• John W Burns, Warren R Nielson, Mark P Jensen, Alicia Heapy, Rebecca Czlapinski, and Robert D Kerns.
• *Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL †Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, London, ON, Canada ‡University of Washington Medical Center, Seattle, WA §VA Connecticut Healthcare System, West Haven ∥Yale University School of Medicine, New Haven, CT.
• Clin J Pain. 2015 Jul 1;31(7):603-11.

ObjectiveTo examine the relative validity of 2 conceptual models-Specific, General-by which therapeutic mechanisms in cognitive-behavioral therapy (CBT) for chronic pain achieve favorable outcomes.MethodsAs part of a clinical trial of enhanced versus standard CBT, people with chronic pain received treatment consisting of 3 pain coping skill modules. In secondary analyses of a subsample (n=56), we examined pretreatment to session 4 (of 10 sessions) changes in Chronic Pain Coping Inventory subscales that corresponded to receipt of one of 3 modules; namely Relaxation, Exercise, and Cognitive Coping modules.ResultsFindings indicated that: (1) participants receiving the Relaxation module improved more than other groups in relaxation skills, and improved substantially on other coping skills, as well; (2) participants receiving Exercise and Cognitive Coping modules showed mixed improvements and did not improve more than other groups on exercise use or cognitive coping, respectively; and (3) measures of patient-therapist working alliance and patient expectations of treatment benefit at session three correlated significantly with some coping skills changes.DiscussionChange with CBT may occur both by theory-specified mechanisms and general mechanisms. However, the results provide the most support for a General Mechanism model in which changes on coping skills have spreading effects on the use of other coping skills. Significant relationships between some skill changes and indexes of patient-therapist working alliance and outcome expectations suggest that nonspecific factors also play a role in treatment-related changes in the use of pain coping strategies.

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