On the bumpy road of happiness: Mechanisms of daily life reward processing and how it can be changed

Non-specific chronic low back pain (NSCLBP) represents a multi-dimensional problem associated with physiological, psychological and social factors (O'Sullivan, 2012). Physiotherapists involved in the management of NSCLBP are challenged to embed psychological perspective into their clinical practice (Foster et al., 2011. Different psychological models for chronic pain help to explain how behavioural changes occur (McCracken et al., 2014). Therapeutic change, however, may not solely be explained by factors related to specific treatment theory or treatment mechanisms.

The common factor model describes factors necessary and sufficient for therapeutic change in psychotherapy, but which are not related to specific treatment mechanisms or the treatment theory. Psychotherapy research supports the relevance of the common factors, particularly for the influence of the therapeutic relationship on treatment outcomes (Wampold, 1997). In physiotherapy, however, very little research has been conducted on common factors. Alliance was identified as independent predictor for positive treatment outcomes (Ferreira et al., 2014; Fuentes et al., 2014). These findings indicate the potential relevance of common factors in physiotherapy for NSCLBP. There remain open questions regarding the common factors perspective in physiotherapy. It unknown how other common factors (e.g. patients’ and therapists’ characteristics, therapists’ clinical skills) influence alliance and treatment outcomes in physiotherapy. Additionally, there are doubts regarding the validity of methods frequently used to measure potential common factors in physiotherapy practice.

The series of studies conducted within this doctoral research aims to make a significant contribution to the development of valid measures of common factors potentially relevant in physiotherapy. By contributing to this young field of research, this doctoral research has the potential to broaden our understanding of the therapist’s role in the treatment of NSCLBP, and to better understand the process of therapeutic change in physiotherapy practice.