Internet-delivered CBT based interventions for adults with chronic pain: a systematic review and meta-analysis of RCT, 2022, Gandy et al

[Cheshire]

Abstract


This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021.

A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% confidence interval [CI] 0.21-0.35), depression (g = 0.43; 95% CI 0.33-0.54), anxiety (g = 0.32; 95% CI 0.24-0.40), pain intensity (g = 0.27; 95% CI 0.21-0.33), self-efficacy (g = 0.39; 95% CI 0.27-0.52) and pain catastrophizing (g = 0.31; 95% CI 0.22-0.39).

Moderator analyses found that interventions which involved clinician guidance had significantly greater effect sizes for interference/disability (g = 0.38), anxiety (g = 0.39), and pain intensity (g = 0.33) compared with those without (g = 0.16, g = 0.18, and g = 0.20, respectively).

Studies using an inactive control had greater effects for depression (g = 0.46) compared with active control trials (g = 0.22). No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy.

Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.



https://journals.lww.com/pain/fullt...vered_cognitive_and_behavioural_based.21.aspx

The authors say in the introduction that CBT results "in small beneficial effects for reducing outcomes of pain, disability, and distress among people with chronic pain."
So online CBT described as "efficacious" does mean as little efficacious as in person CBT...

 

[rvallee]

The authors say in the introduction that CBT results "in small beneficial effects for reducing outcomes of pain, disability, and distress among people with chronic pain."
So online CBT described as "efficacious" does mean as little efficacious as in person CBT...

Not that such results are any reliable, but given this is the nth confirmation that there is simply no difference between "highly-trained", lightly-trained, or simply replaced by an interactive pamphlet, how does it even make sense to employ people to do CBT? And here basically just as useless as ACT. Basically it probably has a tiny effect in a small subset of people with specific, rare, problems, but making this a generic treatment was always doomed to fail.

Not many jobs can be replaced by something as flimsy as simply automating a script. Very, very few, in fact. None that I know of, really. Roles, sure, especially dealing with information. That can be scripted. But entire jobs? Nope.