Cognitive Behavioral Therapy for Chronic Pain in Veterans: Evidence for Clinical Effectiveness in a Model Program

The U.S. Department of Veterans Affairs (VA) has been training clinicians in its cognitive behavioral therapy for chronic pain (CBT-CP) structured protocol since 2012. The aim of this project was to review patient outcomes to determine the effectiveness of the VA's CBT-CP treatment. From 2012-2018, 1,331 Veterans initiated individual CBT-CP treatment as part of the training program. Patient outcomes were assessed with measures of patient-reported pain intensity, pain catastrophizing, depression, pain interference, and quality of life (physical, psychological, social, and environmental). Mixed models of the effects of time indicated significant changes across pretreatment, midtreatment, and treatment conclusion on all outcomes. There was a large effect size (Cohen's d = 0.78) for pain catastrophizing, and there were medium to large effect sizes (d > 0.60) for worst pain intensity, pain interference, depression, and physical quality of life. Systematic training of therapists and implementation of the VA's CBT-CP protocol yielded significant patient improvements across multiple domains. This offers strong support for the VA's CBT-CP as an effective, safe treatment for Veterans with chronic pain and highlights it as a model to increase the availability of training in standardized, pain-focused, evidence-based, behavioral interventions. The findings suggest that the broad dissemination of such training, including in routine, nonpain specialty settings, would improve patient access to effective, nonpharmacological treatment options in both the public and private sectors. Impact Statement Clinical guidelines recommend cognitive behavioral therapy (CBT) as a first-line treatment for individuals with chronic pain, but the availability of trained clinicians remains less than adequate. This evaluation of 1,331 Veterans who initiated cognitive behavioral therapy for chronic pain (CBT-CP) treatment as part of the U.S. Department of Veterans Affairs National Evidence-Based Psychotherapy Training Program found significant improvements in patient outcomes. There is a need to increase access to evidence-based nonpharmacological approaches for pain management, and these findings suggest that the broad dissemination of clinician training in CBT-CP would help improve outcomes for individuals with chronic pain conditions in both the public and private sectors.