Abstract
Cognitive-behavioral theory has played a leading role in the development of psychological interventions for individuals with pain conditions. This chapter outlines the effectiveness and nature of interventions, in particular those intended to reduce pain-related disability. The review is deliberately selective, focusing on interventions that have been systematically evaluated, with clinical references where possible. The following interventions will be discussed: behavioral/operant programs, back schools/information and education interventions, cognitive-behavioral interventions, stress management programs, acceptance and commitment therapy, cognitive processing therapy, risk factor-targeted interventions, and graded activity and exposure. The chapter concludes with key considerations in intervention selection, such as the inclusion of psycho-education, stress reduction, implications of secondary prevention, and risk factors related to chronicity.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Adams, H., Ellis, T., Stanish, W. D., & Sullivan, M. J. L. (2007). Psychosocial factors related to return to work following rehabilitation of whiplash injuries. Journal of Occupational Rehabilitation, 17(2), 305–315.
Alvarez, J., McLean, C., Harris, A. H., Rosen, C. S., Ruzek, J. I., & Kimerling, R. (2011). The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program. Journal of Consulting and Clinical Psychology, 79(5), 590–599.
Bailey, K., Carleton, N., Vlaeyen, J. W. S., & Asmundson, G. J. (2010). Treatments addressing pain-related fear and anxiety in patients with chronic musculoskeletal pain: A preliminary review. Cognitive Behaviour Therapy, 39, 46–63.
Crombez, G., Eccleston, C., Vlaeyen, J. W., Vansteenwegen, D., Lysens, R., & Eelen, P. (2002). Exposure to physical movements in low back pain patients: Restricted effects of generalization. Health Psychology, 21(6), 573–578.
D’Zurilla, T. (1971). Problem-solving and behavior modification. Journal of Abnormal Psychology, 78, 107–126.
D’Zurilla, T. (1990). Problem-solving training for effective stress management and prevention. Journal of Cognitive Psychotherapy, 4, 327–355.
Dysvik, E., Vinsnes, A. G., & Eikeland, O. J. (2004). The effectiveness of a multidisciplinary pain management programme managing chronic pain. International Journal of Nursing Practice, 10(5), 224–234.
Feuerstein, M., Huang, G., Shaheen, M., & Storey, J. (2000). Ergo-stress management for your health: Managing job stress and reducing ergonomic risk. Washington, DC: Monograph.
Feuerstein, M., Nicholas, R., Huang, G., Dimberg, L., Ali, D., & Rogers, H. (2004). Job stress management and ergonomic intervention for work-related upper extremity symptoms. Applied Ergonomics, 35, 565–574.
Forbes, D., Lloyd, D., Nixon, R. D., Elliott, P., Varker, T., Perry, D., et al. (2012). Multisite randomized controlled effectiveness trial of cognitive processing therapy for military-related posttraumatic stress disorder. Journal of Anxiety Disorders, 26(3), 442–452.
Fordyce, W. (1976). Behavioral methods in chronic pain and illness. St. Louis, MO: CV Mosby.
Fordyce, W., Fowler, R., Lehmann, J., & De Lateur, B. (1968). Some implications of learning in problems of chronic pain. Journal of Chronic Diseases, 21, 179–190.
Fordyce, W. E., Roberts, A. H., & Sternbach, R. A. (1985). The behavioral management of chronic pain: A response to critics. Pain, 22(2), 113–125.
Fordyce, W. E., Shelton, J. L., & Dundore, D. E. (1982). The modification of avoidance learning pain behaviors. Journal of Behavioral Medicine, 5(4), 405–414.
Gallagher, R. M. (2006). Problem-solving therapy for pain in the older adult. Pain Medicine, 7(5), 369.
Gatchel, R. (2004). Musculoskeletal disorders: Primary and secondary interventions. Journal of Electromyography and Kinesiology, 14, 161–170.
Gatchel, R. J., & Mayer, T. G. (2008). Evidence-informed management of chronic low back pain with functional restoration. The Spine Journal, 8(1), 65–69.
Gatchel, R., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581–624.
