Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism - This is a competitive renewal application for UH3 DE028520, “Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism.” As per the program announcement (PAR-22-048), ongoing clinical trials supported by NIDCR may be extended if additional time is required to complete the trial. The purpose of this application is to allow us the opportunity to complete the work for which we were initially funded. The current study, “Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism” (U01 DE028520), was funded for the period 2/11/2020 to 1/31/2025. The first year of that study in 2020 saw the country overtaken by the Covid-19 epidemic. In the course of that first grant year we revised all of our procedures to treat patients remotely. We were thus not able to recruit our first subject until 2/01/2021, and recruitment was slowed by the pandemic. Thus, we lost more than a year of time in total. The result is that this study cannot complete all its aims without additional funding during Years 6 and 7 to meet our enrollment, treatment and follow-up goals. The current study is aimed at exploring the extent to which the individualized training of coping skills is an important mechanism of psychosocial treatment. In this renewal we will recruit, and treat 35 patients, and follow the remainder of patients in treatment. As designed, this is a highly innovative behavioral treatment trial. Patients with TMD-related pain of at least 3 months duration all receive a Standard Conservative Treatment (STD) and are randomly assigned to either a Cognitive Behavioral coping skills treatment (STD+CBT), or to an Individualized Assessment and cognitive- behavioral Treatment Program (STD+IATP) for patients with TMD pain. Treatment in IATP is be based on a very detailed functional analysis of the patient’s pain experience, in context, as derived from Experience Sampling (ES). The ES procedure is conducted via smartphone app at a rate of 4 records per day, and is be used to gather information on patients’ pain, momentary cognitions, affects, and coping behaviors, for a 2- week monitoring period prior to the beginning of treatment. Therapists use this information to develop an individual functional analysis of pain and non-pain episodes, and determine what thoughts, feelings and actions are effective for that patient at managing pain and which are not. The information is used to help develop adaptive coping tactics in a 6-session treatment program, offering skills training tailored to specific patient needs. During-treatment ES allows adjustment of the treatment goals and procedures, making the treatment adaptive and able to change with changing circumstances and patient needs. The conventional CBT program promotes coping skills, but is not based on in-vivo assessment of pain. Outcomes include measures of pain, interference, and depressive symptoms out to 12 months. IATP is a step toward a precision behavioral intervention for chronic pain. The results will shed light on mechanisms of treatment for TMD and may have implications for the management of other pain conditions.
