Cognitive Vulnerabilities Predict Medical Outcome in a Sample of Pain Patients

Abstract

This study was designed to evaluate whether measures of specific cognitive vulnerabilities to psychopathology assessed prior to medical treatment are related to treatment outcome for outpatient pain patients. A sample of 71 consecutive admissions to an out-patient pain clinic was assessed at initial intake; 43 patients were reassessed at the termination of treatment or at one-year post-intake. Results from 19 of these patients for whom complete data were available indicate that three cognitive vulnerability variables derived from Weissman and Beck's (1978) Dysfunctional Attitude Scale, measures of ‘Dichotomous Thinking’, ‘Imperatives’ and ‘Vulnerability’, but not self-reported depression scores or pain severity ratings, predict clinician-rated global treatment outcome; a fourth vulnerability, ‘Need to Succeed’, was marginally related to outcome. One of the cognitive vulnerability measures, ‘Imperatives’, also predicted patient-rated post-treatment pain severity. Multiple regression analyses indicate that a combination of two cognitive vulnerability measures, ‘Vulnerability’ and ‘Imperatives’, predicted more than half of outcome variance after the effects of initial depression and initial pain severity were statistically controlled.