Pain, ChronicNCT04907656
Assessment of the Efficacy of Digital CBT for Anxiety in Adults With Chronic Musculoskeletal Pain
A study testing dCBT in people with Pain, Chronic and Pain, Musculoskeletal, run by Boston University Charles River Campus at 1 site in United States.
Trial summary
The present study involves a randomized clinical trial of Digital Cognitive Behavioral Therapy (dCBT) targeting worry and anxiety symptoms in a population with chronic pain and clinical levels of generalized anxiety disorder (GAD) symptoms. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Pain, Chronic, Pain, Musculoskeletal, Anxiety
- What is being tested?
- dCBT
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 86 participants
- Where
- 1 siteUnited States
- Study dates
- 15 Feb 2022to 26 Apr 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Chronic musculoskeletal pain patients engaged in noninvasive treatments
- Age 18 or older
- Post acute phase of chronic pain
- Clinical levels of Generalized Anxiety Disorder (GAD) (operationalized by a score of ≥10 on GAD-7)
Who cannot join
- Factors that may impede the utilization of digital intervention (non-English speaker/literate; no access to a digital device; severely vision impaired, or severe cognitive impairment)
- Pending acute surgery or with a life prognosis of fewer than 6 months
- Current daily opioid use
- The presence [by self-report] of schizophrenia, psychosis, bipolar disorder, seizure disorder, or current substance use disorder (other than nicotine)
- The ability to isolate the effects of the intervention (initiation or change of psychotropic medication dosage within past 4 weeks, received CBT for anxiety in last 3 months)
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Initial Assessment of the Feasibility and Efficacy of a Scaleable Digital CBT for Generalized Anxiety and Associated Symptoms in a Chronic Musculoskeletal Pain Population
The present study involves a randomized clinical trial of Digital Cognitive Behavioral Therapy (dCBT) targeting worry and anxiety symptoms in a population with chronic pain and clinical levels of generalized anxiety disorder (GAD) symptoms. The clinical trial calls for the recruitment and randomization of 80 individuals with chronic musculoskeletal pain and clinical levels of GAD symptoms to either a dCBT program or a waitlist (Control) condition. The current research represents the first-step investigation of a treatment strategy with the potential to enhance care for patients with chronic pain by introducing a scalable, affordable, and system-friendly digital intervention (dCBT) that targets a prominent source of distress and associated disability in these patients. The investigators propose that by targeting GAD in chronic pain in a way that does not tax engagement in ongoing medical care provision, there is the potential to improve the uptake of effective care and to address both GAD and associated distress and disability.
Read the detailed description
An emerging body of research points to the significant impact of generalized anxiety disorder (GAD) on the functioning of adults with chronic pain. The importance of managing stress and anxiety is central to the fear/avoidance models of chronic pain, and fears of pain are elevated in those with GAD. Furthermore, the incidence of GAD is significantly higher in patients with chronic pain than in the general population. Likewise, severity of pain, degree of disability, opioid use, and medical costs have been found to be higher among those with comorbid GAD compared to those with chronic pain alone. The treatment of GAD in a chronic pain population has the potential to benefit pain-related distress and disability in addition to direct benefits on GAD and related quality of life.
Cognitive Behavior Therapy (CBT) is an excellent choice for targeting GAD symptoms in a chronic pain population. CBT is a recommended first-line treatment for GAD according to international guidelines. Despite the potential benefits of treatment, individuals with GAD face significant barriers in accessing CBT, including limitations on the availability of trained therapists, the costs and burden of in-person therapy, and stigma issues. These barriers are likely magnified for individuals with chronic pain who also face their own stigma issues as well as a high medical appointment burden. An innovative solution for overcoming these barriers and providing CBT for GAD at scale is to offer well-validated digital treatment that can be delivered by smartphones, tablets, or computers. Digital CBT (dCBT) offers a cost-effective and scalable alternative to in- person CBT with comparable maintenance of treatment gains to in-person CBT at four-year follow-up. Interest in digital health solutions is evident in those with chronic pain, and digital treatment may also offer a strategy for addressing the significant racial and ethnic disparities in care as well as disparities in the degree of psychological distress reported for those with chronic pain. At this time, however, the efficacy of dCBT for GAD has not been evaluated in patients with chronic pain.
The study contains two phases, with only Phase 2 being registered here. Following the achievement of benchmarks from Phase I, Phase 2 is a randomized clinical trial of Digital Cognitive Behavioral Therapy (dCBT) targeting worry and anxiety symptoms in a population with chronic pain and clinical levels of generalized anxiety disorder (GAD) symptoms. The dCBT under study is a commercially available smartphone application that provides weekly intervention sessions in 4 modules. An initial assessment drives an algorithm to personalize the program and individuals will have 10 weeks to complete the treatment. This randomized clinical trial calls for the recruitment and randomization of 80 individuals to either the dCBT program or a waitlist (control) condition. Specific aims for this project are:
- To show that dCBT leads to lower GAD symptoms relative to the control condition.
