Younger teens stand to benefit more from internet-delivered CBT for chronic pain

Internet-delivered cognitive behavioural therapy (CBT) benefits younger adolescents the most, a recent study has found. Those whose parents have low levels of emotional distress seem to likewise benefit more from CBT over the internet.

Researchers randomly assigned 273 teens (aged 11–17 years; 75.1 percent female) with chronic pain to either an internet-delivered CBT programme (n=138) or pain-education control (n=135). The primary outcome was pain-related disability. Adolescent- and parent-level moderators of CBT efficacy included participant demographics and parent distress, education, and parenting behaviour.

Overall, the internet CBT had a small but significant effect, decreasing adolescent disability up to 6 months after the intervention. The 6-month change in disability scores was significantly greater in the CBT vs education arms (p=0.002). However, the impact of the CBT had worn off 12 months postintervention, such that the difference in distress change values between groups was no longer significant (p=0.054).

Adolescent age emerged as a significant moderator of treatment effect and interacted with the time and group variables to affect the pain-related disability outcome.

Particularly, young adolescents, those aged 11–14 years, showed greater improvements than their older counterparts. Younger teens saw significant drops in pain-related disability 6 and 12 months after the intervention, while older teens demonstrated no such improvements at any time point.

In addition, the internet CBT intervention was found to be more effective in adolescents whose parents had low distress levels and had no impact on teens whose parents reported high distress levels.

Other factors, such as parent education, parenting behaviours, adolescent sex, pain intensity, sleep quality, and emotional distress, had no impact on CBT efficacy.