Gatchel, R., Polatin, P., Noe, C., Gardea, M., Pulliam, C., & Thompson, J. (2003). Treatment - and cost-effectiveness of early intervention for acute low back pain patients: A one-year prospective study. Journal of Occupational Rehabilitation, 13, 1–9.
Gauthier, N., Sullivan, M. J., Adams, H., Stanish, W. D., & Thibault, P. (2006). Investigating risk factors for chronicity: The importance of distinguishing between return to work status and self-report measures of disability. Journal of Occupational and Environmental Medicine, 48(3), 312–318.
George, S. Z., Zeppieri, G., Jr., Cere, A. L., Cere, M. R., Borut, M. S., Hodges, M. J., et al. (2008). A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain, 140(1), 145–157.
Goubert, L., Francken, G., Crombez, G., Vansteenwegen, D., & Lysens, R. (2002). Exposure to physical movement in chronic back pain patients: No evidence for generalization across different movements. Behaviour Research and Therapy, 40(4), 415–429.
Guzman, J., Esmail, R., Karjalainen, K., Malmivaara, A., Irvin, E., & Bombardier, C. (2002). Multidisciplinary bio-psychosocial rehabilitation for chronic low-back pain. The Cochrane Database of Systematic Reviews, 9(1), CD000963. doi:10.1002/14651858.CD000963.
Hay, E. M., Mullis, R., Lewis, M., Vohora, K., Main, C., Watson, P. J., et al. (2005). Comparison of physical treatments versus a brief pain management programme for back pain in primary care: A randomised clinical trial in physiotherapy practice. Lancet, 365, 2024–2030.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford Press.
Heymans, M. W., van Tulder, M. W., Esmail, R., Bombardier, C., & Koes, B. W. (2004). Back schools for non-specific low-back pain. Cochrane Database of Systematic Reviews, 4, CD000261.
Heymans, M. W., van Tulder, M. W., Esmail, R., Bombardier, C., & Koes, B. W. (2005). Back schools for nonspecific low back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine, 30(19), 2153–2163.
Keefe, F. J., Abernethy, A. P., & Campbell, L. C. (2005). Psychological approaches to understanding and treating disease-related pain. Annual Review of Psychology, 56, 601–630.
Keefe, F. J., & France, C. (1999). Pain: Biopsychosocial mechanisms and management. Current Directions in Psychological Science 8, 137–141.
Kerns, R. D., Sellinger, J., & Goodin, B. R. (2011). Psychological treatment of chronic pain. Annual Review of Clinical Psychology, 7, 411–434.
Lazarus, R., & Folkman, S. (1984). Stress, appraisal and coping. New York, NY: Springer.
Leeuw, M., Goossens, M. E., Linton, S. J., Crombez, G., Boersma, K., & Vlaeyen, J. W. (2007). The fear-avoidance model of musculoskeletal pain: Current state of scientific evidence. Journal of Behavioral Medicine, 30(1), 77–94.
Linton, S. (2000). Utility of cognitive-behavioral psychological treatments. In A. Nachemson & E. Jonsson (Eds.), Neck and back pain: The scientific evidence of causes, diagnosis, and treatment. Philadelphia, PA: Lippincott, Williams & Wilkins.
Linton, S., Bradley, L., Jensen, I., Spangfort, E., & Sundell, L. (1989). The secondary prevention of low back pain: A controlled study with follow-up. Pain, 36, 197–207.
Linton, S. J., & Kamwendo, K. (1987). Low back schools: A critical review. Physical Therapy, 67(9), 1375–1383.
Linton, S., & Ryberg, M. (2001). A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: A randomized controlled trial. Pain, 90, 83–90.
Macea, D. D., Gajos, K., Daglia Calil, Y. A., & Fregni, F. (2010). The efficacy of Web-based cognitive behavioral interventions for chronic pain: A systematic review and meta-analysis. The Journal of Pain, 11(10), 917–929.
Main, C., Sullivan, M. J. L., & Watson, P. J. (2007). Pain management: Practical applications of the biopsychosocial perspective in clinical and occupational settings. Edinburg, UK: Churchill Livingstone.
