Unique and Shared Elements of Different Psychological Therapies for Chronic Pain: A Panel Discussion

Psychological therapies are some of the most effective treatments for chronic pain. They have been part of the pain treatment landscape since the development of behavior therapy and its offshoot, cognitive behavioral therapy (CBT). These therapies changed the way that pain was treated by demonstrating that psychological processes, including those related to threat and fear, could contribute to the development and maintenance of chronic pain. For that reason, CBT has long been considered the “gold-standard” psychological therapy for chronic pain. At the same time, there has been an expansion in new therapy types that use potentially novel methods and processes of change to address the threat mechanisms underlying chronic pain, including mindfulness, acceptance, and exposure-based approaches. There is considerable debate in the field about the extent to which newer therapies differ from the traditional CBT approach.

In this panel, four leading researchers in the field of chronic pain treatment will discuss the similarities and differences between four evidence-based psychological treatments for chronic pain:
- Frank Keefe will present the perspective of CBT. Dr. Keefe is the developer of the CBT pain coping skills therapy.
- Lance McCracken will present the perspective of Acceptance and Commitment Therapy (ACT), a prototype process-based therapy. Dr. McCracken was among the first to develop and test research applications of ACT to chronic pain.
- John (Drew) Sturgeon will present the perspective of Pain Reprocessing Therapy. Dr. Sturgeon is actively involved in several ongoing clinical trials testing the efficacy of PRT.
- Mark Lumley will present the perspective of Emotional Awareness and Expression Therapy (EAET). Dr. Lumley co-developed EAET to address the interpersonal and emotional mechanisms underlying pain.

The panel discussion will be moderated by early career pain researchers, Katherine McDermott and Katherine Gnall. Ana-Maria Vranceanu will serve as discussant.

Sample panel questions include:
- Discuss how your therapy conceptualizes chronic pain and its treatment of a typical patient.
- What are the common features of all psychological pain therapies?
- What are some of the key similarities and differences between your therapy and the other approaches? What is the single biggest innovation that your therapy offers and why is it important?
- Research has shown that purported distinct pain therapies operate via common mechanisms. Are there any unique mechanisms of your therapy or differences in how your therapy targets the common mechanisms?
- Is the primary goal of your therapy pain reduction or improved functioning? How well does your therapy accomplish its goal?
- How is the topic of pain recovery or cessation discussed in your therapy?
- Which patients, settings, and types of pain are most appropriate for your therapy and which patients/settings are less appropriate?
- How should practitioners and researchers decide on one approach versus another?