Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: A randomized, controlled trial Brief cognitive-behavioral therapy for temporomandibular disorder pain: Effects on daily electronic outcome and process measures A randomized clinical trial of a tailored comprehensive care treatment program for temporomandibular disorders. Long-Term Efficacy of Biobehavioral Treatment of Temporomandibular Disorders Brief group cognitive-behavioral intervention for temporomandibular disorders The Effects of a Cognitive‐Behavioral Treatment Program on Temporo‐Mandibular Pain and Dysfunction Syndrome Biofeedback-based Cognitive-Behavioral Treatment Compared With Occlusal Splint for Temporomandibular Disorder: A Randomized Controlled Trial Dysfunctional patients with temporomandibular disorders: evaluating the efficacy of a tailored treatment protocol. The Relative Efficacy of Three Cognitive-Behavioral Treatment Approaches to Temporomandibular Disorders Psycho-education programme for temporomandibular disorders: a pilot study Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: a randomized controlled trial. Factors associated with successful outcome from behavioral therapy for chronic temporomandibular joint (TMJ) pain. Momentary pain and coping in temporomandibular disorder pain: Exploring mechanisms of cognitive behavioral treatment for chronic pain A randomized controlled trial of cognitive-behavior therapy for tinnitus. Effects of Orofacial Myofunctional Therapy on Temporomandibular Disorders Mediators, moderators, and predictors of therapeutic change in cognitive–behavioral therapy for chronic pain Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change.
Abstract We evaluated the short‐ and long‐term efficacy of a brief cognitive‐behavioral therapy ( CBT ) for chronic temporom and ibular disorder ( TMD ) pain in a r and omized controlled trial . TMD clinic patients were assigned r and omly to four sessions of either CBT ( n = 79 ) or an education/attention control condition ( n = 79 ) . Participants completed outcome ( pain , activity interference , jaw function , and depression ) and process ( pain beliefs , catastrophizing , and coping ) measures before r and omization , and 3 ( post‐treatment ) , 6 , and 12 months later . As compared with the control group , the CBT group showed significantly greater improvement across the follow‐ups on each outcome , belief , and catastrophizing measure ( intent‐to‐treat analyses ) . The CBT group also showed a greater increase in use of relaxation techniques to cope with pain , but not in use of other coping strategies assessed . On the primary outcome measure , activity interference , the proportion of patients who reported no interference at 12 months was nearly three times higher in the CBT group ( 35 % ) than in the control group ( 13 % ) ( P = 0.004 ) . In addition , more CBT than control group patients had clinical ly meaningful improvement in pain intensity ( 50 % versus 29 % showed ≥50 % decrease , P = 0.01 ) , masticatory jaw function ( P < 0.001 ) , and depression ( P = 0.016 ) at 12 months ( intent‐to‐treat analyses ) . The two groups improved equivalently on a measure of TMD knowledge . A brief CBT intervention improves one‐year clinical outcomes of TMD clinic patients and these effects appear to result from specific ingredients of the CBT & NA ; We used patient daily electronic ratings of outcome ( activity interference , pain intensity , jaw use limitations , negative mood ) and process ( pain‐related beliefs , catastrophizing , and coping ) variables to evaluate a brief cognitive‐behavioral ( CB ) treatment for chronic temporom and ibular disorder ( TMD ) pain . TMD clinic patients ( N=158 ) were assigned r and omly to four biweekly sessions of either CB pain management training ( PMT ) or an education/attention control condition [ self‐care management ( SCM ) ] and were asked to complete electronic interviews three times daily for the 8‐week treatment . We analyzed diary data from 126 participants who completed > 50 % of requested interviews for > 6 weeks . Multilevel regression analyses indicated no statistically significant difference between the study groups in rate of within‐subject change over time on the daily outcome measures , but consistently greater within‐subject improvement in the PMT group on the daily process measures . Significantly ( P<0.05 ) greater proportions of PMT than of SCM patients showed clinical ly important ( > 50 % ) improvement from weeks 1 to 8 in daily activity interference and jaw use limitations . This study is novel in its application of electronic diary methods for assessing outcome and process variables in a chronic pain treatment trial , and supports the feasibility and utility of such methods . The brief CB treatment was efficacious in decreasing catastrophizing and increasing perceived control over pain , and in improving activity interference and jaw use limitations for a subgroup of patients . Longer‐term follow‐ups are ongoing to determine if there is an impact on outcomes over time AIMS To test the usefulness of tailoring cognitive-behavioral therapy ( CBT ) for patients with temporom and ibular disorders ( TMD ) who demonstrated poor psychosocial adaptation to their TMD condition , independent of physical diagnosis . METHODS A r and omized clinical trial compared a 6-session CBT intervention delivered