Alicia A. Heapy, PhD, Assistant Professor of Psychiatry, is the first author of a paper published in JAMA Internal Medicine that found interactive voice response-based cognitive behavioral therapy reduces chronic back pain and improves sleep.
Cognitive behavioral therapy (CBT) is a widely used treatment for chronic pain that has been shown to reduce pain intensity and associated disability and distress for a number of painful conditions. Though effective, people with pain experience many barriers to engaging in CBT for chronic pain.
Because CBT is delivered by specially-trained therapists who are most often located in cities or near large academic medical centers, it is not widely available, especially in rural areas. Also, in-person CBT requires 6-12 weekly office visits which can be burdensome to patients, especially those with transportation barriers or work or family-related commitments that make weekly appointments difficult. CBT delivery assisted by health technology can facilitate in-home treatment and obviate the need for in-person visits, but the effectiveness of this alternative to standard therapy is unknown.
Heapy and her research team conducted a randomized non-inferiority trial of interactive voice response-based CBT (IVR-CBT) versus standard in-person CBT in 125 patients with chronic back pain. IVR-CBT patients received a self-help manual and weekly pre-recorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. In-person CBT included weekly, individual CBT sessions with a therapist. Participants in both conditions received IVR monitoring of pain, sleep, activity levels, and pain coping skill practice during treatment.
The researchers found that IVR-CBT leads to significant reductions in pain intensity, pain-related interference and improvements in sleep. Participants in the IVR-CBT condition completed significantly more treatment weeks than those in in-person CBT and were less likely to drop out of treatment, perhaps because IVR-CBT was perceived as being less burdensome.
Overall, IVR-CBT was no less effective than standard CBT that is delivered in-person by a therapist. IVR-CBT is a low-burden alternative that can increase access to CBT for chronic pain and shows promise as a non-pharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT.