A City Guide To Tongling for Perhaps surprisingly, however, cognitive-behavioural interventions were no more effective than the others in reducing negative, fearful or catastrophic thoughts. Nor were they more effective in changing mood. This may be because the most important therapeutic process in these interventions was that patients engaged in higher levels of activity than they previously had. As we suggested earlier in the chapter, this may change their beliefs about their ability to exercise, to control their pain while doing so, and their mood. Whatever the cause, there is mounting evidence that cognitive change is an important mediator of change in therapy. In a relatively early study of this phenomenon, Burns et al. found that the cognitive changes patients made in the early stages of a cognitive-behavioural programme were strongly predictive of pain outcomes later in therapy. A City Guide To Tongling 2016.