Brief Cognitive Behavioral Therapy For Chronic Pain: Results From a Clinical Demonstration Project in Primary Care Behavioral Health
Abstract
Objectives: Although cognitive behavioral therapy is an effective intervention for chronic pain, it is a lengthy treatment typically applied only in specialty care settings. The aim of this project was to collect preliminary effectiveness data for Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP), an abbreviated, modular form of treatment designed for use in primary care. Methods: A clinical demonstration project was conducted in which Brief CBT-CP was delivered to primary care patients by 22 integrated care providers practicing in the Primary Care Behavioral Health model of Veterans Health Administration primary care clinics. Brief measures were used at each appointment to collect patient-reported clinical outcomes. Results: One hundred eighteen patients provided sufficient data for analysis (male, 75%; mean age, 51.4 y). Multilevel modeling suggested that a composite measure of pain intensity and functional limitations showed statistically significant improvements by the third appointment (Cohen’s d =0.65). Pain-related self-efficacy outcomes showed a similar pattern of results but of smaller effect size (Cohen’s d =0.22). The exploratory analysis identified that Brief CBT-CP modules addressing psychoeducation and goal setting, pacing, and relaxation training were associated with the most significant gains in treatment outcomes. Discussion: These findings provide early support for the effectiveness of Brief CBT-CP when delivered by providers in every day Primary Care Behavioral Health settings. Results are discussed in relation to the need for additional research regarding the potential value of employing safe, population-based, nonpharmacological approaches to pain management in primary care.
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Brief CBT-CP delivered in a community setting in the USA showed improvements in pain intensity, functional limitations and pain-related efficacy outcomes.
“a Brief Cognitive Behavioural Therapy for Chronic Pain (Brief CBT-CP) delivered in a community setting in the USA showed improvements in pain intensity but importantly improvements in functional limitations and pain-related efficacy outcomes [44].”
The Brief CBT-PC demonstration project reported a medium effect size (d = 0.65) at the third appointment in pain intensity and functional limitations, but improvements diminished over subsequent visits.
“Interestingly, the Brief CBT-PC demonstration project (the only study of BHC-delivered treatment to date) reported medium effect size (d = 0.65) at the third appointment in pain intensity and functional limitations, but improvements diminished over subsequent visits [12].”
A study of Brief Cognitive Behavioral Therapy for Chronic Pain found that patients with musculoskeletal pain reported significantly less pain intensity, fewer functional limitations, and improved self-efficacy.
“One study to date examined BHC-delivered pain treatment using Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP) [11] and found that patients with musculoskeletal pain reported significantly less pain intensity, fewer functional limitations and improved self-efficacy [12].”
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- Authors
- Beehler, G. P., Murphy, J. L., King, P. R., Dollar, K. M., Kearney, L. K., Haslam, A., Wade, M., & Goldstein, W. R.
- Affiliations
- VA Western New York Healthcare System (US)
- University of South Florida (US)
- Syracuse VA Medical Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- Raymond G. Murphy VA Medical Center (US)
- Corresponding author
- Beehler, Gregory P.
- King, Paul R.
- Haslam, Aaron
- Goldstein, Wade R.
- ORCID
- Venue
- The Clinical Journal of Pain
- Published
- 2019-10
- Volume
- 35
- Issue
- 10
- Pages
- 809-817
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2958476193
- Cited by
- 39
- References
- 44
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 6
- FWCI
- 1.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- brief cognitive behavioral therapy, chronic pain, primary care, primary care behavioral health, veterans, pain intensity, functional limitations, pacing, relaxation training, psychoeducation, goal setting, non-pharmacological pain management, treatment effectiveness
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Primary Health Care, Cognitive Behavioral Therapy, Treatment Outcome, Chronic Pain
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