The group mechanism in treatment: group identification and cohesion contributes to reducing chronic lower back pain by increasing personal control

Abstract

Purpose

There is increasing recognition of the contribution that group processes, particularly identification and cohesion, make to outcomes of group delivered health treatments. This study examined the role that these particular group processes play in the treatment of lower back pain, and a theorised mechanism of personal control through which group treatment might enhance outcomes.

Methods

Participants (N = 85) elected to either receive NeuroHAB^®, a defined functional movement therapy of 8 weeks duration, or continue with treatment-as-usual (TAU). Pain intensity and disability were assessed at baseline (T1) and post-intervention or 8 weeks later (T2), as well as at a 1-month follow-up (T3). Only the NeuroHAB^® participants additionally completed weekly questionnaires that measured treatment group identification, cohesion, and personal control.

Results

NeuroHAB^® was significantly more effective than TAU in reducing pain intensity and disability at T2 and T3. Furthermore, among NeuroHAB^® recipients, stronger treatment group identification and cohesion early in the program predicted better pain outcomes over time, and this relationship was fully mediated by perceptions of personal control.

Conclusion

These data provide further support for the role of group identification and cohesion as a contributing mechanism of change in group-based treatments and extend this to the domain of pain management.

Implications for Rehabilitation

• A focus on defined functional movement therapy, as offered by the NeuroHAB^® group program, was found to improve pain outcomes in patients with lower back pain.

• A key ingredient in the NeuroHAB^® rehabilitation program was its group delivery.

• Group delivery supported treatment group identification and cohesion which, through enhancing the perception of personal control, reduced pain intensity and disability.

Keywords:

• Social identity
• group cohesion
• chronic pain
• low back pain
• NeuroHAB^®

Acknowledgements

The authors would like to thank the NeuroHAB team for their help in recruitment and the participants who took part in this research. The authors received no financial support for the research, authorship, and/or publication of this article.

Disclosure statement

Two authors (JG and DJ) manage the NeuroHAB^® program, but did not run any of the treatment groups, collect data from patients, or conduct the analyses. There are no other conflicts to declare.