Self-directed vs clinician-delivered cognitive behavioral therapy for chronic pain

A self-directed approach to cognitive behavioral therapy for chronic pain (CBT-CP) produces comparable — and in some respects better — outcomes than clinician-delivered CBT-CP, according to a new study published in JAMA.

The research found that self-directed CBT-CP was associated with modest improvements in pain interference at four months, with those gains sustained through to twelve months. Participants in the self-directed group also showed small to moderate improvements across a range of secondary outcomes at four months. Notably, session-completion rates were higher among those using the self-directed format compared with those receiving clinician-delivered therapy.

Chronic pain affects a significant proportion of the population and places a substantial burden on healthcare systems. CBT is an established psychological treatment for chronic pain, but access to clinician-delivered therapy can be limited by availability, cost, and logistical barriers. The findings suggest that scalable, self-directed formats could help address this gap, potentially increasing the overall uptake of an evidence-based intervention.

The authors conclude that self-directed CBT-CP may represent an effective and more accessible alternative to traditional clinician-delivered care, with implications for how psychological pain management services are designed and delivered.

The study was led by corresponding author Alicia Heapy, PhD, and is published in JAMA (doi:10.1001/jama.2026.7861). The full text is freely accessible here.