in conjunction with the usual TMD treatment to the usual conservative treatment by TMD specialist dentists . For study inclusion , Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) , Axis II criteria , were used to target patients with elevated levels of TMD pain-related interference with daily activities , independent of physical diagnosis ( i.e. , Axis I ) . RESULTS At the post-treatment assessment , about 4 months after the baseline evaluations , the comprehensive care group , when compared to the usual treatment group , showed significantly lower levels of characteristic pain intensity , significantly higher self-reported ability to control their TMD pain , and a strong trend ( P = .07 ) toward lower pain-related interference in daily activities . From post-intervention to 1-year follow-up , all subjects showed improvement . At the 1-year follow-up , the comprehensive care group , while not losing any of its early gains , was not significantly different from the usual care group with regard to reported levels of pain , ability to control pain , and levels of interference in activities . For many of these psychosocially disabled TMD patients , pain and interference 1 year after treatment remained at the same or higher levels than those observed at baseline among a group of patients selected for a separate r and omized clinical trial on the basis of better psychosocial adaptation . CONCLUSION The 6-session CBT intervention for patients with heightened psychologic and psychosocial disability was effective in improving pain-related variables over the course of the CBT in conjunction with usual treatment , but was too brief an intervention to result in further improvement after the sessions ended . Patient ratings of treatment satisfaction and helfulness were high for both groups , but they were significantly higher for the comprehensive care group This study evaluated the relative long-term efficacy of biofeedback , cognitive – behavioral skills training ( CBST ) , combined biofeedback and CBST ( Combined ) , and no-treatment comparison groups in 108 patients suffering from chronic temporom and ibular disorder ( TMD ) . After an initial evaluation , patients were assigned to one of the four treatment conditions . The three biobehavioral treatment interventions consisted of 12 st and ardized sessions . Patients were reevaluated 1 year after completing treatment . Results demonstrated that patients who received the biobehavioral treatments reported significant improvement in subjective pain , pain-related disability , and m and ibular functioning 1 year after receiving treatment . The no-treatment comparison group did not demonstrate such improvements . The combined biofeedback and CBST treatment produced the most comprehensive improvements across all outcome measures . These results again demonstrate the heuristic value of adopting a biopsychosocial perspective to the assessment and treatment of chronic medical/dental disorders such as TMD & NA ; Temporom and ibular disorders ( TMD ) are currently viewed as an interrelated set of clinical conditions presenting with signs and symptoms in masticatory and related muscles of the head and neck , and the soft tissue and bony components of the temporom and ibular joint . Epidemiologie and clinical studies of TMD confirm its status as a chronic pain problem . In this report we present results from a r and omized clinical trial which compared , at 3‐ and 12‐month follow‐ups , the effects of usual TMD treatment on TMD pain and related physical and psychological variables with the effects of a cognitive‐behavioral ( CB ) intervention delivered to small groups of patients before usual TMD treatment began . The purpose of this study was to determine whether a minimal CB intervention followed by dental TMD treatment enhanced the effects of usual clinical dental treatment . A second purpose of the study was to determine whether patients classified as high in somatization and psychosocial dysfunction would respond less favorably to this minimal intervention than would those low in somatization and dysfunction . Patients who participated in the CB intervention followed by usual treatment showed greater long‐term decreases in reported pain level and pain interference in daily activities than did patients who received only usual treatment . The benefits of CB intervention were not seen when the CB and UT groups were compared at 3‐month follow‐up . During the 3–12‐month follow‐up interval , however , the UT group maintained essentially the same level of improvement in characteristic pain while the CB group continued to improve , as hypothesized . During this same follow‐up interval , the CB group also showed a strong trend toward continued improvement in pain interference . Such effects were not observed for depression , somatization , or clinical measures of jaw range of motion . Additionally , as hypothesized , dysfunctional chronic pain patients did not appear to benefit from the brief CB intervention . Intent to treat analyses were also performed to assess generalizability of the results & NA ; Sixty‐one patients clearly diagnosed as suffering from Temporo‐M and ibular Pain and Dysfunction Syndrome ( TMPDS ) were r and omly assigned to one of three groups , 1 ) hypnosis and cognitive coping skills , 2 ) relaxation and cognitive coping skills , or 