Klinische Psychologie des Erwachsenenalters
EFFects of Exposure and Cognitive-behavioural Therapy for chronic BACK pain („EFFECT-BACK “)

The clinical multicentre project EFFECT-Back, funded by the German Research Foundation (DFG) compares two psychological methods in the treatment of chronic low back pain (CLB): cognitive behavioral therapy (CBT) and graduated exposure in vivo (EXP). The trial aims to investigate the effectiveness of these methods and the extent to which they can improve the patients' pain-related disability. Exploratory research will be conducted to identify predictors of effectiveness in subgroups. The objective is to optimize treatment options and develop tailored-treatment. Additionally, EXP will be promoted as a cost-effective treatment within the outpatient healthcare system. The project has been allocated a budget of €1.4 million.
The study will include a total of 380 patients suffering from a minimum of six months of chronic back
pain (age: ≥ 18), who will be recruited from five different centres in Germany.

  • Landau
    WiPP-Psychotherapeutische Universitätsambulanz
    Rheinland-Pfälzische Technische Universität Kaiserslautern – Landau
    Methodenzentrum Landau
    Rheinland-Pfälzische Technische Universität Kaiserslautern – Landau
  • Essen
    Essener Rückenschmerzzentrum
    Universitätsklinikum Essen
  • Heidelberg
    Schmerzzentrum
    Universitätsklinikum Heidelberg
    Institut für Medizinische Biometrie (IMBI)
    Universitätsklinikum Heidelberg
  • Mainz 
    Poliklinische Institutsambulanz für Psychotherapie 
    Johannes Gutenberg-Universität Mainz
  • Marburg
    Psychotherapie Ambulanz Marburg 
    Philipps-Universität Marburg

  • References
    Vogt, R., Haas, J., Baumann, L. et al. EFFects of Exposure and Cognitive behavioral Therapy for chronic BACK pain (“EFFECT-BACK”): study protocol for a randomized controlled trial. Trials 25, 176 (2024). https://doi.org/10.1186/s13063-024-08017-9
  • Former citations
    Glombiewski, J.A., et al., Exposure and CBT for chronic back pain: An RCT on differential efficacy and optimal length of treatment. Journal of Consulting and Clinical Psychology, 2018. 86(6): p. 533-545. 
POINT Pain – Process-oriented, individualised, network-based therapy for chronic primary pain

The treatment of chronic pain is complex and usually includes various forms of treatment (e. g. pharmacotherapy, physiotherapy, psychotherapy). Within the field of psychotherapy, Cognitive Behaviour Therapy (CBT) has been proven to be particularly effective. 

It is common in CBT to rely on standardised treatment manuals. However, many are now calling for new concepts to personalise the therapy of chronic pain to improve outcomes. To do so, it is necessary to better understand the individual difficulties and challenges of people suffering from chronic pain. Only then can the treatment be adapted to the individual’s circumstances. That is the goal of the project Process-oriented, individualised, network-based therapy (POINT) for chronic pain (pain). 

In the POINT Pain project so-called networks are used to individualise psychotherapy. Important therapeutic processes like the pain intensity as well as thoughts, feelings, or behaviours such as avoidance are graphically displayed so that associations between the processes are visible. In the fictitious network that you can see here avoidance follows intense pain. The more avoidance, the more disability is perceived. Sometimes symptoms have influence on one another, for example catastrophic thoughts increase with pain, but also catastrophic thoughts might intensify the feelings of pain themselves. Other symptoms reinforce themselves, like when somebody expects to feel pain in advance and therefore is on the guard for the rest of the day.

In this project, participants will be asked about their relevant psychological processes associated with pain several times per day (so-called Ecological Momentary Assessment, EMA). Using this data, an individual network can be computed that shows how the processes are connected with one another for each individual person. With this information the following psychotherapy will be planned and carried out. 

Even the therapy process will be evaluated within the POINT Pain project: That way, changes can be observed soon and provide evidence regarding the ideal duration for the therapy of chronic pain. After therapy there will be further surveys to ensure that the therapy effects last. Participants will be informed about their survey results regularly.

The POINT Pain project comprises several studies, e. g. developing and evaluating a pain-processes-questionnaire for the use in EMA, a proof-of-principle therapy study applying the POINT Pain procedure, up to a large SCED therapy study comparing the POINT Pain procedure with treatment as usual.

Toward the Personalization of Psychotherapy: Integration of SCED and ESM in Routine Clinical Practice

This project aims to improve personalized psychotherapy by integrating single-case experimental designs (SCED) with experience sampling methods (ESM) in a German outpatient clinic. By supplementing traditional diagnostics with daily ESM surveys, patients and therapists can track progress in real time, fostering self-management, shared decision-making, and scientist-practitioner alignment.

Using a six-phase agile research approach, we will develop, optimize, and evaluate the SCED infrastructure to ensure feasibility, implementation, and long-term sustainability. This initiative bridges research and practice and sets a new standard for data-driven, patient-centered mental health care.

