Effects of Including an Existential Perspective in a Cognitive-Behavioral Group Program for Chronic Pain: A Clinical Trial with 6 Months Follow-Up

Abstract

Objectives: This study investigates the efficacy of a standard cognitive behavioral group-program for chronic pain, in comparison with the same group program that integrates an existential perspective at treatment conclusion, 3-month, and 6-month follow-up. Design: This study is a quasi-experimental clinical trial with two treatment groups. Methods: We included 113 patients suffering from chronic pain who had been accepted for treatment at an interdisciplinary pain center. In addition to the specific therapy program, the patients received intense interdisciplinary treatment. Outcome measures include both pain-related disability and pain severity. Repeated-measures analyses of variance (ANOVAs) were used to test statistical significance, followed by tests of simple contrasts with pre-treatment as a reference-point. Results: Results indicated that the integration of an existential perspective leads to significantly lowered pain-related disability than the classic cognitive behavioral group-program. Additionally, existential aspects seem to be particularly important for patients with a spiritual orientation. The findings from this study support the importance of considering specific existential aspects in the cognitive-behavioral approach in treating chronic illness.

ACKNOWLEDGEMENTS

We thank Dr. Klaus Klimczyk, Dr. Susanne Babel, Dr. Oliver Kuhnt, Kerstin Harrabi, Dr. Maria Rime, Carina Hoeft, Monika Ehrlich, Dr. Ingo Haase, and all other team members of the Fachklinik Enzensberg for their thorough collaboration, which was essential for this study.

Notes

¹In contrast to Piaget (e.g., 1970) the concepts of “assimilation” and “accommodation” refer not to processes of adaptation of cognitive structures, but to different modes of eliminating aim-discrepancies and associated aversive emotions.

²A first incomplete analysis of pre-treatment vs. post-treatment is published in German (Gebler & Maercker, 2012).

Note: ETG = Existential Treatment Group; CTG = Control Treatment Group.

³The manuals (in German) can be requested by the first author.

Note: ETG = Existential Treatment Group; CTG = Control Treatment Group; All d_z are in comparison to pre-treatment.

Note: SS = sum of squares; df = degrees of freedom; MS = mean square deviation; F = ANOVA statistic; .

Note: ETG = Existential Treatment Group; CTG = Control Treatment Group; All d_z are in comparison to pre-treatment.

At the time of this study, the first author was affiliated with Fachklinik Enzensberg, Hopfen am See, Germany, where the study was conducted.

Additional information

Notes on contributors

Florian A. Gebler

Florian A. Gebler graduated in psychology at University of Trier/Germany in 2007. Qualification in “Logotherapy and Existential Analysis” based on Viktor E. Frankl. He is now working at a psychosomatic clinic of DRV Schwaben, Buching-Halblech, Germany.

Andreas Maercker

Andreas Maercker, received his MD at Humboldt University and his PhD at Max Planck Institute for Human Development in Berlin. In 2005 he was appointed as chair and full professor of Psychopathology and Clinical Intervention at the University of Zurich. He is co-director of the Institute's outpatient clinic services.