3 ) a no‐treatment control group . All patients were evaluated with a st and ard hypnotic susceptibility scale before treatment . The two treatment groups received four weekly sessions of their respective treatments . Patients in the hypnosis and relaxation groups reported equivalent decrements in pain , abnormal sounds in the temporom and ibular joint , and limitations of jaw mobility . Hypnotic susceptibility was significantly correlated with reductions in reported pain for the treatment groups . Patients ' age and the duration of pain before treatment were not related to treatment outcome . Patients who dropped out of treatment had fewer limitations in jaw movement but did not differ in any other variable from patients who remained in treatment . These findings are discussed in relation to the hypothesis that Temporo‐M and ibular Pain and Dysfunction Syndrome is stress‐related muscular pain and dysfunction Objectives : Cognitive-behavioral treatment has proven efficacy for chronic temporom and ibular disorder ( TMD ) . However , most patients receive dental treatment that may not address psychological comorbidities often present in TMD . The aim of the present study was to evaluate the efficacy of biofeedback-based cognitive-behavioral treatment ( BFB-CBT ) versus dental treatment with occlusal splint ( OS ) . Moreover , changes in nocturnal masseter muscle activity ( NMMA ) were investigated . Methods : Fifty-eight patients with chronic TMD were r and omly assigned to receive either 8 weekly sessions of BFB-CBT or 8 weeks of OS treatment . Diagnoses were established using Research Diagnostic Criteria for TMD . Pain intensity and disability were defined as primary outcomes . Secondary outcomes included emotional functioning , pain coping , somatoform symptoms , treatment satisfaction , and adverse events . NMMA was assessed during 3 nights pretreatment and posttreatment with portable devices . Follow-up assessment took place 6 months after the treatment . Results : Both treatments result ed in significant reductions in pain intensity and disability , with similar amounts of clinical ly meaningful improvement ( 45 % for BFB-CBT and 48 % for OS ) . Patients receiving BFB-CBT showed significantly larger improvements in pain coping skills . Satisfaction with treatment and ratings of improvement were higher for BFB-CBT . Effects were stable over 6 months , and tended to be larger in the BFB-CBT group for all outcomes . No significant changes were observed in NMMA . Discussion : The fact that BFB-CBT result ed in larger improvements in pain coping skills , and was well accepted by the patients , underlines the importance and feasibility of psychological treatments in the clinical management of TMD Forty-eight dysfunctional patients ( i.e. , high levels of pain , interference , and affective distress and low levels of perceived control ) with temporom and ibular disorders ( TMDs ) were r and omly assigned either to a treatment consisting of an intraoral appliance ( IA ) and stress management with biofeedback ( SM ) plus nondirective , supportive counseling ( SC ) -- IA + SM + SC -- or to a customized treatment that included cognitive therapy ( CT ) with the IA and SM -- IA + SM + CT . Both treatment groups reported statistically significant reductions on a set of physical , psychosocial , and behavioral measures posttreatment and at a 6-month follow-up . However , the intervention that included CT demonstrated significantly greater reductions in pain , depression , and medication use . Only the groups receiving the treatment that included the CT demonstrated continued improvements to the follow-up on pain associated with muscle palpation , self-reported pain severity , depression , and use of medications . These results support the efficacy of the tailored treatment for dysfunctional TMD The purpose of this study was to evaluate the relative efficacy of different biopsychosocial treatment conditions on patients with chronic temporom and ibular disorder . Ninety-four patients with chronic temporom and ibular disorder were assigned to either a biofeedback treatment group , a cognitive-behavioral skills training ( CBST ) treatment group , a combined ( combination of biofeedback/CBST ) treatment group , or a no-treatment control group .  Pain scores were analyzed pretreatment and posttreatment to determine group and within-subjects treatment effects . Results demonstrated that , in terms of a self-reported pain score , all three treatment groups had significantly decreased pain scores from pretreatment to posttreatment , while the no-treatment group did not . Moreover , patients in the biofeedback group were the most significantly improved compared to the no-treatment group . Finally , participants in the three treatment groups displayed significant improvement in mood states Background Temporom and ibular disorders ( TMDs ) are by far the most predominant condition affecting the temporom and ibular joint ( TMJ ) , however many patients have mild self-limiting symptoms and should not be referred for specialist care . The aim of this pilot study was to develop a simple , cost-effective management programme for TMDs using CD-ROM . 41 patients ( age 18–70 ) participated in this study , patients were divided into three groups : the 1st group were involved in an attention placebo CD-ROM ( contain anatomical information about the temporom and ibular system ) , the 2nd group received information on CD-ROM design ed to increase their control and self efficacy , while the 3rd group received the same programme of the 2nd group added to it an introduction to self-relaxing techniques followed by audio tape of progressive muscle relaxation exercises . Each of the groups was asked to complete a number of question naires on the day of initial consultation and six weeks afterwards . Results The two experimental groups ( 2nd & 3rd ) were equally effective in reducing pain , disability and distress , and both were more effective than the attention placebo group ( 1st ) , however the experimental groups appeared to have improved at follow-up relative to the placebo-group in terms of disability , pain and depressed mood . Conclusion This pilot study demonstrates the feasibility and acceptability of the design . A full , r and omized , controlled trial is required to confirm the efficacy of the interventions developed here OBJECTIVE To examine the unique contribution of behavior therapy ( BT ) and cognitive therapy ( CT ) relative to the full cognitive behavior therapy ( CBT ) for persistent insomnia . METHOD Participants were 188 adults ( 117 women ; M age = 47.4 years , SD = 12.6 ) with persistent insomnia ( average of 14.5 years duration ) . They were r and omized to 8 weekly , individual sessions consisting of BT ( n = 63 ) , CT ( n = 65 ) , or CBT ( n = 60 ) . RESULTS Full CBT was associated with greatest improvements , the improvements associated with BT were faster but not as sustained and the improvements associated with CT were slower and sustained . The proportion of treatment responders was significantly higher in the CBT ( 67.3 % ) and BT ( 67.4 % ) relative to CT ( 42.4 % ) groups at post treatment , while 6 months later CT made significant further gains ( 62.3 % ) , BT had significant loss ( 44.4 % ) , and CBT retained its initial response ( 67.6 % ) . Remission rates followed a similar trajectory , with higher remission rates at post treatment in CBT ( 57.3 % ) relative to CT ( 30.8 % ) , with BT falling in between ( 39.4 % ) ; CT made further gains from post treatment to follow up ( 30.9 % to 51.6 % ) . All 3 therapies produced improvements of daytime functioning at both post treatment and follow up , with few differential changes across groups . CONCLUSIONS Full CBT is the treatment of choice . Both BT and  CT  are effective , with a more rapid effect for BT and a delayed action for CT . These different trajectories of changes provide unique insights into the process of behavior change via behavioral versus cognitive routes A total of 42 chronic temporom and ibular joint pain patients completed behavioral therapy for their pain . The role of clinical , sociodemographic , and psychosocial factors was examined in relation to treatment outcome ( immediately following treatment and at 2-yr follow-up ) . Psychosocial factors were better predictors of treatment outcome than clinical and demographic factors . Patients who had the most successful outcomes ( both short- and long-term ) were more motivated and less depressed than other patients and were internal with respect to their health locus of control ABSTRACT The purpose of this study was to determine whether cognitive – behavioral treatment ( CBT ) operates by effecting changes in cognitions , affects , and coping behaviors in the context of painful episodes . Patients were 54 men and women with temporom and ibular dysfunction‐related orofacial pain ( TMD ) enrolled in a study of brief ( 6 weeks ) st and ard conservative treatment ( STD ) or st and ard treatment plus CBT ( STD + CBT ) . Momentary affects , pain , and coping processes were recorded on a cell phone keypad four times per day for 7 days prior to treatment , and for 14 days after treatment had finished , in an experience sampling paradigm . Analyses indicated no treatment effects on general retrospective measures of pain , depression , or pain‐related interference with lifestyle at post‐treatment . However , mixed model analyses on momentary pain and coping recorded pre‐ and post‐treatment indicated that STD + CBT patients reported greater decreases in pain than did STD patients , significantly greater increases in the use of active cognitive and behavioral coping , and significantly decreased catastrophization . Analyses of experience sampling data indicated that post‐treatment momentary pain was negatively predicted by concurrent active coping , self‐efficacy , perceived control over pain , and positive‐high arousal affect . Concurrent catastrophization was strongly predictive of pain . Active behavioral coping and self‐efficacy reported at the prior time point ( about 3 h previously ) were also protective , while prior catastrophization and negative‐high arousal mood were predictive of momentary pain . The results suggest that CB treatment for TMD pain can help patients alter their coping behaviors , and that these changes translate into improved outcomes This study is a r and omized , waitlist-controlled trial testing the effect of a brief , " manualized " cognitive-behavioral group therapy on  distress associated with tinnitus , quality of well-being , psychological distress including depression , and internal focus .  