(481) Catastrophizing, pain self-efficacy, mindfulness, and acceptance: relationships and changes among individuals receiving CBT, MBSR, or usual care for chronic back pain
The Journal of Pain
Format: Journal Article
Publication Year: 2015
Source ID: shanti-sources-53656
Abstract: Key mechanisms of action of psychosocial treatments for chronic pain include decreased catastrophizing and increased self-efficacy [cognitive-behavioral therapy (CBT)] and increased mindfulness and possibly pain acceptance [mindfulness-based stress reduction (MBSR)]. Greater understanding of overlap among these variables is important in understanding treatment-specific and shared mechanisms of action. We examined, in an RCT comparing group CBT (n=112), MBSR (n=116), and usual care (UC; n=113) for chronic back pain: (1) baseline relationships among the Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and Five Facet Mindfulness Questionnaire-short form (FFMQ-SF); and (2) pre- to post-treatment changes in these measures. We hypothesized that: (1) at baseline, the PCS would be associated negatively with the CPAQ-8, PSEQ, and FFMQ-SF Non-Reactivity, Non-Judging, and Acting with Awareness scales, and the CPAQ-8 would be associated positively with the PSEQ; and (2) adjusting for baseline variables, FFMQ-SF and CPAQ-8 scores would increase more pre- to post-treatment in MBSR than in CBT and UC, and PCS scores would decrease more and PSEQ scores would increase more in CBT than in MBSR and UC. The hypothesized baseline associations were confirmed between the PCS and the CPAQ-8 (Spearman’s rho = -0.40 to -0.55), PSEQ (-0.57), and FFMQ (-0.22 to -0.30) scales (all Ps < 0.01), and between the CPAQ-8 and the PSEQ (0.46-0.65; all Ps < 0.01). Among all participants who completed baseline and post-treatment assessments (n = 290), catastrophizing decreased significantly more pre- to post-treatment in MBSR than in UC and CBT. Among those who attended >6 of the 8 group sessions, mindfulness increased more in MBSR than in CBT, but the groups did not differ significantly in pre- to post-treatment change on the other measures. The results suggest overlap in mechanisms of action of CBT and MBSR. Supported by NCCAM grant 1R01AT006226.