Therapist-patient correspondence in internet-based CBT for chronic pain: Associations with outcome and adherence

Guided Internet-based Cognitive Behavioral Therapy (iCBT) typically involves text correspondence with a clinician who provides feedback and answers questions during the course of the treatment. Previous research indicates that therapist guidance can improve outcomes. A few studies show that therapists' type of feedback, and possibly participant's choice of questions, are associated with treatment adherence and outcome. While a small number of studies have been published on this topic, few has reported on both therapist and patient correspondence in the same study, and to our knowledge no studies have been published on correspondence in iCBT for patients with chronic pain.

The aim of the current study was to characterize therapist-participant correspondence and to examine whether specific behaviors correlate with treatment adherence and/or clinical outcomes in a guided, individually tailored iCBT for individuals with chronic pain and psychological distress.

Data were obtained from a previously published randomized controlled trial (Gasslander et al., 2022). The study included 1240 therapist messages and 609 participant messages, which were coded using two separate coding schemes. Proportions of coded behaviors were analyzed through correlations to explore associations between therapist-participant communication patterns, treatment adherence (defined as the number of completed treatment steps), and treatment outcomes (pre-to post treatment change scores).

Participant and therapist behaviors were identified and comparisons with previous studies revealed notable similarities and differences. Correlational analyses showed associations both between and within therapist and participant behaviors. No significant associations were observed between specific behaviors and outcome. However, several observed behaviors demonstrated significant correlations with treatment adherence.

Distinct therapist and participant behaviors can be identified in guided iCBT for individuals with chronic pain. While the relationship with treatment outcome is unclear, adherence to treatment seems to be related to the specific types of behaviors exhibited in the text-based correspondence.