Date of Award


Document Type


Degree Name

Doctor of Psychology (PsyD)


Graduate Department of Clinical Psychology

First Advisor

Kathleen Gathercoal, PhD

Second Advisor

Mary Peterson, PhD

Third Advisor

Kristie Schmidlkofer, PsyD


Chronic pain costs up to $635 billion dollars annually and impacts 25.3 million adult U.S. citizens (Nahin, 2015). Treatment options have typically included opioid medications, which potentially causes harm with long-term use and has contributed to an epidemic of opioid misuse. Treatment has expanded beyond monotherapy to include holistic approaches to health, such as occupational therapy and mental health therapy. The present study sought to evaluate the effectiveness of group therapy as it is conducted in a rural Oregon clinic using the Quadruple Aim to measure treatment outcomes (Bodenheimer, & Sinsky, 2014). Participants diagnosed with chronic pain and placed on an opioid contract by their primary care provider were mandated to attend four weeks of one hour group therapy which included expectations for healthcare practices between sessions, and participants were asked to complete a packet of mental health screeners before and after treatment. Additional financial data regarding participant spending on medical costs was analyzed. Researchers expected participants’ screener scores to improve and financial expenditures to decrease overall. Results suggested that group participation was not significantly correlated with subjective support of pain, although their medical costs decreased compared to a matched sample of peers who did not attend group therapy. Ultimately, the patients and clinic will benefit from ongoing research designed to improve patient satisfaction while continuing to maintain cost effectiveness. One option discussed to engage in individual therapy to supplement group therapy. Future research is encouraged to incorporate provider satisfaction as a means of better utilizing the Quadruple Aim, and to revisit the experimental design as to include true control and experimental groups thereby allowing variables to be independently evaluated and stronger conclusions to be drawn regarding the effectiveness of group therapy.