Self-Administered Psychotherapy for Chronic Non-Cancer Pain and Depression
Clinical Question: In adult individuals with a diagnosis of chronic non-cancer pain (CNCP) and depressive symptoms, do self-administered cognitive behavioral therapy (CBT) and mindfulness exercises decrease Numerical Pain Rating Scale (NPRS) scores? Purpose: CNCP negatively impacts quality of life, which is often exacerbated by a comorbid diagnosis of depression. The combination of chronic pain, depression, and low quality of life results in limited improvement when treating CNCP. Treatment methods for CNCP are typically focused on pharmacologic options that tend to carry higher treatment risks and negative outcomes. Despite evidence that psychological treatment options are beneficial for CNCP patients and depressed patients, there is a lack of access to these services. Focus must be directed on treating CNCP and depression together while simultaneously improving access to less utilized, safer treatment options such as CBT and mindfulness. Methods: A cross-sectional, single blind, randomized controlled study was conducted for CNCP adults with depressive symptoms. The independent variable of self-administered CBT and mindfulness techniques was performed for 8 weeks in the experimental group. The NPRS, Patient Health Questionnaire-9 (PHQ-9), and Quality of Life Scale (QOLS) were utilized in the control and experimental group to assess the dependent variables of pain severity, depression severity, and quality of life. Inclusion Criteria: Age 18 and older, diagnosis of CNCP, PHQ-9 score greater than or equal to 5, no thoughts of self-harm, access to a computer/smartphone, email address, ability to read and write in English. Analysis: SPSS and JMP software was utilized. A 2X2 mixed design ANOVA was run on each dependent variable. Homogeneity of covariances was tested with Levene’s test. Significance was set at p < .05. There was a marginally significant change in the experimental group for pain, however after Tukey correction p = .059 for NPRS scores. Implications for Practice: Self-administered CBT and mindfulness interventions may be effective in improving clinical outcomes for CNCP and depression. Further research is needed on self-administered psychotherapy to determine efficacy of this intervention as an adjunct management tool for chronic pain. This study data confirms that all individuals with CNCP should be screened for depression with a validated screening tool, as it is evident CNCP and depression occur in conjunction.
Sylvia, Julia M, "Self-Administered Psychotherapy for Chronic Non-Cancer Pain and Depression" (2021). Doctoral Dissertations. AAI28491779.