Mindfulness-Based Cognitive-Behavior Therapy (Mcbt) versus Virtual Reality (Vr) Enhanced Cbt, versus Treatment as Usual for Chronic Back Pain. a Clinical Trial

Abstract

IntroductionChronic pain is a major health care problem, while low back pain is one of the most frequent musculoskeletal disorders (Vos et al., 2012), affecting many aspects of everyday life, working life, emotional and social well-being, and quality of life. In a survey (Stewart et al., 2003), approximately 30% of people reported that, because of their back pain they were less able or unable to maintain an independent lifestyle and 40% said that their pain made them feel helpless and they could not function normally.In the last decade, cognitive-behavioral therapy (CBT) research on pain posited that pain catastrophizing, erroneous beliefs that pain disables, fear of movement or re-injury, maladaptive coping strategies, and negative outcome expectancies contributed to the future pain outcomes, associated emotional problems, and treatment-related improvement in patients with chronic low back pain (Vlaeyen & Linton, 2000). Consequently, the selected cognitions and behaviors targeted for change in cognitive behavioral (back) pain interventions (Jensen et al., 2001) refer to: (1) decreasing patient`s catastrophizing beliefs (beliefs that pain disables them and signals harm) and maladaptive strategies of coping with pain; (2) increasing healthy coping with pain strategies and patient`s beliefs regarding their capacity to control pain. Currently, CBT is considered the standard for chronic pain.Chronic pain patients have inbuilt ideas about pain in general and they develop further unrealistic beliefs about their own pain. Therefore, patients must be re-educated about the meaning of pain, they have to be know that although in acute pain hurt equals harm, in their case hurt does not equal harm. This reappraisal must be done before any other psychological intervention is attempted so that altering more complex cognitions about pain may be done (Turk & Fernandez, 1997). specific cognitive errors that patients with chronic pain often make in the way they interpret their pain are: (1) Catastrophizing - by focusing entirely on the worst possible scenario no matter the probability of its occurrence, The pain in my spine is so bad, it must be a sign of a tumor. I must be dying. (2) Overgeneralization - extrapolation from one or few instances to an extensive range of scenarios The failure of a past treatment means no future treatment will work for me. and (3) Selective abstraction - Focusing attention on selective pieces of information instead of looking at the whole picture, The only reflection of my quality of life is how much pain I am in rather than everything else going on.Such cognitions and emotional states are likely to generate maladaptive behaviors like avoidance, withdrawal, or aggressiveness that contribute to the suffering and dysfunction of the patient (Turk & Fernandez, 1997).Evidence-based psychological treatment techniques for chronic painSeveral studies have shown the efficiency of certain therapeutic techniques for chronic pain and chronic back pain associated problems. Some of the most important are: (1) cognitive restructuring, (2) virtual reality distraction, and (3) mindfulness.Cognitive restructuringThe general principles of cognitive restructuring can also be applied in the rehabilitation of patients with chronic pain (e.g., Turk & Fernandez, 1997). purpose of the intervention is that patients must become aware of their maladaptive beliefs and attitudes and how these relate to emotional distress and intensified pain. Maladaptive beliefs, attitudes and expectancies become main targets for modification . CBT is considered the golden treatment for chronic pain; however, the effect size is only a medium one (Morley et al., 1999), suggesting that current CBT protocols should be improved, for example by including new techniques. Two potentially useful techniques that could be used in addition to classical CBT are virtual reality distraction and mindfulness. …