- To evaluate whether dCBT leads to greater changes in the secondary worry, mood, sleep, quality of life, and anxiety sensitivity outcomes than the control condition.
- To evaluate whether dCBT leads to lower pain distress and disability outcomes than the wait-list control condition.
- Conditions
- Pain, Chronic, Pain, Musculoskeletal, Anxiety
- Being tested
- dCBT
- Keywords
- Anxiety, Worry, Depression, Sleep difficulties, Anxiety sensitivity, Pain intensity, Pain interference
- Medical subject headings
- Chronic Pain, Musculoskeletal Pain, Anxiety Disorders, Depression, Pain
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
dCBTBehavioural
Also called Daylight
As per arm of the same name
| Study group | Role | What they receive |
|---|---|---|
| dCBT Condition | Experimental | The dCBT used in this study (Daylight) was selected due to its noted efficacy in treating GAD. 25 interventions will be provided in four modules, with an average duration of 20 minutes. Sessions are unlocked weekly, and completion of an initial assessment drives an algorithm to personalize the program. Individuals may progress through treatment at a slower pace than weekly sessions; 10 weeks is allowed for treatment completion. Treatment is based on principles of applied relaxation, stimulus control, cognitive restructuring, and imaginal exposure. Participants schedule a time for each session and receive prompts if they miss the appointment. All interventions are aided by the use of an animated therapist. Receives: Behavioral: dCBT |
| Waitlist (control) Condition | No intervention | Participants allocated to the waitlist (control) condition will not receive an active intervention during the study. Participants will still complete all scheduled study assessments. They will receive access to the dCBT after completion of all study assessments. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Anxiety Severity
The Generalized Anxiety Disorder 7 (GAD 7) is a self-report measure that assesses the full range of symptoms associated with GAD. Responses are summed to create a composite score, with higher scores indicating more severe anxiety. Composite scores range from 0 to 21.
Measured: Week 10
Secondary outcomes (13)
Worry Severity
The Penn State Worry Questionnaire (PSWQ) is a self report measure of worry. Responses are summed to create a composite score, with higher scores indicating more severe worry. Composite scores range from 16 to 80.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Depression
The Patient Health Questionnaire (PHQ-8) is a self report measure of depression symptoms experienced in the past two weeks. It excludes the suicide item of the PHQ-9.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Sleep Difficulty
The Sleep Condition Indicator (SCI) is a self-report measure used to assess sleep related difficulties and insomnia based on the DSM-5 criteria. All 8 items are summed to create the composite score. Possible composite scores range from 0 to 32, with higher scores indicating better sleep.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Health status
The Short Form Health Survey (SF-12) is a self-report measure that assesses quality of life related to both physical and mental health. This measure does not have public scoring details and uses a weighted scoring algorithm. The average of select items is computed for subscale scores (physical and mental). Scores range from 0 to 100, with higher scores indicating better health/well-being and no disability.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Anxiety sensitivity
The Anxiety Sensitivity Index (ASI-3) is a self-report measure that assess three dimensions of anxiety sensitivity: fear of physical symptoms, fear of cognitive dyscontrol, and fear of social concerns. All 18 items are summed to create the composite score, with higher scores indicating more severe anxiety sensitivity.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Clinician-rated anxiety severity
The Hamilton Anxiety Rating Scale (HARS) will be administered per the structured interview guide for this instrument to provide a clinician-rated measure of anxiety severity. Detailed scoring instructions are available in the interview guide; composite scores range from 0 to 56, with higher scores indicating more severe distress and impairment.
Measured: Week 0 (baseline), Week 10 (post-intervention)
Pain intensity
The Brief Pain Inventory (BPI) is a self-report measure with 4 items used to assess pain severity. The severity score is the mean of the 4 items. Scores can range from 0 to 10, with higher scores indicating more intense pain.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain interference/disability
The BPI is a self-report measure with 7 items used to assess pain disability/interference. The interference score is the mean of the 7 items. The mean can be used if 50%, or 4 of the 7, items are completed. Scores can range from 0 to 10, with higher scores indicating more complete interference.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Fear of pain
The Pain Anxiety Symptoms Scale (PASS-20) is a self-report used to assess fear of pain. Responses are summed to create a composite score, ranging from 0 to 100 with higher scores indicating more severe fear of pain
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain medication use
Use of pain medication and other pain interventions will be assessed with a self-report form developed by the research team for use in this study. Based on a composite scoring of medication dosages reported by participants, pain medication use at week 6 and week 10 will be coded as an increase, decrease, or steady state from the baseline dosages.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain catastrophizing
The Pain Catastrophizing Scale (PCS) is a self-report measure used to assess catastrophic thinking related to pain. Responses to all 13 items are summed to create a composite score, with higher scores indicating more severe catastrophic thinking. Scores range from 0 to 52.
