Predictors of treatment outcome in cognitive behavioural therapy for chronic pain: a systematic review.

The aim of this systematic review was to synthesise the research identifying possible influences on CBT outcomes in chronic pain. Variations in the effectiveness of psychological therapies, such as CBT, in chronic pain have led to research investigating predictors of improved treatment outcomes. We identified randomised controlled and cohort studies of CBT for chronic pain, published between 1974 to 2nd August 2023, which identified predictors of CBT outcomes. Nineteen studies were included in the review. Baseline sociodemographic, physical and emotional factors that influence the outcomes of CBT for chronic pain were identified. The most commonly reported predictors of CBT outcome, with medium to large effect sizes, were anxiety, depression and negative cognitions about pain and coping. Sociodemographic predictors of outcomes demonstrated small effects and lacked replicability. There was variability across study designs, CBT delivery and outcomes measures. Further research is needed in chronic pain to identify the predictive factors which influence treatment outcomes, and consistency across study designs and outcome variables is needed to reduce heterogeneity. This review synthesised research identifying factors predicting outcomes of Cognitive Behavioural Therapy for chronic pain.The most commonly reported predictors of Cognitive Behavioural Therapy outcome, with medium to large effect sizes, were anxiety, depression, and negative cognitions about pain and coping. sociodemographic predictors of outcomes demonstrated small effects and lacked replicability.There is a move towards more individualised treatments in chronic pain.Our results suggest that decisions regarding Cognitive Behavioural Therapy for chronic pain should carefully consider baseline levels of anxiety, depression, and negative cognitions about pain.