National dissemination of cognitive-behavioral therapy for chronic pain in veterans: therapist and patient-level outcomes.

Journal Article (Journal Article)

OBJECTIVE: This paper assesses the effects of training in and implementation of Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) in the US Department of Veterans Affairs (VA) health care system on therapists' CBT-CP competencies and patients' pain-related outcomes. METHODS: A total of 71 therapists participated in the VA CBT-CP Training Program. Patients included 148 Veterans treated by therapist training participants. Therapists completed a 3-day workshop followed by 6 months of weekly consultation. Therapy session tapes were rated by expert training consultants using a standardized competency rating form. Patient outcomes were assessed with measures of patient-reported pain intensity, pain-related cognitions, overall distress, depression, pain interference, and quality of life. The therapeutic alliance was also assessed. RESULTS: Among the 71 therapists who participated in the training program, 60 (85%) completed all training requirements, including competency-based performance criteria. Of the 148 Veteran patients treated, 117 (79%) completed all CBT-CP protocol sessions. Intent-to-treat analyses indicated significant improvements in pain catastrophizing, interference, quality of life, and other domains, as well as on the therapeutic alliance. DISCUSSION: Training in and implementation of CBT-CP in the VA health care system were associated with significant increases in therapist competencies to deliver CBT-CP and improvements in several domains for Veteran patients. Results support the feasibility and effectiveness of broad dissemination of CBT-CP in routine, nonpain specialty settings.

Full Text

Duke Authors

Cited Authors

  • Stewart, MO; Karlin, BE; Murphy, JL; Raffa, SD; Miller, SA; McKellar, J; Kerns, RD

Published Date

  • August 2015

Published In

Volume / Issue

  • 31 / 8

Start / End Page

  • 722 - 729

PubMed ID

  • 25171637

Pubmed Central ID

  • 25171637

Electronic International Standard Serial Number (EISSN)

  • 1536-5409

Digital Object Identifier (DOI)

  • 10.1097/AJP.0000000000000151


  • eng

Conference Location

  • United States