OBJECTIVE Cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain treatment produce outcome improvements. Evidence also suggests that changes in putative therapeutic mechanisms are associated with changes in outcomes. Nonetheless, methodological limitations preclude clear understanding of how psychosocial chronic pain treatments work. In this comparative mechanism study, we examined evidence for specific and shared mechanism effects across the three treatments. METHOD CT, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of "specific" mechanisms (pain catastrophizing, mindfulness, behavior activation) and outcomes. RESULTS CT, MBSR, and BT produced similar pre- to posttreatment effects on all mechanism variables, and all three active treatments produced greater improvements than TAU. Participant ratings of expectations of benefit and working alliance were similar across treatments. Lagged and cross-lagged analyses revealed that prior week changes in both mechanism and outcome factors predicted next week changes in their counterparts. Analyses of variance contributions suggested that changes in pain catastrophizing and pain self-efficacy were consistent unique predictors of subsequent outcome changes. CONCLUSIONS Findings support the operation of shared mechanisms over specific ones. Given significant lagged and cross-lagged effects, unidirectional conceptualizations-mechanism to outcome-need to be expanded to include reciprocal effects. Thus, prior week changes in pain-related cognitions could predict next week changes in pain interference which in turn could predict next week changes in pain-related cognitions, in what may be an upward spiral of improvement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

中文翻译：

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慢性腰痛患者的认知疗法、正念减压和行为疗法：一项比较机制研究。

目标 认知疗法 (CT)、正念减压 (MBSR) 和行为疗法 (BT) 用于慢性疼痛治疗可改善疗效。证据还表明，假定治疗机制的变化与结果的变化有关。尽管如此，方法上的局限性阻碍了对社会心理慢性疼痛治疗如何起作用的清晰理解。在这项比较机制研究中，我们检查了三种治疗的特定和共享机制效应的证据。方法 在慢性腰痛患者 (N = 521) 中比较 CT、MBSR、BT 和常规治疗 (TAU)。每周对“特定”机制（疼痛灾难化、正念、行为激活）和结果进行八次单独会议的评估。结果 CT、MBSR、和 BT 对所有机制变量产生了类似的治疗前后效果，并且所有三种积极治疗都比 TAU 产生了更大的改善。参与者对收益期望和工作联盟的评分在不同治疗中是相似的。滞后和交叉滞后分析表明，前一周机制和结果因素的变化预示着下周相应因素的变化。方差贡献分析表明，疼痛灾难化和疼痛自我效能的变化是后续结果变化的一致独特预测因子。结论 调查结果支持共享机制对特定机制的运作。考虑到显着的滞后和交叉滞后效应，单向概念化——结果机制——需要扩展以包括互惠效应。因此，前一周疼痛相关认知的变化可以预测下周疼痛干扰的变化，这反过来又可以预测下周疼痛相关认知的变化，这可能是一个螺旋上升的改善。（PsycInfo 数据库记录 (c) 2023 APA，保留所有权利）。