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Cognitive Behavioral Therapy for Depression and Anxiety in an Interdisciplinary Rehabilitation Program for Chronic Pain: a Randomized Controlled Trial with a 3-Year Follow-up

Abstract

Purpose

Cognitive behavioral therapy (CBT) is known to be effective for treating depression and anxiety in patients with chronic pain, but there is limited research studying the long-term benefits of CBT in this population. The present study evaluated the effects of CBT provided in the context of an interdisciplinary pain management program with a 3-year follow-up.

Methods

One hundred fifteen patients with chronic musculoskeletal pain participated in an interdisciplinary pain management program. Eighty of these patients meeting criteria for CBT treatment were randomized to receive or not receive CBT for depression and anxiety in addition to rehabilitation pain management. The remaining 35 patients constituted a second comparison group. Follow-up data were collected 1 and 3 years post-treatment with 19% of the patients dropping out after 1 year and 34% after 3 years. Attrition analysis did not indicate that there was significant attrition bias in the data.

Results

All three groups evidenced improved depression following treatment (p < 0.001). The pre- to post-treatment effect sizes (Cohen’s d) for depression in the CBT treatment group was large (ES = 1.36). The CBT treatment group maintained improvements on all measures at a 3-year follow-up, while the comparison groups did not. This was especially evident with respect to depression (pre-treatment to 3 years follow-up ES = 1.35 and between-group ES = 0.57). Before treatment, 36% of all the patients reported that they were able to work. At 3 years post-treatment, 59%, 58%, and 44% of the patients were working who were in the CBT treatment group, the Comparison group, and the Non-CBT group, respectively.

Conclusion

The results indicate that providing CBT for depression and anxiety as part of a rehabilitation pain management program may enhance the long-term benefits of treatment. This finding, if replicated in additional studies, has important clinical and economic implications.

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Acknowledgements

We will like to thank the staff at the Reykjalundur Rehabilitation Center pain clinic.

We thank Professor Stephen Morley for invaluable advice in writing this paper and Anton Örn Karlsson for advice on statistics.

Funding

The study was funded by The Icelandic Research Center (RANNÍS).

Clinical Study Registration Number: VSNa2003060024/03.1

Some (but not all) of the findings presented here were reported at the IASP (International Association for the Study of Pain) 16th world congress in Japan 2016.

Author information

Correspondence to Magnús Ólason.

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Conflict of Interest Statement

The authors declare that they have no conflict of interest.

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Ólason, M., Andrason, R.H., Jónsdóttir, I.H. et al. Cognitive Behavioral Therapy for Depression and Anxiety in an Interdisciplinary Rehabilitation Program for Chronic Pain: a Randomized Controlled Trial with a 3-Year Follow-up. Int.J. Behav. Med. 25, 55–66 (2018) doi:10.1007/s12529-017-9690-z

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Keywords

  • Cognitive behavioral therapy
  • Chronic musculoskeletal pain
  • Depression and anxiety
  • Long-term follow-up
  • Pain management