Therapist-supported versus self-guided digital CBT for chronic pain with neurodevelopmental traits: A pilot feasibility randomized controlled trial

Background Chronic pain frequently co-occurs with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). If these traits are overlooked, standard cognitive behavioral therapy (CBT) may be less effective. We developed a brief digital CBT program that adds psychoeducation on NDD traits to standard CBT for chronic pain. This study primarily examined its feasibility in adults with chronic pain and comorbid NDDs. Methods In this three-arm pilot feasibility randomized controlled trial, 44 adults with chronic pain and a self-reported diagnosis of ASD or ADHD were randomized to therapist-supported digital CBT (n = 15), self-guided digital CBT (n = 16), or a sham condition (n = 13; daily submission of the weekday and weather). The program comprised ten 15-min videos over two weeks. Primary outcomes were feasibility and pain catastrophizing; depressive symptoms were exploratory. Mixed models for repeated measures were used. Results Post-intervention retention was 90.9% (40/44). Of 31 participants allocated to CBT, 29 (93.5%) completed the program, all rating it as safe. Compared with sham, pain catastrophizing decreased significantly more in both the self-guided and therapist-supported groups ( p = .006 and p = .035), with no clear difference between the two CBT formats. Depressive symptoms showed a similar pattern. Other outcomes did not differ. Conclusions A brief digital CBT program for this population appears feasible and acceptable. Preliminary estimates favored both CBT formats but were imprecise because the trial was not powered for between-group comparisons. An adequately powered trial with follow-up and systematic assessment of negative effects is needed.