Pike, AR; (2014) The parts are greater than the sum of the whole. Exploring the Process of Change in a Pain Management Programme using Single Case Study Design. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

This three-part thesis reviews the effectiveness of psychological interventions for chronic non-cancer pain on healthcare use and sick leave from work, and explores the process of change in a pain management programme using single case methods. Part 1 is a meta-analysis of 16 randomised controlled trials of psychological interventions in a chronic pain population. Small to moderate effect sizes were found for reduced healthcare use but no significant benefit for sick leave. Part 2 is a study using single case design methodology to explore trajectories of change in 8 patients attending a CBT-based chronic pain management programme. Baseline, intervention and bi-weekly follow-up self-report of catastrophic thinking, mood, self-efficacy, and goal attainment, and of process variables of working alliance and adherence, were supplemented by a post treatment change telephone interview which was qualitatively analysed. Detailed examination of change for each participant provided rich data: three participants improved significantly over the course of the programme, three deteriorated, and all improved in at least one goal. Therapeutic alliance was high and participants rated central elements of the programme, explanations of their pain, and peer support/group membership as important. Part 3 is a critical appraisal of the study and the review, contrasting the approaches, and concluding with a personal reflection on the process.

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