Measured: Week 0 (baseline), week 6, week 10 (post-intervention)
Anxiety Severity
The Generalized Anxiety Disorder 7 (GAD 7) is a self-report measure that assesses the full range of symptoms associated with GAD. Responses are summed to create a composite score, with higher scores indicating more severe anxiety. Composite scores range from 0 to 21.
Measured: Week 0 (baseline), week 3, week 6
Resolution of clinical GAD
The proportion of participants no longer meeting GAD-7 clinical severity, operationalized as a score of less than 10 at the week 10 evaluation. Scoring will be the same as described for the GAD-7 above.
Measured: Week 10 (post-intervention)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Jun 2021
- Study start15 Feb 2022
- Primary completion26 Apr 2023
- Study completion26 Apr 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Pain, ChronicStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Model description
- Participants will be randomly assigned to either the dCBT app or a waitlist (control) condition with a 1.5:1 allocation (dCBT:Control) using a blocked randomized sequence. If initially allocated to the control condition, participants will be given access to the dCBT app after week 10 (that is, after the post-treatment evaluation, participants in the control group will be provided (crossed over to) dCBT).
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 86 participants (actual)
Sponsor and investigators
- Lead sponsor
- Boston University Charles River Campus
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Michael Otto, Boston University Charles River Campus
- Investigators
- Michael W Otto, PhD, Principal investigator, Boston University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04907656
- Sponsor's protocol ID
- 5975E
- Status last verified
- Jul 2023
- First submitted
- 18 May 2021
- Last updated
- 21 Jul 2023
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 21 Jul 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Initial Assessment of the Feasibility and Efficacy of a Scaleable Digital CBT for Generalized Anxiety and Associated Symptoms in a Chronic Musculoskeletal Pain Population
- ClinicalTrials.gov ID
- NCT04907656
- Acronym / sponsor ID
- 5975E
- Conditions
- Pain, Chronic, Pain, Musculoskeletal, Anxiety
- Keywords
- Anxiety, Worry, Depression, Sleep difficulties, Anxiety sensitivity, Pain intensity, Pain interference
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 86 participants (actual)
- Lead sponsor
- Boston University Charles River CampusUniversity, hospital or other
- Study start
- 15 Feb 2022 (actual)
- Primary completion
- 26 Apr 2023 (actual)
- Study completion
- 26 Apr 2023 (actual)
- First posted
- 1 Jun 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The present study involves a randomized clinical trial of Digital Cognitive Behavioral Therapy (dCBT) targeting worry and anxiety symptoms in a population with chronic pain and clinical levels of generalized anxiety disorder (GAD) symptoms. The clinical trial calls for the recruitment and randomization of 80 individuals with chronic musculoskeletal pain and clinical levels of GAD symptoms to either a dCBT program or a waitlist (Control) condition. The current research represents the first-step investigation of a treatment strategy with the potential to enhance care for patients with chronic pain by introducing a scalable, affordable, and system-friendly digital intervention (dCBT) that targets a prominent source of distress and associated disability in these patients. The investigators propose that by targeting GAD in chronic pain in a way that does not tax engagement in ongoing medical care provision, there is the potential to improve the uptake of effective care and to address both GAD and associated distress and disability.
Detailed description
An emerging body of research points to the significant impact of generalized anxiety disorder (GAD) on the functioning of adults with chronic pain. The importance of managing stress and anxiety is central to the fear/avoidance models of chronic pain, and fears of pain are elevated in those with GAD. Furthermore, the incidence of GAD is significantly higher in patients with chronic pain than in the general population. Likewise, severity of pain, degree of disability, opioid use, and medical costs have been found to be higher among those with comorbid GAD compared to those with chronic pain alone. The treatment of GAD in a chronic pain population has the potential to benefit pain-related distress and disability in addition to direct benefits on GAD and related quality of life.
Cognitive Behavior Therapy (CBT) is an excellent choice for targeting GAD symptoms in a chronic pain population. CBT is a recommended first-line treatment for GAD according to international guidelines. Despite the potential benefits of treatment, individuals with GAD face significant barriers in accessing CBT, including limitations on the availability of trained therapists, the costs and burden of in-person therapy, and stigma issues. These barriers are likely magnified for individuals with chronic pain who also face their own stigma issues as well as a high medical appointment burden. An innovative solution for overcoming these barriers and providing CBT for GAD at scale is to offer well-validated digital treatment that can be delivered by smartphones, tablets, or computers. Digital CBT (dCBT) offers a cost-effective and scalable alternative to in- person CBT with comparable maintenance of treatment gains to in-person CBT at four-year follow-up. Interest in digital health solutions is evident in those with chronic pain, and digital treatment may also offer a strategy for addressing the significant racial and ethnic disparities in care as well as disparities in the degree of psychological distress reported for those with chronic pain. At this time, however, the efficacy of dCBT for GAD has not been evaluated in patients with chronic pain.
