Posted: 12.18.2014 | by AMRA

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Are mindfulness-based interventions (MBIs) as effective as cognitive behavioral therapy (CBT) in treating chronic pain? Davis et al. [Journal of Consulting and Clinical Psychology] analyzed data from a 2008 study of the relative effectiveness of CBT, a mindful acceptance intervention (MBI), and rheumatoid arthritis education (AE) on pain, fatigue, and stress in 144 rheumatoid arthritis patients.

The predominantly female (68%), White (85%), middle-aged (mean = 54 years) participants were randomly assigned to one of the three treatments. Patients rated their pain in daily diaries 30 days before and 30 days after the intervention.

All the intervention conditions were delivered in once-weekly 2-hour groups over an 8-week period and were co-led by clinical psychologist/graduate student teams trained in CBT and MBI approaches to pain. The CBT intervention emphasized reappraising maladaptive thoughts, relaxation training, and activity pacing. The MBI focused on nonjudgmental moment-to-moment awareness and savoring pleasant experiences. The AE served as an education control, presenting medical information about rheumatoid arthritis.

MBI patients showed greater reductions in their pain-related catastrophizing, morning stiffness, fatigue and anxiety than did CBT and AE patients. MBI and CBT patients both catastrophized less compared with AE patients, but only MBI patients reduced their catastrophizing when confronted with severe pain. CBT patients, on the other hand, experienced greater increases in their sense of perceived pain control.

Mindful acceptance and cognitive reappraisal strategies each appear to have specific benefits and limitations. Arthritis patients with histories of recurrent depression, for example, benefited more from the MBI than CBT. Mindful acceptance seems to be more effective when pain is severe and cognitive resources are taxed. Cognitive reappraisal has the advantage of giving patients the perception of enhanced control when pain is less severe.

Reference:

Davis, M. C., Zautra, A. J., Wolf, L. D., Tennen, H., & Yeung, E. W. (2014). Mindfulness and cognitive–behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity. Journal of Consulting and Clinical Psychology.

[Link to abstract]