Implementation Outcomes
Implementation outcomes are measures of how well and how often Cognitive Behavioral Therapy for Chronic Pain is being implemented. Health outcomes are measures of whether Cognitive Behavioral Therapy for Chronic Pain works. Click the buttons on the left to read more about implementation outcomes and health outcomes that have been measured for Cognitive Behavioral Therapy for Chronic Pain, as well as to consider some potential research questions. In addition, view the RASC guide Integrating Implementation Outcomes into Effectiveness Studies for practical guidance on how to include implementation outcomes in your studies.
CBT-CP is impacted by stigma towards therapy, especially as it relates to pain management. However, providers undergoing CBT-CP training are shown to adhere to training and implement the practice.
Acceptability is assessed from the perspective of either the person delivering the intervention or the individual receiving the intervention and is defined as the perception that a given service is agreeable, palatable, or satisfactory.
The acceptability of CBT-CP has been assessed using qualitative open-ended interview questions regarding individual experiences and beliefs about treatment.
A trial compared CBT-CP-only treatment, physical exercise-only treatment, and CBT-CP combined with physical exercise conditions. Participants reported that CBT-CP was less relevant to them than physical exercise in managing their pain. This was largely due to their perception that CBT-CP did not fit with their view of pain as a physical condition and the stigma surrounding CBT-CP as a psychological therapy. Participants who received CBT-CP in combination with physical exercise were more likely to hold stigmatizing views of CBT-CP and view it as complementary to their exercise treatment.
In another study assessing the impact of CBT-CP on musculoskeletal chronic pain, two-thirds of participants attributed positive change to CBT-CP sessions (e.g., reduction in reported pain or improvement in perceptions of pain management abilities). The remaining participants believed their positive changes were due to other pain management interventions.
Fidelity refers to the degree to which an intervention is delivered as designed or intended. Sustainment is defined as the degree to which an intervention is practiced over time. Both of these implementation outcome measures can be obtained by episodic surveys or interviews with providers who can attest to the specific ways they practice, how their practices adhere to or differ from trained methods, and how their practice is sustained over time.
Among therapists that participated in the Veterans Health Administration’s national CBT-CP training program, six months post-training, approximately 2/3rds of the therapists reported they used CBT-CP with their care recipients and that they adhered to the manual approximately 3/4ths of the time.