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Overall, 100 patients completed the treatments, 40 in the OBT group, 40 in the CBT group, and 20 in the AP group. Treatment expectation and satisfaction There were no statistically significant differences between the groups in treatment expectations (F(2, 122) = 1.47, P = 0.24) in the first treatment session. For treatment satisfaction, calculated as a combination of first and last session, an ANOVA revealed neither a significant group (F(2, 122) = 1.42, P = 0.25) nor a significant group × phase (first versus last session) (F(2, 122) = 0.53, P = 0.59) effect. The adherence of patients in the CBT and OBT groups was excellent. In the OBT group, only 4.3% sessions were missed and 5.5% of homework was not completed. In the CBT group, 3.2% sessions were missed and 4.7% of homework was not completed. The subsample of the AP group who were retained in the treatment missed 7.6% sessions. The post hoc ANOVA revealed a statistically significant group × time interaction (Table 2) with OPT and CBT significantly different from AP but not from one another. Interestingly, OBT and CBT showed a statistically significant decrease of functional limitations at the 12-month follow-up, whereas the AP group displayed a statistically significant increase at the 12-month follow-up (Figure 2). However, only the OBT showed significantly reduced functional limitations 12 months after the treatment compared with pre-treatment (Table 2) whereas their functional limitations did not change immediately after or 6 months after treatment. Functional limitations showed a large ES (Table 3) for the OBT (1.15) which increased from pre-treatment to the two follow-up periods. Differences in physical impairment among cognitive behavioural therapy (CBT) (solid line), operant behavioral therapy (OBT) (dashed line), and attention-placebo (AP) (dotted line) groups prior to treatment (T1), immediately after treatment (T2), and at 6- (T3) and 12-month (T4) follow-ups. The ANOVA on pain intensity revealed a significant group × time interaction (F(3, 121) = 11.95, P < 0.001) with significant differences between AP and both CBT and OBT. Both CBT and OBT showed significant pain reduction at the 6-month and 12-month follow-ups. Unexpectedly, the AP group showed a statistically significant increase of pain intensity 6 months after the treatment in comparison with the CBT and OBT. There were no significant differences between CBT and OBT at the 6-month and 12-month follow-ups (Figure 3). Comparable with physical impairment, pain intensity did not change immediately after or 6 months after treatment). There were large ESs for pain intensity) in both the CBT (1.14) and the OBT treatments (1.10). In general, the ESs of the CBT and OBT increased over time, supporting the maintenance of the improvements. Consistent with the results for pain and functional impact, the ANOVA yielded a significant group × time interaction (F(3, 121) = 5.89, P < 0.005) with significant group differences between CBT and AP and between OBT and AP but not between CBT and OBT). The CBT showed a significant decrease of affective distress (Table 2) immediately after, 6 months after, and 12 months after treatment. The OBT did not display any significant changes over time (Table 2). In contrast to CBT and OBT (Table 2), the AP group showed an increase of affective distress at 6 months after treatment and a further increase 12 months after treatment. In comparison with AP, the CBT patients achieved significantly lower levels of affective distress immediately after, 6 months after, and 12 months after treatment, the OBT patients only after 12 months. There were no significant differences between CBT and OBT The CBT demonstrated large effects in reducing affective distress (0.76–1.57) with increasing ESs over time Differences in affective distress among cognitive behavioural therapy (solid line), operant behavioral therapy (dashed line), and attention-placebo (dotted line) groups prior to treatment (T1), immediately after treatment (T2), and at 6- (T3) and 12-month (T4) follow-ups. An ANOVA demonstrated a significant group × time interaction (F(2, 122) = 33.52, P < 0.001) with significant group differences between OBT and AP (P < 0.001) and
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