PREPRINT: Matching cognitive behavioural interventions to psychological processes to personalise chronic pain treatments: a mixed-methods study using Delphi and Focus Groups

Background. Chronic pain is a highly prevalent condition that requires multimodal treatment approaches. Among non-pharmacological interventions, Cognitive Behavioural Therapy is guideline-recommended. Although its efficacy is well established, overall treatment effects remain moderate. Recent efforts to enhance outcomes of Cognitive Behavioural Therapy have focused on process-based and personalised approaches. While psychotherapists commonly tailor treatment using case formulations, such decisions often rely on clinical judgement, which has been shown to be inconsistent. As the data base for purely data-driven treatment algorithms in chronic pain remains insufficient, structured input from clinical and scientific experts appears to be a necessary interim step – one that may also help to bridge the science-practice gap.Methods. In this mixed-methods study, focus groups, online surveys, and an adapted Delphi technique were used to develop a Matching Matrix linking cognitive behavioural modules to process-based treatment targets. Twenty-two clinicians participated in the first Delphi round consisting of five focus groups and selected two modules per item. Fifteen clinicians contributed to the second round via an online survey. Their recommendations were subsequently validated by a focus group of four chronic pain researchers. Results. For all 23 target processes, two cognitive behavioural modules could be matched based on the assessed data. However, eight out of 46 item-module pairs required discussion within the study team due to insufficient consensus. Overall, especially the first-choice modules appear well-founded.Conclusion. The presented Matching Matrix is a first step towards the development of a broader evidence base for data-informed clinical decision-making in the treatment of chronic pain.