[Graded balance in pain therapy : Risk factor-based approaches based on the avoidance-endurance model]

Cognitive behavioral therapy (CBT) is one of the most frequently used and effective procedures in pain psychotherapy. Nevertheless, meta-analyses exhibit significant variability in response to treatment. Graded balance interventions (GBI) are among the CBT measures with a specific indication for pain patients who, according to the avoidance-endurance model (AEM), exhibit dysfunctional pain processing with respect to fear-avoidant or suppressive pain responses.

The article presents the individual treatment approach of GBI, which is aimed at patients with subacute or chronic pain and an AEM-based dysfunctional pattern of pain processing. Based on the goal of enabling those affected to flexibly alternate between short-term relaxation and resumption of the respective activity with simultaneous pain relief, the concrete procedure is outlined as a model, illustrated by a case study and the preliminary empirical evidence is presented.

Based on selected empirical literature and clinical case reports, the approach of a modular form of CBT is presented, which, guided by a self-reported screening on pain processing, opens up an individually targeted psychological procedure that can effectively support medical measures.

Based on a large number of randomized, controlled clinical trials on the efficacy of CBT in patients with chronic pain in different locations, a first randomized long-term study with individually targeted GBI shows superiority over a standardized procedure in terms of reduction of pain intensity, impairment and emotional distress in patients with subacute radicular pain.

The use of GBI opens the way to individualization and thus greater homogenization of the approach, based on contrasting patterns of affective, cognitive and behavioral pain processing. The findings to date provide initial indications of the long-term effectiveness of GBI, although there is still a great need for research with respect to its superiority over generalized CBT and into assumed mechanisms of action.