McAllister, M. J., McKenzie, K. E., Schultz, D. M., & Epshteyn, M. G. (2005). Effectiveness of a multidisciplinary chronic pain program for treatment of refractory patients with complicated chronic pain syndromes. Pain Physician, 8(4), 369–373.
McCracken, L. M. (2005). Contextual cognitive therapy for chronic pain. Seattle, WA: IASP Press.
McCracken, L. M., & Eccleston, C. (2006). A comparison of the relative utility of coping and acceptance-based measures in a sample of chronic pain sufferers. European Journal of Pain, 10(1), 23–29.
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43(10), 1335–1346.
Melzack, R., & Wall, P. (1965). Pain mechanisms: A new theory. Science, 150, 971–979.
Meng, K., Seekatz, B., Roband, H., Worringen, U., Vogel, H., & Faller, H. (2011). Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: A randomized controlled trial. The Clinical Journal of Pain, 27(3), 248–257.
Monson, C. M., Schnurr, P. P., Resick, P. A., Friedman, M. J., Young-Xu, Y., & Stevens, S. P. (2006). Cognitive processing therapy for veterans with military-related post-traumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907.
Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive-behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain, 80, 1–13.
Moseley, G. L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130–140.
Moseley, G. L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain Neurorehabilitation and Neural Repair, 26, 646–652.
Moseley, L.G., Nicholas, M.K., Hodges, P.W. (2004). A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain. Clinical Journal of Pain, 20, 324–330.
Nezu, A., & Perri, M. (1989). Social problem-solving therapy for unipolar depression: An initial dismantling investigation. Journal of Consulting and Clinical Psychology, 57, 408–413.
Otis, J. D., Keane, T. M., Kerns, R. D., Monson, C., & Scioli, E. (2009). The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder. Pain Medicine, 10(7), 1300–1311.
Palermo, T. M., Wilson, A. C., Peters, M., Lewandowski, A., & Somhegyi, H. (2009). Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain. Pain, 146(1–2), 205–213.
Rogerson, M. D., Gatchel, R. J., & Bierner, S. M. (2010). A cost utility analysis of interdisciplinary early intervention versus treatment as usual for high-risk acute low back pain patients. Pain Practice, 10(5), 382–395.
Sanders, S. H. (1996). Operant conditioning of chronic pain: Back to basics. In R. Gatchel & D. C. Turk (Eds.), Psychological approaches to pain management. New York, NY: Guilford.
Smeets, R. J., Vlaeyen, J. W., Hidding, A., Kester, A. D., van der Heijden, G. J., & Knottnerus, J. A. (2008). Chronic low back pain: Physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain, 134(3), 263–276.
Staal, J. B., Hlobil, H., van Tulder, M. W., Waddell, G., Burton, A. K., Koes, B. W., et al. (2003). Occupational health guidelines for the management of low back pain: An international comparison. Occupational and Environmental Medicine, 60(9), 618–626.
Sullivan, M. J. L. (2003). Emerging trends in secondary prevention of pain-related disability. Clinical Journal of Pain, 19, 77–79.
Sullivan, M. J. L., & Adams, H. (2010). Psychosocial techniques to augment the impact of physical therapy interventions for low back pain. Physiotherapy Canada, 62(3), 180–189.
Sullivan, M. J. L., Adams, H., Rhodenizer, T., & Stanish, W. D. (2006a). A psychosocial risk factor-targeted intervention for the prevention of chronic pain and disability following whiplash injury. Physical Therapy, 86(1), 8–18.
Sullivan, M. J., Adams, H., Thibault, P., Corbiere, M., & Stanish, W. D. (2006b). Initial depression severity and the trajectory of recovery following cognitive-behavioral intervention for work disability. Journal of Occupational Rehabilitation, 16(1), 63–74.
Sullivan, M. J. L., Adams, H., & Ellis, T. (2012). Targeting catastrophic thinking to promote return to work in individuals with fibromyalgia. Journal of Cognitive Psychotherapy, 26, 12–25.
Sullivan, M. J. L., Feuerstein, M., Gatchel, R. J., Linton, S. J., & Pransky, G. (2005a). Integrating psychological and behavioral interventions to achieve optimal rehabilitation outcomes. Journal of Occupational Rehabilitation, 15, 475–489.
