Enhance outcome efficacy. If patients have previously received several forms of pain
treatment, they may believe that nothing works. They are taught to believe in the
cognitive behavioural approach to pain treatment and that with their cooperation the
treatment will improve their condition.
Foster self-efficacy. Chronic pain sufferers may see themselves as passive and helpless.
They are taught to believe that they can be resourceful and competent.
Break up automatic maladaptive coping patterns. Chronic pain sufferers may have learnt
emotional and behavioural coping strategies that may be increasing their pain, such
as feeling consistently anxious, limping or avoiding exercise. They are taught to
monitor these feelings and behaviours.
Skills training. Once aware of the automatic emotions and behaviours that increase
their pain, pain sufferers are taught a range of adaptive coping responses.
Self-attribution. Chronic pain sufferers may have learnt to attribute any success to
others and failure to themselves. They are taught to accept responsibility for the
success of the treatment.
Facilitate maintenance. Any effectiveness of the cognitive behavioural treatment
should persist beyond the actual treatment intervention. Therefore, pain sufferers are
taught how to anticipate any problems and to consider ways of dealing with these
problems.
Within this model of pain treatment, Basler and Rehfisch (1990) set out to examine
the effectiveness of a cognitive behavioural approach to pain. In addition, they aimed to
examine whether such an approach could be used within general practice.
Methodology
Subjects Sixty chronic pain sufferers, who had experienced chronic pain in the head,
shoulder, arm or spine for at least six months, were recruited for the study from general
practice lists in West Germany. Subjects were allocated to either (1) the immediate treat-
ment group (33 subjects started the treatment and 25 completed it); or (2) the waiting
list control group (27 subjects were allocated to this group and 13 completed all
measures).
Design All subjects completed measures at baseline (time 1), after the 12-week treat-
ment intervention (time 2) and at six-month follow-up (time 3). Subjects in the control
group completed the same measures at comparable time intervals.
Measures At times 1, 2 and 3, all subjects completed a 14-day pain diary, which
included measures of:
Intensity of pain: the subjects rated the intensity of their pain from ‘no pain’ to ‘very
intense pain’ every day.
Mood: for the same 14 days, subjects also included in the diary measures of their
mood three times a day.
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