  • Prof. Dr. Julia Glombiewski
  • Dr. Julia Haas
  • Dr. Philip Herzog
  • Dr. Lea Schemer
  • Dr. Saskia Scholten
  • M.Sc. Lisa Kolb-Grunder
  • M.Sc. Simon Stenkamp

  • Schemer, L., Glombiewski, J. A., & Scholten, S. (2023). All good things come in threes: A systematic review and Delphi study on advances and challenges of ambulatory assessments, network analyses, and single-case experimental designs. Clinical Psychology: Science and Practice, 30(1), 95–107. doi.org/10.1037/cps0000083
  • Scholten, S., Schemer, L., Herzog, P., Haas, J. W., Heider, J., Winter, D., Reis, D., & Glombiewski, J. A. (2024). Leveraging single-case experimental designs to promote personalized psychological treatment: Step-by-step implementation protocol with stakeholder involvement for a single-case outpatient clinic. Administration and Policy in Mental Health and Mental Health Services Research, 51(5), 702–724. doi.org/10.1007/s10488-024-01363-5

Open-label placebo: Personalizing treatment and exploring individual predictors of response

In open-label placebo (OLP) treatment, placebos are applied with full transparency. Although this approach sounds paradoxical, OLP treatment can significantly improve symptoms in several conditions. In this project, we aim toinvestigate individual predictors of OLP response in a set of single-case experimental designs (SCED) with daily ambulatory assessments. Participants with irritable bowel syndrome will learn about OLP, develop a personal treatment regimen and undergo alternating treatment and control phases. Our goal is to provide a scalable framework for individual treatment optimization to enhance clinical applicability in the future and to explore potential OLP mechanisms.

  • Dr. Julia Haas
  • Dr. Christopher Milde
  • Prof. Dr. Julia Glombiewski

  • Haas, J.W.*, Ongaro, G.*, et al. (2022). Patients’ experiences treated with open-label placebo versus double-blind placebo: a mixed methods qualitative study. BMC Psychology, 10, 20. https://doi.org/10.1186/s40359-022-00731-w
  • Ballou, S.*, Haas, J.W.*, et al. (2022). Psychological Predictors of Response to Open-label versus Double-blind Placebo in a Randomized Controlled Trial in Irritable Bowel Syndrome. Psychosomatic Medicine, 84(6), 738-746. https://doi.org/10.1097/PSY.0000000000001078

*Equal contributions

Conceptualizing, assessing, and changing expectations in stressor-related and personality disorders

Stressor-related and personality disorders are highly complex and heterogeneous mental disorders, which poses challenges for their treatment. For example, more than half of all patients with posttraumatic stress disorder (PTSD) show a unique pattern of symptoms with 636,120 (mathematically) potential clinical presentations of PTSD according to the definition by DSM-5. Although efficacious on average, non-response to evidence-based psychological treatments is a striking problem in this clinical population, highlighting the need for improving the treatment outcome for the individual patient. Theoretically, our understanding of mental health problems has refined in recent years: It has been proposed that expectations are a particularly important subset of cognitions that contribute significantly to the development and maintenance of a variety of mental disorders. However, little is known how expectations and psychopathology manifests in stressor-related and personality disorders. Therefore, the present project investigates the role of expectations in this clinical population, mainly focusing on symptoms related to Posttraumatic Stress Disorder (e.g., re-experiencing symptoms such as intrusions), Moral Injury (e.g., chronic guilt), and Borderline Personality Disorder (e.g., affective instability).
To gain a deeper understanding of the interplay between expectations and psychopathology, we currently conduct several studies using various quantitative clinical psychology approaches:

  • TraumaEX: This longitudinal observational study leverages Experience Sampling Methodology (ESM) to understand the dynamics between dysfunctional expectations and intrusive re-experiencing in the daily lives of people with PTSD, particularly aiming to identify relevant processes relevant to their maintenance. Capitalizing on the intensive longitudinal data gathered by ESM, our goal is to develop personalized psychopathological models (e.g., by using network analysis) that help to better understand the heterogeneity underlying PTSD.
  • ExBPD: This cross-sectional validation study examines the psychometric properties of a newly developed self-report questionnaire – “Expectations in Borderline Personality Disorder Scale (ExBPD)” – that assesses dysfunctional expectations in patients with BPD to develop a more fine-grained understanding of expectations in this clinical population.
  • MIX: A series of studies investigate the role of expectations on symptom development after exposure to potentially morally injurious events (PMIE) in high-risk populations (e.g., specific occupations like health care workers). By building up on a current cross- sectional study on the frequency of PMIE exposure in high-risk occupations, we plan to conduct a new longitudinal ESM study that examines the frequency of exposure to PMIE, their perception as moral violations, post event processes related to the update of moral beliefs and its impact on MI-related mental health outcomes, aiming to determine individual symptom trajectories.

