A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress

Juan P Sanabria-Mazo; Ariadna Colomer-Carbonell; Óscar Fernández-Vázquez; Georgina Noboa-Rocamora; Gemma Cardona-Ros; Lance M McCracken; Antonio Montes-Pérez; Juan R Castaño-Asins; Sílvia Edo; Xavier Borràs; Antoni Sanz; Albert Feliu-Soler; Juan V Luciano

doi:10.3389/fpsyg.2023.1200685

A systematic review of cognitive behavioral therapy-based interventions for comorbid chronic pain and clinically relevant psychological distress

Front Psychol. 2023 Dec 22:14:1200685. doi: 10.3389/fpsyg.2023.1200685. eCollection 2023.

Authors

Juan P Sanabria-Mazo^{1

2

3}, Ariadna Colomer-Carbonell^{1

2

3}, Óscar Fernández-Vázquez^{1

4}, Georgina Noboa-Rocamora^{1

4}, Gemma Cardona-Ros¹, Lance M McCracken⁵, Antonio Montes-Pérez⁶, Juan R Castaño-Asins⁶, Sílvia Edo², Xavier Borràs^{2

3}, Antoni Sanz², Albert Feliu-Soler^{3

7}, Juan V Luciano^{1

3

7}

Affiliations

¹ Teaching, Research, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
² Department of Basic, Developmental and Educational Psychology, Autonomous University of Barcelona, Barcelona, Spain.
³ Centre for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
⁴ Faculty of Psychology, University of Barcelona, Barcelona, Spain.
⁵ Psychology Department, Uppsala University, Uppsala, Sweden.
⁶ Parc de Salut MAR, Barcelona, Spain.
⁷ Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain.

Abstract

Objective: Chronic pain frequently co-occurs with clinically relevant psychological distress. A systematic review was conducted to identify the efficacy of cognitive behavioral therapy-based interventions for patients with these comorbid conditions.

Methods: The systematic search was carried out in Medline, PsycINFO, Web of Science, and Scopus up to March 18th, 2023. Four reviewers independently conducted screenings, extraction, and quality assessment.

Results: Twelve randomized controlled trials and one non-randomized controlled trial involving 1,661 participants that examined the efficacy of Cognitive Behavioral Therapy (nine studies), Mindfulness-based Interventions (three studies), Acceptance and Commitment Therapy (one study), and Behavioral Activation Therapy for Depression (one study) were included. Compared to treatment as usual, six out of eight studies of traditional Cognitive Behavioral Therapy reported significant differences in the reduction of depressive symptoms at post-treatment (d from 1.31 to 0.18) and four out of six at follow-up (d from 0.75 to 0.26); similarly, five out of six reported significant differences in the reduction of anxiety symptoms at post-treatment (d from 1.08 to 0.19) and three out of four at follow-up (d from 1.07 to 0.27). Overall, no significant differences between traditional Cognitive Behavioral Therapy and treatment as usual were reported at post-treatment and follow-up in the studies exploring pain intensity and pain catastrophizing.

Conclusion: The available evidence suggests that traditional Cognitive Behavioral Therapy may produce significant benefits for the improvement of depression, anxiety, and quality of life, but not for pain intensity and pain catastrophizing. More evidence is needed to determine the effects of MBI, ACT, and BATD.

Systematic review registration: PROSPERO, CRD42021219921.

Keywords: anxiety; chronic pain; cognitive behavioral therapy; depression; distress; systematic review.

Publication types

Systematic Review

Grants and funding

This study has been funded by the Institute of Health Carlos III (ISCIII; PI19/00112; ICI20/00080) and has been co-financed with European Union ERDF funds. JS-M has a PFIS predoctoral contract from the ISCIII (FI20/00034). AC-C has a FI predoctoral contract from AGAUR (FI_B/00216).