Change of cognition in psychological pain therapy: A meta-analysis of the cognitive-behavioral model

The cognitive-behavioral model postulates a relationship between changes in behavior and changes in cognition. The present meta-analysis aims to inves tigate cognition in the course of cognitive-behavioral therapy for patients with chronic pain. Inclusion criteria were: prospective controlled design with randomized assignment of patients, cognitive-behavioral treatment, mea surement of cognitive variables pre and post treatment, reported means and standard deviations for experimental and control conditions, and a minimum sample size of 5 for each treatment group. Fourteen studies with a total of 569 chronic headache or low back I pain patients met these criteria. For h eadache patients, cognitive variables show an effect size of d+ = 0.88 (a s trong effect), whereas in low back pain patients the effect size is d+ = 0. 30 (a weak effect). Both effect sizes are statistically significant and of clinical relevance. The data show that cognitive-behavioral therapy results in an improvement of pain-related cognitions, The magnitude of the cogniti ve changes depends on the pain diagnosis. Effect sizes of cognition are rel ated to those of depression and disability in back pain patients. Results s upport the cognitive-behavioral model. Further research will have to addres s the interrelation between cognition and behavior in the treatment process .