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Use of Cognitive‐Behavioral Therapy in a Nation‐Wide Veterans Health Administration Sample: The Role of Clinic, Therapist, and Patient Factors

ABSTRACT

Objective

To examine the use of CBT-CP (Cognitive-behavioral therapy for chronic pain) by CBT-CP-trained therapists to treat patients with pain over a five-year period (October 2015–February 2020).

Data Sources and Study Setting

CBT-CP is a core evidence-based practice that is central to multidisciplinary chronic pain care. However, research suggests that CBT-CP is underused. The current study used national Veterans Health Administration data to examine the use of CBT-CP by CBT-CP-trained therapists to treat patients with pain over a five-year period.

Study Design

Multilevel modeling was used to evaluate clinic, therapist, and patient-level factors as predictors of CBT-CP receipt.

Data Collection

Administrative data on 37,514 patients seen at a national sample of Veterans Health Administration locations for pain were collected from the U.S. Veterans Health Administration central data repository.

Principal Findings

Results indicated 38.4% of patients with pain seen by a CBT-CP-trained therapist received CBT-CP during the observation period. Patients were more likely to receive CBT-CP if more time elapsed since their therapist received CBT-CP training and if their therapist had a master’s degree (vs. a doctorate). Patients with somatic symptom disorder and depressive disorders were more likely to receive CBT-CP, while patients with comorbid personality disorders or substance use disorders were less likely to receive CBT-CP. Patients seen in pain specialty, PTSD, biomedical, and mental health clinics were more likely to receive CBT-CP than those not seen in these clinics.

Conclusions

Findings suggest that the reach of CBT-CP is substantively related to factors at each level. Future research is needed to better understand the therapy treatment decision-making processes and to address education gaps and other factors that impede the implementation of evidence-based practices.

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Posted in: Journal Article Abstracts on 05/16/2025 | Link to this post on IFP |
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