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Moderators of Mindfulness Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain: A Test of the Limit, Activate, and Enhance Model.

The journal of pain
January 1, 2020
Melissa A Day et al. (8 authors)
Comparative StudyJournal ArticleRandomized Controlled TrialResearch Support, Non-U.S. Gov'tHuman StudyClinical
Study Details

Study Goal

The researchers aimed to determine how baseline moderators (e.g., pain catastrophizing, brain state, mindfulness traits) influence the effectiveness of mindfulness meditation (MM), cognitive therapy (CT), and mindfulness-based cognitive therapy (MBCT) for chronic low back pain.

Results Summary

The study found that higher baseline pain catastrophizing was associated with greater pain intensity improvement in MM, while lower baseline nonreactivity improved physical function in MM. Higher baseline theta power improved depression in MBCT but interfered with CT response.

Population

Adults (N = 69) with chronic low back pain.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (6)
InterventionDirectionEndpointPopulationDosageImpactClaim #
mindfulness-meditation (MM)
decrease
pain intensity
Adult participants with chronic low back pain (CLBP)
-
was associated with greater improvement
#1
mindfulness-based cognitive therapy (MBCT)
decrease
pain intensity
Adult participants with chronic low back pain (CLBP)
-
was associated with greater improvement
#2
mindfulness-based cognitive therapy (MBCT)
decrease
depression
Adult participants with chronic low back pain (CLBP)
-
was associated with greater improvement
#3
cognitive therapy (CT)
no change
depression
Adult participants with chronic low back pain (CLBP)
-
interfered with response
#4
mindfulness-meditation (MM)
increase
physical function
Adult participants with chronic low back pain (CLBP)
-
was associated with greater improvement
#5
mindfulness-based cognitive therapy (MBCT)
increase
physical function
Adult participants with chronic low back pain (CLBP)
-
was associated with greater improvement
#6
Abstract

This study examined psychosocial pain treatment moderation in a secondary analysis of a trial that compared cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-based cognitive therapy (MBCT) for chronic low back pain (CLBP). The Limit, Activate, and Enhance (LA&E) model of moderation provided a framework for testing a priori hypotheses. Adult participants (N = 69) with CLBP completed a pretreatment assessment of hypothesized moderators: pain catastrophizing, brain state as assessed by electroencephalogram, mindful observing, and nonreactivity. Outcomes were pain interference, characteristic pain intensity, physical function, and depression, assessed at pre- and post-treatment. Moderation analyses found significant interaction effects, specifically: 1) higher and lower baseline pain catastrophizing was associated with greater improvement in pain intensity in MM and MBCT, respectively; 2) higher baseline theta power was associated with greater improvement in depression in MBCT and interfered with response to CT; 3) lower baseline nonreactivity was associated with greater improvement in physical function in MM while higher nonreactivity was associated with greater improvement in MBCT. The findings support the possibility that different patients are more or less likely to benefit from various treatments. Theory-driven moderation research has the capacity to inform the development of patient-treatment matching algorithms to optimize outcome. PERSPECTIVE: This study presents preliminary findings from theory-driven tests of the moderators of mindfulness meditation, cognitive therapy, and mindfulness-based cognitive therapy for chronic low back pain. The results of such analyses may inform the understanding of for whom various evidence-based psychosocial pain treatments may engender the most meaningful benefits.

Medical Subject Headings (MeSH)
Brain WavesCatastrophizationChronic PainCognitive Behavioral TherapyDepressionHumansLow Back PainMeditationMiddle AgedMindfulnessModels, PsychologicalOutcome and Process Assessment, Health CarePilot ProjectsPsychological TheorySingle-Blind MethodTheta Rhythm
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations16
Citations/Year3.2
Relative Citation Ratio1.58
NIH Percentile66.8%
Research Impact Scores
APT Score0.75
Weight Score2.39
Normalized Score0.66
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