Findings suggest that cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain produce improvements through changes in putative mechanisms. Evidence supporting this notion is largely based on findings showing significant associations between treatment mechanism variables and outcomes. An alternative view is that treatments may work by reducing or decoupling the impact of changes in mechanism variables on changes in outcomes. We examined the degree to which relationships between previous changes in potential treatment mechanisms and subsequent changes in outcomes changed as treatment progressed and vice versa. Cognitive therapy, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of putative treatment mechanisms and outcomes. Lagged analyses revealed mechanism × session number interactions and outcome × session number interactions, such that associations between mechanism and outcome variables were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. These effects were similar across treatment conditions but did not emerge among people undergoing TAU. Results suggest that during the course of CT, MBSR, and BT, the links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes and vice versa. Thus, starting by midtreatment and continuing into late treatment, participants may have learned through participation in the treatments that episodes of maladaptive pain-related thoughts and/or spikes in pain need not have detrimental consequences on their subsequent experience.

中文翻译：

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认知疗法、基于正念的减压和慢性疼痛的行为疗法的治疗机制和结果脱钩效应。


研究结果表明，认知疗法 （CT）、基于正念的减压 （MBSR） 和针对慢性疼痛的行为疗法 （BT） 通过改变假定机制产生改善。支持这一观点的证据主要基于显示治疗机制变量和结果之间存在显着关联的研究结果。另一种观点认为，治疗可能通过减少或解耦机制变量变化对结局变化的影响而起作用。我们检查了潜在治疗机制的先前变化与随后结局变化之间的关系随着治疗进展而变化的程度，反之亦然。在慢性腰痛患者中比较认知疗法、 MBSR 、 BT 和常规治疗 （TAU） （N = 521）。进行了 8 次单独的会议，每周评估推定的治疗机制和结果。滞后分析揭示了机制×会话编号相互作用和结果 × 会话编号相互作用，因此机制和结果变量之间的关联在治疗的前三分之一是强烈且显着的，但随着时间的推移而减弱，到治疗的后三分之一变得不显著。这些影响在不同治疗条件下相似，但在接受 TAU 的人群中没有出现。结果表明，在 CT 、 MBSR 和 BT 过程中，治疗机制变量变化之间的联系与随后的结果变化脱钩，反之亦然。因此，从治疗中期开始一直持续到晚期治疗，参与者可能已经通过参与治疗了解到，适应不良的疼痛相关想法和/或疼痛尖峰的发作不一定会对他们随后的经历产生不利影响。