  • Prof. Dr. Richard J. McNally, Harvard University
  • Prof. Dr. Talya Greene, University College London

  • Herzog, P. (in press). Moralische Verletzung: Konzept, Klinische Modelle, Erfassung und
    Behandlung. Zeitschrift Für Klinische Psychologie Und Psychotherapie.
  • Herzog, P., Kaiser, T., Rief, W., Brakemeier, E.-L., & Kube, T. (2023). Assessing
    Dysfunctional Expectations in Posttraumatic Stress Disorder: Development and
    Validation of the Posttraumatic Expectations Scale (PTES). Assessment, 30(4), 1285–
    1301. https://doi.org/10.1177/10731911221089038
  • Herzog, P., Kube, T., & Fassbinder, E. (2022). How childhood maltreatment alters
    perception and cognition – the predictive processing account of borderline personality
    disorder. Psychological Medicine, 52(14), 2899–2916.
    https://doi.org/10.1017/S0033291722002458
  • Herzog, P., Barth, C., Rief, W., Brakemeier, E.-L., & Kube, T. (2022). How Expectations
    Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma
    Film Paradigm. Cognitive Therapy and Research, 46(4), 809–826.
    https://doi.org/10.1007/s10608-022-10290-4
  • Kube, T., Berg, M., Kleim, B., & Herzog, P. (2020). Rethinking post-traumatic stress
    disorder – A predictive processing perspective. Neuroscience & Biobehavioral Reviews,
    113(April), 448–460. https://doi.org/10.1016/j.neubiorev.2020.04.014 
Non-Ergodicity in Pain Science

Pain processes are inherently dynamic and vary significantly between and within individuals. While intensive longitudinal data, such as ambulatory assessments, can capture these fluctuations in near real-time, pain research continues to rely heavily on cross-sectional and panel data to infer individual pain processes. However, such inferences are only valid at the individual level if the pain process in question is ergodic—meaning that group-level patterns accurately reflect individual-level dynamics. If pain processes are non-ergodic, statistical associations derived from between-person data (e.g., cross-sectional studies) do not translate to meaningful insights at the within-person level, limiting their utility for understanding, predicting, and optimizing individual treatment outcomes.
This project investigates whether the assumption of ergodicity holds in pain research. Using intensive longitudinal datasets, we systematically compare within-person and between-person statistics to detect violations of ergodicity in key pain variables and their predictors. Furthermore, we apply advanced metrics from dynamical systems theory to identify non-linear patterns that drive discrepancies between group-level statistics and individual pain processes. By uncovering these sources of non-ergodicity, we aim to refine study design, improve statistical modeling techniques, and enhance the personalization of pain treatment strategies.

NWO gravitation program “New Science of Mental Disorders”:
www.nsmd.eu (grant number 024.004.016) by the Dutch Research Council, Netherlands.

  • Johan W.S. Vlaeyen, Experimental Health Psychology, Maastricht University, Netherlands and Health Psychology Research, KU Leuven University, Belgium
  • Mark P. Jensen, Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington, United States
  • Melissa A. Day, School of Psychology, The University of Queensland,
    Brisbane, QLD, Australia
  • Putu Gita Nadinda, Department of Health, Medical, and Neuropsychology Leiden University, the Netherlands and Department of Clinical Psychological Science, Maastricht University, the Netherlands
  • Madelon L. Peters, Maastricht University, Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
  • Patrick H. Finan, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, United States
EXPECT - Expectation Processing in Chronic Pain

Chronic pain is strongly influenced by expectations about pain intensity and duration. A crucial question in clinical research is whether these expectations are updated when individuals experience pain levels that contradict their prior beliefs (e.g., experiencing less pain than expected). While classical learning models suggest that such experiences should lead to expectation adjustment, empirical evidence indicates that a substantial proportion of individuals fail to revise their pain expectations, even when confronted with disconfirming evidence, such as in exposure therapy or behavioral experiments. 

This phenomenon, known as cognitive immunization, refers to the tendency to maintain pre-existing beliefs despite contradictory experiences. Originally described in developmental psychology, cognitive immunization has been increasingly recognized in other psychological domains, particularly in the context of affective disorders (Kube et al., 2018). However, its role in chronic pain remains largely unexplored.

The EXPECT project aims to investigate how individuals with chronic pain update - or fail to update - their pain expectations in response to expectation violations. Specifically, we examine whether the persistence of maladaptive pain expectations can be explained by cognitive immunization mechanisms and how this process might contribute to the maintenance of chronic pain. Understanding these mechanisms could provide critical insights for optimizing therapeutic approaches, particularly those targeting expectation modification in chronic pain patients.

  • Prof. Dr. Julia A. Glombiewski
  • Dr. Tobias Kube
  • M.Sc. Amelie Papp

WiPP-Psychotherapeutische Universitätsambulanz
Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau