Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment

Litt, Mark D.; Shafer, David M.; Kreutzer, Donald L.

doi:10.1016/j.pain.2010.06.030

Cited by 118Temporomandibular Joint DisordersMusculoskeletal pain and rehabilitationFibromyalgia and Chronic Fatigue Syndrome Research

Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment

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Litt, Mark D., Shafer, David M., Kreutzer, Donald L.·2010·Pain

DOI 10.1016/j.pain.2010.06.030PMC PMC2939176

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Abstract

The purpose of this study was to determine whether a brief (6-8 sessions) cognitive-behavioral treatment for temporomandibular dysfunction-related pain could be efficacious in reducing pain, pain-related interference with lifestyle and depressive symptoms. The patients were 101 men and women with pain in the area of the temporomandibular joint of at least 3 months duration, randomly assigned to either standard treatment (STD; n=49) or standard treatment+cognitive-behavioral skills training (STD+CBT; n=52). Patients were assessed at posttreatment (6 weeks), 12 weeks, 24 weeks, 36 weeks, and 52 weeks. Linear mixed model analyses of reported pain indicated that both treatments yielded significant decreases in pain, with the STD+CBT condition resulting in steeper decreases in pain over time compared to the STD condition. Somatization, self-efficacy and readiness for treatment emerged as significant moderators of outcome, such that those low in somatization, or higher in self-efficacy or readiness, and treated with STD+CBT reported of lower pain over time. Somatization was also a significant moderator of treatment effects on pain-related interference with functioning, with those low on somatization reporting of less pain interference over time when treated in the STD+CBT condition. It was concluded that brief treatments can yield significant reductions in pain, life interference and depressive symptoms in TMD sufferers, and that the addition of cognitive-behavioral coping skills will add to efficacy, especially for those low in somatization, or high in readiness or self-efficacy.

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Treatment response to CBT and MBSR varies substantially between individuals.
“Although the group-level treatment effects may be similar, there is substantial individual variability in treatment response to CBT and MBSR.19,51”
From Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain (2023) · cites this paper as [51]
The Results (Tests of Moderators of Treatment; page not provided) report that self-efficacy altered response in the STD+CBT condition, supporting individual variability in CBT response among patients with TMD pain. This study compared standard treatment with standard treatment plus CBT; it does not address MBSR or variability in response to it. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Previous studies provide conflicting evidence on pain self-efficacy, pain catastrophizing, depressive symptoms, and treatment expectations as moderators and predictors in behavioral pain trials.
“Previous studies provide conflicting evidence for pain self-efficacy, pain catastrophizing, depressive symptoms, and treatment expectations as moderators and predictors in behavioral trials for pain.5,19,51,56,81,86”
From Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain (2023) · cites this paper as [51]
The Discussion (page unavailable) describes differences from Turner et al.’s moderator findings and says this study did not support a hypothesis involving depressive symptoms. The Results (page unavailable) identify pain self-efficacy as a moderator, while the paper also considers catastrophizing. These passages support conflicting evidence for some proposed moderators, but our copy does not address treatment expectations, so it does not support the full list. (LLM, conf=0.84)
Experimental — accuracy not yet measured
A study of CBT for temporomandibular disorder pain also found greater benefits for those with higher pain self-efficacy.
“A study of CBT for temporomandibular disorder pain also found greater benefits for those with higher pain self-efficacy.51”
From Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain (2023) · cites this paper as [51]

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Authors: Litt, M. D., Shafer, D. M., & Kreutzer, D. L.
Affiliations: University of Connecticut (US)
Corresponding author: Litt, Mark D.
ORCID: Litt, Mark D.
Shafer, David M.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2010-10
Volume: 151
Issue: 1
Pages: 110-116
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2010.06.030
PMC: PMC2939176
OpenAlex: W2097647917
Cited by: 118
References: 33
Citations by year: 2026: 5 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 9 · 2021: 3 · 2020: 7 · 2019: 6 · 2018: 8 · 2017: 11 · 2016: 5 · 2015: 12 · 2014: 6 · 2013: 11 · 2012: 7
FWCI: 11.79
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Dental and Craniofacial Research (R01-DE14607, R01DE014607)
National Center for Research Resources (M01RR006192, M01 RR 06192)
Topics: Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords: temporomandibular disorders, TMD pain, cognitive behavioral therapy, short-term treatment, pain interference, depressive symptoms, somatization, self-efficacy, moderators of treatment outcome, coping skills training
MeSH terms: Depression, Female, Humans, Longitudinal Studies, Male, Pain Measurement, Patient Compliance, Psychiatric Status Rating Scales, Temporomandibular Joint Disorders, Time Factors, Cognitive Behavioral Therapy, Treatment Outcome

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Brief cognitive-behavioral treatment for TMD pain: Long-term outcomes and moderators of treatment

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