Intervention
Barriers and facilitators (sometimes called "contextual determinants") are factors that make it harder or easier to implement Cognitive Behavioral Therapy for Chronic Pain. These factors span multiple levels. Click the buttons on the left to read more about common barriers and facilitators for Cognitive Behavioral Therapy for Chronic Pain. In addition, view the RASC guides on Contextual Determinants Affecting Implementation and the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) to learn practical ways to assess these constructs.
CBT-CP can be delivered in a wide range of formats and is well-suited for various delivery settings, though specific settings and formats may present obstacles.
Barriers
Group delivery of CBT-CP presents specific barriers for some individuals. In group settings, participants may have mixed feelings about the group facilitators (e.g., being too strict or too relaxed with managing group dynamics), feeling unsupported by other group members, not having shared experiences with other group members (e.g., chronic pain or military service), or beliefs that group therapy could not provide relief for their specific individual experience of pain.
Individuals with chronic pain may have difficulty sitting in one position for a significant period of time. Physical discomfort from sitting through longer sessions can be a barrier to in-person CBT-CP therapy for some.
Telephone delivery may be less personal, impacting the quality of the therapeutic relationship and reducing the effectiveness of CBT-CP. Computer-based interventions may feel too rushed, repetitive, or not personalized to their own needs.
Facilitators
Participants in groups appreciate support from other patients with chronic pain and the ability to share pain management strategies. Additionally, group-based CBT-CP can be more cost-effective than individual-based interventions.
While CBT-CP approaches vary, homework and self-management resources can play a modest role in the effectiveness of CBT-CP treatment. These materials can serve as reminders of CBT-CP methods for participants to use outside of therapy sessions. Some participants may like the ease of access to additional resources. Others may find that standard CBT-CP materials are less applicable to their personal experience of pain, can be repetitive, or are difficult to navigate. In addition to therapist-guided sessions, self-management materials can be useful when tailored to specific chronic pain conditions and have a specific identifiable use outside of therapy sessions (e.g., daily goal setting).
Virtual delivery of CBT-CP can address geographical and time barriers that may be especially pertinent for individuals with chronic pain due to a common barrier of discomfort associated with driving long distances. When CBT-CP is delivered online, participants report appreciating the availability and variety of materials published online, the increased access to CBT-CP, and their ability to complete the materials on their schedule.