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Single-Session Psychodynamic Interview For People With Chronic Musculoskeletal Pain And Childhood Adversity: A Randomized Controlled Trial
Date of Award
Mark A. Lumley
There are considerable costs of chronic musculoskeletal pain, both for the individual and for society. Chronic pain is known to be influenced by psychosocial trauma and interpersonal conflicts. In particular, childhood adversity is thought to precipitate the onset of chronic pain in adulthood, yet the most widely used psychological interventions for pain do not address such experiences. Prior research demonstrates that emotion-focused and psychodynamic treatments are effective at reducing pain and improving physical and psychological functioning. Two prior studies also demonstrate that a single-session of an emotion-focused intervention can lead to meaningful benefits for individuals which chronic pain. Chronic musculoskeletal pain is the most prevalent and costly chronic pain condition, and the single-session intervention has yet to be tested for this population. Given the focus of these interventions on unresolved emotional conflicts, it is likely that individuals who report histories of substantial stress or trauma would be most likely to benefit. In addition, the evidence that interpersonal problems contribute to pain symptoms suggests the need to focus explicitly on interpersonal traumas and conflicts, as opposed to emotions and stress more generally. Finally, the growing use of telehealth suggests the value of testing an internet-administered, single-session interview. To address the limitations of prior research and extend the literature, a single-session psychodynamic interview was developed that targets emotional and interpersonal conflicts related to childhood adversity. The present study tested the interview’s effects on pain-related and psychological outcomes. Adults (N = 91; ages 21 to 70, M = 44.64; 87.9% women) reporting chronic axial or widespread musculoskeletal pain and at least 3 adverse childhood experiences on the 10-item ACE were recruited from community sources. Participants completed online measures of pain-related outcomes, emotional distress, and pain attributions at baseline and 6-week follow-up. Participants were randomized to immediate interview or waitlist control (WLC) conditions. The 90-minute interview was conducted remotely via video, and the interviewer elicited disclosure of adverse experiences and relationship conflicts, linked these with pain, and encouraged the experience and expression of avoided, adaptive emotions. RM-ANOVAs produced significant condition x time interactions for pain interference (p = .016, ηp2 = 0.05), pain-related anxiety (p = .008, ηp2 = 0.06), and both psychological (p < .001, ηp2 = 0.15) and brain attributions (p = .022, ηp2 = 0.05) for pain, indicating that the interview led to greater improvements on these outcomes than WLC. Conditions did not differ on change in depression, anger, or pain severity, although pain reduced significantly in the interview condition (p = .003, d = -0.33) but not WLC (p = .16, d = -0.17), and findings trended in the expected direction for depression and anger. The present findings indicate that addressing childhood adversity and emotional conflicts in an interview is beneficial for people with CMP. In addition, this study demonstrates that the interview can be effectively administered via telehealth, which may help to expand utilization and access to this treatment.
Krohner, Shoshana, "Single-Session Psychodynamic Interview For People With Chronic Musculoskeletal Pain And Childhood Adversity: A Randomized Controlled Trial" (2022). Wayne State University Dissertations. 3637.