This Phase I research will assess the feasibility of tailored cognitive-behavior therapy, delivered using interactive voice response (IVR) telephone technology, to improve the outcomes of chronic back pain patients. Cognitive-behavior therapy (CBT) has consistently been shown to be an effective treatment for chronic pain. However, not all patients respond uniformly to CBT. Both patient-related and treatment-related factors undermine treatment effectiveness. Efforts to improve treatment participation and adherence have important implications for improving chronic back pain outcomes. Tailoring treatments to patients' psychosocial-behavioral characteristics could significantly enhance the efficiency and effectiveness of CBT. Combining clinically sensitive treatment matching and computer-automated telephone technologies offers the potential to extend more effective CBT to larger populations. In Phase I, we will create and test the usability, acceptance, and potential value of a working TCBT-IVR prototype among physicians and chronic back pain patients. We will use assessments we have developed and IVR software to deliver tailored CBT matched to each patient's stage of readiness to engage in therapy and to their personal preferences for learning, adopting and using specific pain coping skills. We hypothesize that tailored CBT will help chronic back pain patients participate more fully in their treatment by increasing their motivation and helping them learn, practice, and maintain specific pain coping skills that will improve their quality of life and productivity. Patients receiving tailored CBT will also improve treatment adherence and lower treatment refusal and dropout rates. Patients will maintain higher rates of use of adaptive pain coping skills and sustain treatment gains for longer periods of time. Our product goal is an interactive, telephone-based software application that will extend and strengthen the delivery of effective cognitive-behavioral therapy to larger numbers of patients who could benefit. If we are successful in Phase I, we will conduct an efficacy test of TCBT-IVR in Phase II. Our CBT-IVR, if successful, will have significant commercial potential in employer, payer, and provider markets.
