is limited across chronic pain research generally; the introduction says momentary assessment has been used in that broader field. Page numbers were not supplied in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSCEDs provide evidence of the effectiveness of interventions, drawing on substantially fewer participants than nomothetic approaches such as RCTs.
“In doing this, SCEDs provide evidence of the effectiveness of interventions, drawing on substantially fewer participants than nomothetic approaches (such as RCTs) [51,52,53,54,55,56,57,58].”
From Brief and Telehealth Acceptance and Commitment Therapy (ACT) Interventions for Stress in Inflammatory Bowel Disease (IBD): A Series of Single Case Experimental Design (SCED) Studies (2022) · cites this paper as [51]
Section 1 (page unavailable) describes SCDs as an alternative to group-based nomothetic designs, including RCTs, and says their findings can contribute to general knowledge through replication and meta-analysis. It contrasts individual-based SCDs with aggregated group data, but does not establish the claim that they use substantially fewer participants. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA recent scoping review of SCEDs in persistent pain highlights that only three out of 55 included studies explored mechanisms of therapeutic change.
“A recent scoping review of SCEDs in persistent pain highlights that only three out of 55 included studies explored mechanisms of therapeutic change (Lavefjord et al., 2021).”
From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Lavefjord et al., 2021
Idiographic approaches like SCEDs are an important alternative to traditional nomothetic research as they can provide a detailed perspective on individual treatment responses and evaluate processes of change.
“Idiographic approaches like SCEDs are an important alternative to traditional nomothetic research as they can provide a detailed perspective on individual treatment responses and evaluate processes of change --mechanisms of treatment response -- (Lavefjord et al., 2021).”
From Acceptance and Commitment Therapy for women living with Vulvodynia: A single-case experimental design study of a treatment delivered online (2022) · cites this paper as Lavefjord et al., 2021
Different researchers have recently pointed out the limitations of analyzing processes of clinical change by exclusively relying on a nomothetic framework, with standardized measures collected in situations removed from the individual's natural context.
“Different researchers have recently pointed out the limitations of analyzing processes of clinical change by exclusively relying on a nomothetic framework, with standardized measures of process and outcome variables collected in situations removed from the individual's natural context (Ciarrochi et al., 2021; Lavefjord et al., 2021).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Lavefjord et al., 2021
At present, little consensus exists with respect to measurement in SCEDs, which impedes the comparison and generalizability of findings.
“At present, little consensus exists with respect to measurement in SCEDs, which impedes the comparison and generalizability of findings [51].”
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References 92 · Cited by 14
Research works printed but not linked: 2
- Edwards, J. (2003). Behaviour therapy and cognitive behaviour therapy for chronic low back pain: A single case series (order No. U182853) [doctoral dissertation, university of east anglia]. ProQuest dissertations and theses global.
- D. Clin.Psych. Dissertation, the open university]. ProQuest dissertations and theses global.
- Authors
- Lavefjord, A., Sundström, F. T. A., Buhrman, M., & McCracken, L. M.
- Affiliations
- Uppsala University (SE)
- Corresponding author
- Sundström, Felicia T.A.
- Venue
- Journal of Contextual Behavioral Science
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 21
- Pages
- 121-135
- ISSN
- 2212-1447 (ISSN-L)
- OpenAlex
- W3162284870
- Cited by
- 14
- References
- 92
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 1
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Contextual Behavioral Science (publishedVersion, cc-by)
- Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- single-case experimental design, chronic pain, psychological intervention, outcome measures, behavioral assessment, psychometric validation, physical function, pain assessment, therapeutic mechanisms
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