The non-specific effects of group-based cognitive--behavioural treatment of chronic pain

Group-based cognitive-behavioural therapy (CBT) for chronic, non-malignant pain is recognized as the treatment of choice for patients with intractable pain problems. The core components of CBT pain treatment have been standardized, and meta-analyses have shown that that this form of intervention is effective. However, the psychotherapy literature points to a range of influences on treatment outcome that arise out of the process of treatment, rather than directly from the active treatment components. These so-called non-specific treatment effects include the composition of the group, the leadership style of the group leader, and the ways in which group dynamics are dealt with. Although CBT pain management programmes are conducted in a group format, and are therefore subject to similar kinds of influences to other forms of group treatment, these issues have not been discussed in detail in any previous literature. The present paper proposes a number of non-specific treatment factors that are likely to be associated with positive outcomes from CBT pain management programmes, and discusses ways in which these factors may be deliberately manipulated in order to maximize treatment effectiveness.