Risk-targeted behavioral activation for the management of work disability associated with comorbid pain and depression: a feasibility study

Michael J L Sullivan; Timothy H Wideman; Nathalie Gauthier; Pascal Thibault; Tamra Ellis; Heather Adams

doi:10.1186/s40814-022-01040-0

Risk-targeted behavioral activation for the management of work disability associated with comorbid pain and depression: a feasibility study

Pilot Feasibility Stud. 2022 Apr 23;8(1):90. doi: 10.1186/s40814-022-01040-0.

Authors

Michael J L Sullivan¹, Timothy H Wideman², Nathalie Gauthier³, Pascal Thibault⁴, Tamra Ellis⁵, Heather Adams⁶

Affiliations

¹ Department of Psychology, McGill University, Montreal, QC, H3A 1G1, Canada. Michael.Sullivan@McGill.ca.
² School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
³ Clinique de Consultation Conjugale et Familiale Poitras-Wright, Coté, Longueuil, QC, Canada.
⁴ Department of Psychology, McGill University, Montreal, QC, H3A 1G1, Canada.
⁵ Centre for Rehabilitation and Health, Toronto, ON, Canada.
⁶ University Centre for Research and Disability, Halifax, Nova Scotia, Canada.

Abstract

Purpose: The purpose of the present study was to conduct a preliminary evaluation of the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with comorbid pain and depression.

Methods: The design of the study was a single-arm non-randomized trial. The sample consisted of 66 work-disabled individuals with comorbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice, and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up.

Results: The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were "very" or "completely" satisfied with their involvement in the treatment program. Significant reductions in pain (Cohen's d = 0.71), depression (d = 0.86), catastrophic thinking (d = 1.1), and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, and perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes.

Conclusions: Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with comorbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with comorbid pain and depression.

Trial registration: ClinicalTrials.gov: NCT0517442 . Retrospectively registered.

Keywords: Depression; Musculoskeletal; Pain; Rehabilitation.

Abstract

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