Cognitive-behaviour therapy for the management of sickle cell disease pain: An evaluation of a community-based intervention


Department of Nursing Studies, King's College London, Cornwall House, Waterloo Road, London SE1 8WA, UK.


Objectives. To evaluate the immediate effectiveness of a cognitive-behavioural group therapy intervention for the management of sickle cell disease SCD pain. Design. This study is taken from an ongoing longitudinal, multi-centred, randomized controlled trial. Method. Ninety-seven patients with SCD recruited from seven London hospitals were randomly allocated to one of three treatment conditions after giving written consent: a CBT pain management group, an attention placebo group and a nointervention control. All participants completed a number of measures at baseline and post-intervention to assess psychological well-being, pain and coping. Results. Results are presented for the 59 participants who met the study entrance criteria, attended treatment group sessions above the cut-off point selected for treatment completion, and completed sessions both baseline and post-intervention assessments. Significant post-intervention treatment group differences in favour of the CBT intervention were identified for nearly all of the psychological measures using the Kruskal-Wallis test. Within-group significant differences over time were also found for the CBT condition for the majority of the measures. Following the identification of centre differences in baseline measures, two-way ANCOVAs were conducted with centre and condition for the ranked data of each psychological measure using ranked baseline scores as covariates. Observation of the adjusted means indicated that most of the post-intervention effect was accounted for by centres 1 and 2, with centre 4 having a minimal effect and, for centre 3, some of the measures showing a reverse effect to that predicted. Conclusions. Overall, the cognitive-behavioural approach employed appears to be immediately effective for the management of SCD pain in terms of reducing psychological distress and pain, and improving coping. Further analysis of longitudinal and cost-effectiveness data currently being collated will indicate whether long-term and financial benefits are to be gained.