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Guided Internet-Based Cognitive Behaviour Therapy for Chronic Pain
Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
2012 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Chronic pain is a one of the most common causes of disability and sick leave. Psychological factors play a central role in the experience of pain and are important in the management of pain. However, for many people with chronic pain CBT is not available. There is a need to develop alternative ways to deliver treatments that reach more individuals with chronic pain. Internet-based treatments have been shown to be effective for several disorders and recent research suggests that internet-based CBT for chronic pain can be effective. The present thesis included four randomized controlled studies with the aim of evaluating whether guided internet-based treatments based on CBT can help individuals with chronic pain regarding psychological variables.

Study I investigated the effects of an internet-based CBT intervention with telephone support for chronic back pain. The study showed reductions in some variables assessed.     

Study II investigated the effects of an internet-based CBT intervention for chronic back pain without telephone support and with a live structured interview before inclusion. It was found that the treatment can reduce some of the distress associated with chronic pain.

Study III investigated the effects of a guided internet-delivered CBT as a secondary intervention. Participants were patients who had previously completed multidisciplinary treatment at a pain management unit. Results showed that the internet-based treatment can be a feasible option for persons with residual problems after completed pain rehabilitation. Effects remained at six-month follow-up.   

Study IV focused on the effect of a guided internet-delivered acceptance and commitment therapy (ACT) for persons with chronic pain. Results suggest that an internet-delivered ACT treatment can help persons with chronic pain. Effects remained at six-month follow-up.

In conclusion, guided internet-based CBT can decrease distress associated with chronic pain.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2012. , 81 s.
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 83
Nyckelord [en]
Chronic pain, Cognitive Behaviour Therapy, Internet, Acceptance and Commitment Therapy, Guided self-help, Secondary intervention
Nationell ämneskategori
Psykologi
Forskningsämne
Psykologi
Identifikatorer
URN: urn:nbn:se:uu:diva-183326ISBN: 978-91-554-8516-0 (tryckt)OAI: oai:DiVA.org:uu-183326DiVA: diva2:562457
Disputation
2012-12-07, Sal IV, Universitetshuset, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2012-11-15 Skapad: 2012-10-24 Senast uppdaterad: 2013-01-23Bibliografiskt granskad
Delarbeten
1. Controlled trial of Internet-based treatment with telephone support for chronic back pain
Öppna denna publikation i ny flik eller fönster >>Controlled trial of Internet-based treatment with telephone support for chronic back pain
2004 (Engelska)Ingår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 111, nr 3, 368-377 s.Artikel i tidskrift (Refereegranskat) Published
Nationell ämneskategori
Psykologi (exklusive tillämpad psykologi)
Forskningsämne
Psykologi
Identifikatorer
urn:nbn:se:uu:diva-183336 (URN)10.1016/j.pain.2004.07.021 (DOI)15363881 (PubMedID)
Tillgänglig från: 2012-10-24 Skapad: 2012-10-24 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
2. Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial
Öppna denna publikation i ny flik eller fönster >>Guided internet-based cognitive behavioural treatment for chronic back pain reduces pain catastrophizing: a randomized controlled trial
Visa övriga...
2011 (Engelska)Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, nr 6, 500-505 s.Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: The aim of this study was to investigate whether an Internet-based cognitive behavioural intervention would have an effect on the symptoms of chronic back pain. Design: Experimental design with a treatment group and a control group measured before and after a treatment period. Subjects: Participants who met the criteria for chronic back pain (n = 54). Methods: All participants were screened in a live, structured interview before inclusion. The study period was 12 weeks and the treatment consisted of education, cognitive skills acquisition, behavioural rehearsal, generalization and maintenance. The main outcome of interest was the catastrophizing subscale of the Coping Strategies Questionnaire. Results: There were statistically significant reductions from pre- to post-treatment in catastrophizing in the treatment group, and an improvement in quality of life for the treatment group. However, most outcome measures did not indicate a positive treatment outcome. On a scale measuring pain catastrophizing, 58% (15/26) of the treated participants showed reliable improvement, compared with 18% (5/28) of the control group. Conclusion: Internet-based cognitive behavioural therapy can serve as a complement for individuals with chronic pain who prefer this treatment and have difficulties accessing specialist treatment facilities.

Nyckelord
chronic back pain, Internet-based treatment, pain management programme, minimal therapist contact, cognitive behavioural therapy
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-155234 (URN)10.2340/16501977-0805 (DOI)000291242400007 ()
Tillgänglig från: 2011-06-21 Skapad: 2011-06-20 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
3. Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation: Randomized controlled trial
Öppna denna publikation i ny flik eller fönster >>Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation: Randomized controlled trial
Visa övriga...
2013 (Engelska)Ingår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, nr 5, 753-765 s.Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohen's d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.

Nationell ämneskategori
Psykologi (exklusive tillämpad psykologi)
Identifikatorer
urn:nbn:se:uu:diva-183338 (URN)10.1002/j.1532-2149.2012.00244.x (DOI)000316810000013 ()23139021 (PubMedID)
Tillgänglig från: 2012-10-24 Skapad: 2012-10-24 Senast uppdaterad: 2017-12-07Bibliografiskt granskad
4. Guided Internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial
Öppna denna publikation i ny flik eller fönster >>Guided Internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial
Visa övriga...
2013 (Engelska)Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, nr 6, 307-315 s.Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain.

Nyckelord
Internet-delivered CBT, Chronic pain, Acceptance and commitment therapy, Mindfulness, Guided self-help
Nationell ämneskategori
Psykologi (exklusive tillämpad psykologi)
Identifikatorer
urn:nbn:se:uu:diva-183341 (URN)10.1016/j.brat.2013.02.010 (DOI)000319175400010 ()23548250 (PubMedID)
Tillgänglig från: 2012-10-24 Skapad: 2012-10-24 Senast uppdaterad: 2017-12-07

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