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between CBT and AP (P = 0.001) but not between CBT and OBT (P = 0.48). The CBT did not show any significant changes over time The OBT displayed a significant decrease of physician visits at the 12-month follow-up, whereas the AP group showed a significant increase of the numbers of physician visits at the 12-month follow-up. In comparison with AP patients, CBT- and OBT-treated patients had made significantly fewer physician visits at the 12-month follow-up. There were, however, no significant differences between CBT and OBT. The number of physician visits showed a very large ES for the OBT with 2.13 (1.45 adjusted). The CBT treatment was specifically designed to target maladaptive beliefs. To confirm the efficacy of the treatment on cognitive variables, a MANOVA on the two scales of the PRSS, active coping and catastrophising, was calculated. It revealed a significant effect of time (F(1, 122) = 4.52, P < 0.03), cognitive variables (F(1, 122) = 5352, P < 0.001), cognitive variables × time (F(1, 122) = 8.32, P < 0.01), cognitive variables × group (F(2, 122) = 14.92, P < 0.001), and cognitive variables × time × group (F(2, 122) = 27.41, P < 0.001). There was no significant effect of treatment (F(1, 122) = 0.77, P = 0.47). Coping An ANOVA demonstrated a significant interaction for group × time (F(3, 121) = 16.18, P < 0.001) with significant group differences between CBT and AP and between OBT and AP but not between CBT and OBT. Both CBT and OBT showed a significant increase of adaptive coping immediately after the treatment as well as at the 6-month and 12-month follow-ups. In contrast to and OBT, the AP group showed a decline in the use of positive coping at both follow-ups. Means, SDs, and F and P values of the ANOVA effects for group, time, and group × time (G × T) and T and P values for secondary measures: cognitive variables and behavioural variables pre-treatment (T1) in comparison with post-treatment (T2), 6 months (T3) and 12 months (T4) in the CBT, OBT, and AP groups In comparison with the AP, the CBT-treated patients responded with improved coping immediately after, 6 months after, and 12 months after the treatment, OBT-treated patients only after 6 and 12 months. There were no significant differences between CBT and OBT. CBT produced a larger ES (2.66) on active coping than did the OBT treatment (1.23), although both were large. In general, the ESs of the CBT and OBT increased over time Catastrophising Post hoc ANOVAs demonstrated a significant treatment × time interaction (F(3, 121) = 12.99, P < 0.001) with significant group differences between CBT and AP (P < 0.03) and between OBT and AP (P < 0.005) but not between CBT and OBT. The CBT and OBT showed a significant decrease of catastrophising (Table 4) immediately after treatment as well as at the 6- and 12-month follow-ups. In contrast to the CBT and OBT (Table 4), the AP group showed an increase of catastrophising at the follow-ups. The CBT and OBT groups showed significantly less catastrophising immediately after treatment, and this was maintained over both follow-ups in comparison with the AP group. Larger ESs for catastrophising were obtained for CBT (1.44) than for OBT (0.97), although both ESs were large Behavioural variables These included pain behaviours and pain-related solicitous spouse behaviours. A MANOVA revealed a significant effect for group (F(2, 122) = 3.36, P < 0.03), variables (F(2, 121) = 126.35, P < 0.001), variables × group (F(2, 121) = 9.12, P < 0.001), time × group (F(2, 122) = 16.39, P < 0.001), and group × time × variables (F(2, 122) = 30.09, P < 0.001). Post hoc analyses showed a significant difference between OBT and AP (P < 0.02) but not between CBT and AP or between CBT and OBT. Pain behaviors Post hoc ANOVAs demonstrated a significant treatment × time (F(3, 121) = 11.39, P < 0.001) effect with significant group differences only between OBT and AP (P < 0.02) but not between CBT and AP or between CBT and OBT Whereas the CBT did not show any significant decrease of pain behaviour the OBT displayed a significant decrease of pain behaviour (Table 4) immediately after the treatment and at the 6-month and 12-month follow-ups. In contrast to CBT and OBT the AP group
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