Cognitive-behavioral therapy ( CBT ) included training in activity planning , relaxation training and , primarily , cognitive restructuring .  Sixty-five participants were recruited , and 41 completed treatment . Participants were r and omly assigned to receive 8 weeks of manualized group CBT either immediately or after an 8-week waiting period . Participants completed outcome measures at the time of their r and om assignment and at 8 , 16 , and 52 weeks later . Repeated-measure analysis of covariance revealed significant group-by-time interactions on measures of tinnitus distress and depression , indicating that CBT led to greater improvement in those symptoms . The current results suggest that CBT , applied in a group format using a manual , can reduce the negative emotional distress , including depression , associated with tinnitus Abstract The objectives of the current study were to analyze the effects of orofacial myofunctional therapy ( OMT ) on the treatment of subjects with associated articular and muscular temporom and ibular disorders ( TMD ) . Thirty subjects with associated articular and muscular TMD , according to the Research Diagnostic Criteria ( RDC/TMD ) , were r and omly divided into groups : 10 were treated with OMT ( T group ) , 10 with an occlusal splint ( OS group ) , and 10 untreated control group with TMD ( SC ) . Ten subjects without TMD represented the asymptomatic group ( AC ) . All subjects had a clinical examination and were interviewed to determine Helkimo ’s Indexes ( Di and Ai ) , the frequency and severity of signs and symptoms , and orofacial myofunctional evaluation . During the diagnostic phase , there were significant differences between groups T and AC . There were no significant differences between group T and OC and SC groups . During the final phase , groups T and OS presented significant improvement , however , the group T presented better results and differed significantly from group OS regarding the number of subjects classified as AiII ; the severity of muscular pain and TMJ pain ; the frequency of headache and the muscles and stomatognathic functions . The group T differed significantly from the SC group but no longer differed significantly from the AC group . OMT favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the TMJs ; an increased measure of m and ibular range of motion ; reduced Helkimo ’s Di and Ai scores ; reduced frequency and severity of signs and symptoms ; and increased scores for orofacial myofunctional conditions Abstract Although cognitive – behavioral therapies ( CBT ) have been demonstrated to be effective for a variety of chronic pain problems , patients vary in their response and little is known about patient characteristics that predict or moderate treatment effects . Furthermore , although cognitive – behavioral theory posits that changes in patient beliefs and coping mediate the effects of CBT on patient outcomes , little research has systematic ally tested this . Therefore , we examined mediators , moderators , and predictors of treatment effects in a r and omized controlled trial of  CBT for chronic temporom and ibular disorder ( TMD ) pain . Pre‐ to post‐treatment changes in pain beliefs ( control over pain , disability , and pain signals harm ) , catastrophizing , and self‐efficacy for managing pain mediated the effects of CBT  on pain , activity interference , and jaw use limitations at one year . In individual mediator analyses , change in perceived pain control was the mediator that explained the greatest proportion of the total treatment effect on each outcome . Analyzing the mediators as a group , self‐efficacy had unique mediating effects beyond those of control and the other mediators . Patients who reported more pain sites , depressive symptoms , non‐specific physical problems , rumination , catastrophizing , and stress before treatment had higher activity interference at one year . The effects of CBT generally did not vary according to patient baseline characteristics , suggesting that all patients potentially may be helped by this therapy . The results provide further support for cognitive – behavioral models of chronic pain and point to the potential benefits of interventions to modify specific pain‐related beliefs in CBT and in other health care encounters Cognitive-behavioral therapy ( CBT ) is an effective treatment of bulimia nervosa , but its mechanisms of action have not been established . In this study the authors analyzed the results of a r and omized control trial comparing CBT with Interpersonal Psychotherapy ( IPT ) to identify possible mediators of change of CBT for BN and its time course of action . Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting . Measures of self-efficacy concerning eating behavior , negative affect , and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 weeks . No evidence was found that the therapeutic alliance mediated treatment outcome . CBT had a significantly more rapid treatment effect than IPT , with 62 % of posttreatment improvement evident by Week 6
There is insufficient evidence to make firm recommendations for the use of CBT over other intervention for the treatment of TMD .
Cognitive-behavioural therapy ( CBT ) and its effects on  temporom and ibular disorders ( TMD ) have been examined in several studies .
We are trying to combine results of these studies and to explore the effectiveness .