The study contains two phases, with only Phase 2 being registered here. Following the achievement of benchmarks from Phase I, Phase 2 is a randomized clinical trial of Digital Cognitive Behavioral Therapy (dCBT) targeting worry and anxiety symptoms in a population with chronic pain and clinical levels of generalized anxiety disorder (GAD) symptoms. The dCBT under study is a commercially available smartphone application that provides weekly intervention sessions in 4 modules. An initial assessment drives an algorithm to personalize the program and individuals will have 10 weeks to complete the treatment. This randomized clinical trial calls for the recruitment and randomization of 80 individuals to either the dCBT program or a waitlist (control) condition. Specific aims for this project are:
- To show that dCBT leads to lower GAD symptoms relative to the control condition.
- To evaluate whether dCBT leads to greater changes in the secondary worry, mood, sleep, quality of life, and anxiety sensitivity outcomes than the control condition.
- To evaluate whether dCBT leads to lower pain distress and disability outcomes than the wait-list control condition.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned to either the dCBT app or a waitlist (control) condition with a 1.5:1 allocation (dCBT:Control) using a blocked randomized sequence. If initially allocated to the control condition, participants will be given access to the dCBT app after week 10 (that is, after the post-treatment evaluation, participants in the control group will be provided (crossed over to) dCBT).
| Arm | Type | Receives |
|---|---|---|
| dCBT Condition | Experimental | Behavioral: dCBTThe dCBT used in this study (Daylight) was selected due to its noted efficacy in treating GAD. 25 interventions will be provided in four modules, with an average duration of 20 minutes. Sessions are unlocked weekly, and completion of an initial assessment drives an algorithm to personalize the program. Individuals may progress through treatment at a slower pace than weekly sessions; 10 weeks is allowed for treatment completion. Treatment is based on principles of applied relaxation, stimulus control, cognitive restructuring, and imaginal exposure. Participants schedule a time for each session and receive prompts if they miss the appointment. All interventions are aided by the use of an animated therapist. |
| Waitlist (control) Condition | No intervention | –Participants allocated to the waitlist (control) condition will not receive an active intervention during the study. Participants will still complete all scheduled study assessments. They will receive access to the dCBT after completion of all study assessments. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Chronic musculoskeletal pain patients engaged in noninvasive treatments
- Age 18 or older
- Post acute phase of chronic pain
- Clinical levels of Generalized Anxiety Disorder (GAD) (operationalized by a score of ≥10 on GAD-7)
Key exclusion criteria (5 listed)
- Factors that may impede the utilization of digital intervention (non-English speaker/literate; no access to a digital device; severely vision impaired, or severe cognitive impairment)
- Pending acute surgery or with a life prognosis of fewer than 6 months
- Current daily opioid use
- The presence [by self-report] of schizophrenia, psychosis, bipolar disorder, seizure disorder, or current substance use disorder (other than nicotine)
- The ability to isolate the effects of the intervention (initiation or change of psychotropic medication dosage within past 4 weeks, received CBT for anxiety in last 3 months)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| dCBTAlso: DaylightAs per arm of the same name | Behavioural | dCBT Condition |
Primary outcome
Anxiety Severity
Time frame: Week 10
The Generalized Anxiety Disorder 7 (GAD 7) is a self-report measure that assesses the full range of symptoms associated with GAD. Responses are summed to create a composite score, with higher scores indicating more severe anxiety. Composite scores range from 0 to 21.
13 secondary outcomes
Worry Severity
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Depression
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Sleep Difficulty
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Health status
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Anxiety sensitivity
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Clinician-rated anxiety severity
Time frame: Week 0 (baseline), Week 10 (post-intervention)
Pain intensity
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain interference/disability
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Fear of pain
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain medication use
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Pain catastrophizing
Time frame: Week 0 (baseline), week 6, week 10 (post-intervention)
Anxiety Severity
Time frame: Week 0 (baseline), week 3, week 6
Resolution of clinical GAD
Time frame: Week 10 (post-intervention)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Jul 2023.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michael W Otto, PhD principal investigator
Boston University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing dCBT in people with Pain, Chronic and Pain, Musculoskeletal, run by Boston University Charles River Campus at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 21 Jul 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Anxiety Severity (time frame: Week 10). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Jul 2023.