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There is now a large body of
evidence on interventions that
really did offer psychological
treatment to people
with chronic pain and low
back pain within this.
There were several
systematic reviews.
Most of the trials included
cognitive behavioral therapy,
not necessarily delivered
by a psychologist.
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The systematic reviews report
that the effect size is shrinking.
In other words, the
original systematic review
that looked at all of this reported
an effect size of around 0.5,
which is a respectable moderate
effect size for improvement.
But as trials get better,
the effect size gets smaller,
and it's now only around 0.2.
We're getting much
better at doing trials.
The authors of the most recent
systematic review in 2012
report that the methodology
is improving all the time.
However, the delivery of treatment,
what is actually given to patients,
is not improving.
The dose is still diluted.
Fidelity and integrity
are not evident.
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The conclusion from
systematic reviews
is that cognitive behavioral
therapy is effective.
It improves mood.
It changes beliefs.
It increases social
and work engagement.
It decreases disability, and
it improves function, a little.
This is disappointing, considering
that the psychological obstacles
to recovery are robust, and we
would think that psychological
interventions that try and tackle
these would show a medium to large
effect size, but they don't.
