The Impact of Optimism and Pain Interference on Response to Online Behavioral Treatment for Mood and Anxiety Symptoms.

2021 
To explore if 1) high pain interference has a negative effect on response to computerized cognitive behavioral therapy (cCBT) for anxiety and depression and 2) whether high optimism can buffer the negative effects of pain interference on cCBT outcomes. METHODS We performed a secondary analysis of data on 403 participants from the randomized controlled clinical trial "Online Treatment for Mood and Anxiety Disorders in Primary Care." It examined the impact of cCBT, with and without access to an internet support group, on health-related quality of life (HRQoL), mood, and anxiety symptoms. RESULTS High vs low pain interference had a negative effect on response to cCBT for physical HRQoL regardless of high or low optimism level (between group difference -3.46 (-5.89, -1.03) p=0.005 or -4.06 (-6.28, -1.85) p < 0.001 respectively). However, in the context of low optimism high pain interference only negatively impacted the effect of cCBT on mental HRQoL (3.68 (0.63, 6.73) p = 0.018) and anxiety symptoms (-2.61 (-4.87, -0.35) p = 0.024). Although the pattern of effects was similar for depressive symptoms, the between-group differences were not significant. CONCLUSIONS High optimism may buffer against the negative effects of pain interference on treatment response from cCBT. Primary care patients who report high pain interference yet also lack optimism may not receive as much benefit from cCBT as other groups. Furthermore, this study found an unexpected positive effect of low optimism on treatment response. For depressed and anxious patients with low pain interference, low optimism enhanced the impact of cCBT on mental HRQoL.TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT01482806.
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