Research Summary

Digital Cognitive Behavioral Therapy Matches Pain Education for Adults with Sickle Cell Disease

Kate Young

Key Highlights:

  • 6-month improvements in pain interference were similar between digital cognitive behavioral therapy and digital education programs.
  • Both interventions improved depression, anxiety, and quality of life.
  • Health coach engagement was high, suggesting human support enhanced participation.

A large, multisite, randomized clinical trial published in Blood Advances evaluated whether a digital cognitive behavioral therapy (CBT) program could reduce pain interference more effectively than a digital pain and sickle cell disease (SCD) education program. Despite expectations, researchers found no significant difference between the two interventions, suggesting both may serve as effective, accessible approaches to managing chronic pain in adults with SCD.

The CaRISMA trial enrolled 359 adults (aged ≥18 years) with SCD-related chronic pain or daily opioid use, recruited virtually from seven U.S. sickle cell centers and community organizations. Participants were randomized to either a 12-week digital CBT program or an educational intervention, both delivered via an interactive Facebook Messenger chatbot and supported by trained health coaches. The primary outcome was six-month change in pain interference, assessed using the PROMIS Pain Interference Short Form 8a. Secondary outcomes included pain intensity, depression (PHQ-8/9), anxiety (GAD-7), quality of life, and self-efficacy.

Study Findings

Among 359 randomized participants, 92% identified as Black and 66% were women, with a mean age of 36 years. At 6 months, 250 participants (70%) completed follow-up. Both digital CBT and education groups showed significant within-group improvements in pain interference scores (−2.13 and −2.66, respectively), but the between-group difference was not significant (mean difference, 0.54; P = .57). Similarly, there were no group differences in pain intensity, depression, anxiety, or quality-of-life outcomes.

Engagement varied by component: 76% of participants connected to the chatbot, 48% completed at least one digital lesson, and 80% completed at least one health coach session. On average, participants attended four of twelve coaching sessions, primarily conducted by phone. Both groups exhibited improvements in depression (CBT: −1.33; education: −1.12) and anxiety (CBT: −0.85; education: −1.49), while only CBT showed a significant gain in self-efficacy (+1.45 points).

Clinical Implications

The findings indicate that digital CBT and digital pain/SCD education, when paired with health coach support, are equally effective as adjunctive, nonpharmacological options for managing chronic pain in adults with SCD. The high level of engagement with health coaching—compared with digital content alone—suggests that human interaction plays a key role in sustaining participation and therapeutic benefit. Study authors noted that these interventions could offer scalable, low-cost strategies for delivering behavioral pain management in underserved communities.

Expert Commentary

“Both health coach–supported digital interventions effectively improved pain interference, mental health, and quality of life in adults with SCD,” the researchers concluded. “Digital CBT or pain education, when combined with centralized health coach support, may serve as a scalable and low-cost method for delivering behavioral care to underserved communities.”

Reference:
Jonassaint CR, Lalama CM, Carroll CP, et al. Digital cognitive behavioral therapy vs education for pain in adults with sickle cell disease. Blood Advances. 2024;8(24):6257–6266. doi:10.1182/bloodadvances.2024013861.