Category: Treatment - CBT

Symposium

Heterogeneity of Treatment Effects Between Literacy-Adapted Group CBT for Chronic Pain and Pain Education

Keywords: Pain | Randomized Controlled Trial | Psychotherapy Outcome
Presentation Type: Symposium

Presenter(s)

• BV

  Benjamin Van Dyke, M.A.

  The University of Alabama

  Nothing to disclose

BACKGROUND: Understanding how different populations respond to different treatments can better enable providers to meet individual needs, giving patients the best chance to be successful. Furthermore, research on heterogeneity of treatment effects can provide valuable feedback on how successfully treatments have been adapted for target populations, such as the current study on literacy-adapted psychosocial treatments for pain.

METHODS: The Learning About My Pain (LAMP) study is a comparative effectiveness trial of literacy-adapted group cognitive-behavioral therapy for chronic pain (CBT) vs. pain education (EDU) vs. medical treatment-as-usual (TAU) at low-income health centers in AL. 241 participants completed the post-treatment assessment (83%). Analyses used the PROCESS macro for SPSS (Hayes, 2012) to evaluate potential sociodemographic and cognitive moderators of the differences between the treatment groups at post-treatment on primary and secondary outcome variables (pain severity, pain interference, and depression). All analyses controlled for pre-treatment scores.

RESULTS: Years of education and literacy (WRAT grade-level equivalent) significantly moderated (p < .05) the difference between CBT and EDU on pain severity, and age and working memory (Backward Digit Span) were marginally significant (p < .10). Age, literacy, and working memory were significant moderators of treatment effect on pain interference. Age significantly moderated the treatment effect on depression, and minority status was marginally significant.

CONCLUSION: This unique study reached patients from low-income settings with multiple disparities. CBT was carefully tailored to reduce cognitive demands; EDU was similarly adapted but without specific skills training. Patients who benefitted most from CBT were older, had lower working memory, lower literacy, were minorities, and had fewer years of education. Younger patients, those with higher working memory or higher literacy, non-minorities, or those who had more years of education received greater benefit from EDU. These data suggest that literacy-adapted CBT more successfully met the needs of those with multiple disadvantages.