(PS4-76) Testing the efficacy of CLEVER, a positive body image-based intervention enhanced by Virtual Reality to improve pain intensity, pain interference and emotional distress. A Nf1 design study

Abstract Text: Chronic pain affects approximately 34% of the European population (Zimmer et al., 2022) and between 18% and 34.5% of the U.S. population, with 8% experiencing high-impact pain (Yong et al., 2021; Dahlhamer et al., 2018). Although pharmacological treatments can relieve symptoms, they also present limitations such as tolerance and dependence (Crofford, 2010; Pergolizzi et al., 2020). Similarly, psychological interventions have shown positive effects (Hoffman et al., 2007), but their efficacy remains limited, with small-to-moderate effects on key pain-related variables (Williams et al., 2012, 2020). Importantly, body image disturbances are prevalent among individuals with chronic pain (Senkowski & Heinz, 2016), making body image a relevant clinical target (Levenig et al., 2018). In this context, virtual reality (VR) has emerged as a promising tool for intervention (Harvie et al., 2022).
CLEVER is a four-session intervention targeting key psychological factors through four clinical modules: pain psychoeducation, body awareness, pain acceptance, and functionality appreciation and gratitude. VR environments were incorporated into the body awareness and pain acceptance sessions to enhance intervention effects. A single-case multiple-baseline AB design was employed, consisting of a pre-treatment baseline (A) and a treatment phase (B). Thirteen participants were randomly assigned to four baseline conditions, ensuring at least four replications of the effect. The treatment phase started at different time points (7, 10, 11, or 14 days), ensuring a baseline duration of 7–14 days with at least five measurement points for data reliability. Daily assessments via M-Path measured pain intensity, interference, catastrophizing, kinesiophobia, emotional distress, disability, body awareness, pain acceptance, and functionality appreciation. For data analysis, the Percentage of All Non-Overlapping Data (PAND) was calculated.
Findings revealed generalized improvements in pain intensity, kinesiophobia, catastrophizing, emotional distress, functionality appreciation, body appreciation, body awareness, pain acceptance, and positive affect. Moreover, adherence was high, with only one participant dropping out due to scheduling conflicts. These results suggest that CLEVER is a promising intervention for improving body image and other pain-related variables. However, further studies are needed to confirm its efficacy.