Evidence based principles for the conduction of group psychotherapy with chronic pain patients

Objectives: To evaluate existing models of psychological therapies and identify trans-theoretical principles for practice that can be applied in support groups for chronic pain.Methods: 1. Systematic review and meta-analysis of mediators of psychological therapies for chronic pain; 2. Statistical analysis of clinical data collected from an NHS pain clinic to explore moderators of treatment improvement; 3. Reflexive thematic analysis of in-depth interviews with chronic pain patients to understand what patients identify as helpful or unhelpful aspects of therapy.Results: Study one: Meta-analysis supports the role of psychological flexibility, catastrophizing, and self-efficacy as mediators of treatment outcomes. Study two: Antidepressants were associated with larger improvements in depression symptomatology after therapy, and female patients attained larger reductions in pain intensity than men. Study three: Thematic analysis identified three overarching themes: 1. Experiencing compassionate peers and tailored care; 2. Personal enjoyment and subjective values; 3. Re-construction and recognition of one’s own value.Conclusion: Group therapy for chronic pain may welcome members of different ages and with different pain presentation, but it is important for the group of peers to establish and maintain a supportive and compassionate relationship. Psychological therapy for chronic pain should support patients in regaining the centre of their experience that is otherwise dominated by pain and reconnect them with a sense of self-efficacy and value. In doing so, treatments should recognise the synergy between an emotionally supportive environment and therapy as a process fostering a renovated and positive sense of functioning. Psychological flexibility seemed well suited to support this process but it should be combined with the resolution of the detrimental effects of self- loathing and catastrophizing. Treatment may support and motivate patients to identify and engage achievable goals that stem from their sense of identity, and that can be pursued in the here and now