title: Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain The Relative Efficacy of Three Cognitive-Behavioral Treatment Approaches to Temporomandibular Disorders Brief group cognitive-behavioral intervention for temporomandibular disorders Clinical analysis of mid-laser versus placebo treatment of arthralgic TMJ degenerative joints. Long-Term Efficacy of Biobehavioral Treatment of Temporomandibular Disorders A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. Efficacy of an early intervention for patients with acute temporomandibular disorder-related pain: a one-year outcome study. Brief cognitive-behavioral therapy for temporomandibular disorder pain: Effects on daily electronic outcome and process measures Essential Elements of Self-Help/Minimal Intervention Strategies for Smoking Cessation Cost-effectiveness of treatments for temporomandibular disorders: biopsychosocial intervention versus treatment as usual. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial
abstract: Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters The purpose of this study was to evaluate the relative efficacy of different biopsychosocial treatment conditions on patients with chronic temporom and ibular disorder . Ninety-four patients with chronic temporom and ibular disorder were assigned to either a biofeedback treatment group , a cognitive-behavioral skills training ( CBST ) treatment group , a combined ( combination of biofeedback/CBST ) treatment group , or a no-treatment control group .  Pain scores were analyzed pretreatment and posttreatment to determine group and within-subjects treatment effects . Results demonstrated that , in terms of a self-reported pain score , all three treatment groups had significantly decreased pain scores from pretreatment to posttreatment , while the no-treatment group did not . Moreover , patients in the biofeedback group were the most significantly improved compared to the no-treatment group . Finally , participants in the three treatment groups displayed significant improvement in mood states & NA ; Temporom and ibular disorders ( TMD ) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck , and the soft tissue and bony components of the temporom and ibular joint . Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem . In this report we present results from a r and omized clinical trial which compared , at 3‐ and 12‐month follow‐ups , the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive‐behavioral ( CB ) intervention delivered to small groups of patients before usual TMD treatment began . The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment . A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction . Patients who participated in the CB intervention followed by usual treatment showed greater long‐term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment . The benefits of CB intervention were not seen when the CB and UT groups were compared at 3‐month follow‐up . During the 3–12‐month follow‐up interval , however , the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve , as hypothesized . During this same follow‐up interval , the CB group also showed a strong trend toward continued improvement in pain interference . Such effects were not observed for depression , somatization , or clinical measures of jaw range of motion . Additionally , as hypothesized , dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention . Intent to treat analyses were also performed to assess generalizability of the results Laser therapy has been found effective in the management of  pain  associated with rheumatoid and degenerative joint arthritis and disease . The efficacy of mid-laser therapy has been tested specifically on patients with degenerative joint disease ( DJD ) involving the temporom and ibular joint ( TMJ ) . The following controlled clinical study was design ed to test the efficacy of mid-laser therapy to placebo therapy in the reduction of pain associated with TMJ disorders specific to arthralgic DJD This study evaluated the relative long-term efficacy of biofeedback , cognitive – behavioral skills training ( CBST ) , combined biofeedback and CBST ( Combined ) , and no-treatment comparison groups in 108 patients suffering from chronic temporom and ibular disorder ( TMD ) . After an initial evaluation , patients were assigned to one of the four treatment conditions . The three biobehavioral treatment interventions consisted of 12 st and ardized sessions . Patients were reevaluated 1 year after completing treatment . Results demonstrated that patients who received the biobehavioral treatments reported significant improvement in subjective pain , pain-related disability , and m and ibular functioning 1 year after receiving treatment . The no-treatment comparison group did not demonstrate such improvements . The combined biofeedback and CBST treatment produced the most comprehensive improvements across all outcome measures . These results again demonstrate the heuristic value of adopting a biopsychosocial perspective to the assessment and treatment of chronic medical/dental disorders such as TMD AIMS To test the usefulness of tailoring cognitive-behavioral therapy ( CBT ) for patients with temporom and ibular disorders ( TMD ) who demonstrated poor psychosocial adaptation to their TMD condition , independent of physical diagnosis . METHODS A r and omized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists . For study inclusion , Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) , Axis II criteria , were used to target patients with elevated levels of TMD pain-related interference with daily activities , independent of physical diagnosis ( i.e. , Axis I ) . RESULTS At the post-treatment assessment , about 4 months after the baseline evaluations , the comprehensive care group , when compared to the usual treatment group , showed significantly lower levels of characteristic pain intensity , significantly higher self-reported ability to control their TMD pain , and a strong trend ( P = .07 ) toward lower pain-related interference in daily activities . From post-intervention to 1-year follow-up , all subjects showed improvement . At the 1-year follow-up , the comprehensive care group , while not losing any of its early gains , was not significantly different from the usual care group with regard to reported levels of pain , ability to control pain , and levels of interference in activities . For many of these psychosocially disabled TMD patients , pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate r and omized clinical trial on the basis of better psychosocial adaptation . CONCLUSION The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment , but was too brief an intervention to result in further improvement after the sessions ended . Patient ratings of treatment satisfaction and helfulness were high for both groups , but they were significantly higher for the comprehensive care group BACKGROUND The authors conducted a r and omized clinical trial to evaluate the efficacy of a biopsychosocial intervention for patients who were at high risk ( HR ) of progressing from acute to chronic temporom and ibular disorder (TMD)-related pain . METHODS The authors classified subjects ' risk using a predictive algorithm and r and omized them into an early-intervention ( EI ) or a nonintervention ( NI ) group . The EI included cognitive behavioral skills training and biofeedback . The authors assessed pain and psychosocial measures at intake and at a one-year follow-up . Subjects '  self-reported pain levels were measured on an analog scale and as a response to palpation . RESULTS At one year , EI-group subjects had significantly lower levels of self-reported pain and depression . At one year , more NI-group subjects than EI-group subjects had utilized health care for jaw-related pain . NI-group subjects were 12.5 times as likely to have a somatoform disorder , more than seven times as likely to have an anxiety disorder , and 2.7 times more likely to have an affective disorder at one year , compared with EI-group subjects . CONCLUSIONS EI-group subjects had reduced pain levels , improved coping abilities and reduced emotional distress at one year . CLINICAL IMPLICATION S The TMD-related pain experience is complex and requires early identification with a biopsychosocial EI to achieve maximal , sustainable results & NA ; We used patient daily electronic ratings of outcome ( activity interference , pain intensity , jaw use limitations , negative mood ) and process ( pain‐related beliefs , catastrophizing , and coping ) variables to evaluate a brief cognitive‐behavioral ( CB ) treatment for chronic temporom and ibular disorder ( TMD ) pain . TMD clinic patients ( N=158 ) were assigned r and omly to four biweekly sessions of either CB pain management training ( PMT ) or an education/attention control condition [ self‐care management ( SCM ) ] and were asked to complete electronic interviews three times daily for the 8‐week treatment . We analyzed diary data from 126 participants who completed > 50 % of requested interviews for > 6 weeks . Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within‐subject change over time on the daily outcome measures , but consistently greater within‐subject improvement in the PMT group on the daily process measures . Significantly ( P<0.05 ) greater proportions of PMT than of SCM patients showed clinical ly important ( > 50 % ) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations . This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial , and supports the feasibility and utility of such methods . The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain , and in improving activity interference and jaw use limitations for a subgroup of patients . Longer‐term follow‐ups are ongoing to determine if there is an impact on outcomes over time Two decades of research suggest that self-help/minimal intervention strategies for smoking cessation * may be the preferred means by which smokers stop and can produce success rates approximating those of more formal programs , at lower cost and with greater access to relevant population s. In order to make the best possible use of these self-help/ minimal intervention approaches , the National Cancer Institute ( NCI ) supported a series of r and omized , controlled intervention trials and , in June of 1988 , convened an Expert Advisory Panel to address the question " What are the essential elements of self-help/ minimal intervention strategies for smoking cessation ? " . The panel 's recommendations were that : ( 1 ) Intervention efforts should focus on increasing smokers ' motivations to make serious quit attempts ; ( 2 ) Delivery of programs be broadened to include all smokers ; ( 3 ) Programs be targeted to stages of cessation and specific population s ; ( 4 ) All programs include ( a ) elements focused on health and social consequences of smoking , and ( b ) strategies and exercises aim ed at quitting , maintenance of nonsmoking , relapse preven tion , and recycling ; ( 5 ) Material s and programs be made widely available rather than " fine tuning " existing programs or developing new ones ; and ( 6 ) Programs make use of specific adjunctive strategies . In this way , a reacceleration of the decline in smoking prevalence may be realized in the 1990s and significantly contribute to the NCI 's Year 2000 goals and the Surgeon General 's aim of a smoke-free society BACKGROUND The authors conducted a r and omized clinical trial to evaluate the cost-effectiveness of a biopsychosocial intervention with patients who are at high risk ( HR ) of progressing from acute to chronic TMD-related pain . METHODS The authors classified 96 patients with acute TMD ( less than six months ' duration ) as HR according to a predictive algorithm and r and omized them into an early intervention ( EI ) or a nonintervention ( NI ) group . The NI group received a biopsychosocial treatment that included cognitive behavioral skills training and biofeedback . Both groups were followed up for one year . The authors collected TMD cost data throughout the year . RESULTS The authors found that the EI group spent significantly fewer jaw-related health care dollars , relative to the NI group , from intake to the one-year follow-up . CONCLUSION AND CLINICAL IMPLICATION S The reduced jaw-related health care expenditures for patients in the EI group compared with expenditures for patients in the NI group at one year suggest that an early biopsychosocial intervention is a cost-effective measure in dealing with often unnecessarily costly TMD-related pain Abstract We evaluated the short‐ and long‐term efficacy of a brief cognitive‐behavioral therapy ( CBT ) for chronic temporom and ibular disorder ( TMD ) pain in a r and omized controlled trial . TMD clinic patients were assigned r and omly to four sessions of either CBT ( n = 79 ) or an education/attention control condition ( n = 79 ) . Participants completed outcome ( pain , activity interference , jaw function , and depression ) and process ( pain beliefs , catastrophizing , and coping ) measures before r and omization , and 3 ( post‐treatment ) , 6 , and 12 months later . As compared with the control group , the CBT group showed significantly greater improvement across the follow‐ups on each outcome , belief , and catastrophizing measure ( intent‐to‐treat analyses ) . The CBT group also showed a greater increase in use of relaxation techniques to cope with pain , but not in use of other coping strategies assessed . On the primary outcome measure , activity interference , the proportion of patients who reported no interference at 12 months was nearly three times higher in the CBT group ( 35 % ) than in the control group ( 13 % ) ( P = 0.004 ) . In addition , more CBT than control group patients had clinical ly meaningful improvement in pain intensity ( 50 % versus 29 % showed ≥50 % decrease , P = 0.01 ) , masticatory jaw function ( P < 0.001 ) , and depression ( P = 0.016 ) at 12 months ( intent‐to‐treat analyses ) . The two groups improved equivalently on a measure of TMD knowledge . A brief CBT intervention improves one‐year clinical outcomes of TMD clinic patients and these effects appear to result from specific ingredients of the CBT
target: There is insufficient evidence to make firm recommendations for the use of CBT over other intervention for the treatment of TMD .
background: Cognitive-behavioural therapy ( CBT ) and its effects on  temporom and ibular disorders ( TMD ) have been examined in several studies .
  We are trying to combine results of these studies and to explore the effectiveness .