Sullivan, M. J. L., & Simon, G. (2012). A telephonic intervention for promoting occupational re-integration in work-disabled individuals with muscuoloskeletal pain. Translational Behavioral Medicine, 2, 22–32.
Sullivan, M. J. L., Ward, L. C., Tripp, D., French, D. J., Adams, H., & Stanish, W. D. (2005b). Secondary prevention of work disability: Community-based psychosocial intervention for musculoskeletal disorders. Journal of Occupational Rehabilitation, 15(3), 377–392.
Thorn, B., Boothy, J., & Sullivan, M. (2002). Targeted treatment of catastrophizing for the management of chronic pain. Cognitive and Behavioral Practice, 9, 127–138.
Turk, D. (1966). Biopsychosocial perspective on chronic pain. In R. Gatchel & D. Turk (Eds.), Psychological approaches to pain management. New York, NY: Guilford.
Turk, D. (2002). Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain, 18, 355–365.
Turk, D., Meichenbaum, D., & Genest, M. (1983). Pain and behavioral medicine: A cognitive-behavioral perspective. New York, NY: Guilford.
Van den Hout, J., Vlaeyen, J., Heuts, P., Zijlema, J., & Wijnen, J. (2003). Secondary prevention of work-related disability in non-specific low back pain: Does problem-solving therapy help? A randomized clinical trial. Clinical Journal of Pain, 19, 87–96.
Van Tulder, M. W., Esmail, R., Bombardier, C., & Koes, B. W. (2002). Back schools for non-specific low back pain. Cochrane Database of Systematic Reviews, 2, CD000261.
Vlaeyen, J. W., de Jong, J., Geilen, M., Heuts, P. H., & van Breukelen, G. (2001). Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain. Behaviour Research and Therapy, 39(2), 151–166.
Vlaeyen, J. W., de Jong, J., Geilen, M., Heuts, P. H., & van Breukelen, G. (2002a). The treatment of fear of movement/(re)injury in chronic low back pain: Further evidence on the effectiveness of exposure in vivo. Clinical Journal of Pain, 18(4), 251–261.
Vlaeyen, J. W., De Jong, J. R., Onghena, P., Kerckhoffs-Hanssen, M., & Kole-Snijders, A. M. (2002b). Can pain-related fear be reduced? The application of cognitive-Behavioral exposure in vivo. Pain Research & Management, 7(3), 144–153.
Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85(3), 317–332.
Vowles, K. E., & McCracken, L. M. (2008). Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. Journal of Consulting and Clinical Psychology, 76(3), 397–407.
Waddell, G. (1998). The back pain revolution. Edinburgh, UK: Churchill Livingstone.
Waddell, G., & Burton, A. K. (2001). Occupational health guidelines for the management of low back pain at work: Evidence review. Occupational Medicine (London), 51(2), 124–135.
Wall, P. D. (1979). On the relation of injury to pain. The John J. Bonica lecture. Pain, 6(3), 253–264.
Whitfill, T., Haggard, R., Bierner, S. M., Pransky, G., Hassett, R. G., & Gatchel, R. J. (2010). Early intervention options for acute low back pain patients: A randomized clinical trial with one-year follow-up outcomes. Journal of Occupational Rehabilitation, 20(2), 256–263.
Williams, A. C., Pither, C. E., Richardson, P. H., Nicholas, M. K., Justins, D. M., Morley, S., et al. (1996). The effects of cognitive-behavioral therapy in chronic pain. Pain, 65(2–3), 282–284.
Zachrisson-Forsell, M. (1981). The back school. Spine, 6, 104–106.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this chapter
Cite this chapter
Sullivan, M.J.L. (2016). Cognitive-Behavioral Approach to Return to Work. In: Schultz, I., Gatchel, R. (eds) Handbook of Return to Work. Handbooks in Health, Work, and Disability, vol 1. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7627-7_20
Download citation
DOI: https://doi.org/10.1007/978-1-4899-7627-7_20
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4899-7626-0
Online ISBN: 978-1-4899-7627-7
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)