The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial.
Melissa A Day, Marcia A Ciol, M Elena Mendoza, Jeffrey Borckardt, Dawn M Ehde, Andrea K Newman, Joy F Chan, Sydney A Drever, Janna L Friedly, John W Burns, Beverly E Thorn, Mark P Jensen
BMC Medicine April 12, 2024 DOI: 10.1186/s12916-024-03383-2 (opens in new tab)
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Study at a glance
AI-extracted from the abstract| Characteristics | Randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 302 |
| Population | Adults with chronic low back pain |
| Interventions | Cognitive therapy Behavioral activation Mindfulness meditation |
| Duration | Pre- to post-treatment, with 3- and 6-month follow-ups |
| Topics | Meditation |
| Keywords | Psychological treatment Randomized clinical trial Telehealth |
| Citations | 9 |
| Registration | NCT03687762 |
| Key findings | Group, videoconference-delivered cognitive therapy, behavioral activation, and mindfulness meditation each produced medium-to-large reductions in pain interference for chronic low back pain, with no significant between-group differences at any time point except for sleep disturbance improvement favoring behavioral activation over mindfulness meditation. |
Abstract
Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness meditation (MM), and behavioral activation (BA). This study aimed to evaluate the relative immediate (pre- to post-treatment) and longer term (pre-treatment to 3- and 6-month follow-ups) effects of group, videoconference-delivered CT, BA, and MM for CLBP. This is a secondary analysis of a three-arm, randomized clinical trial comparing the effects of three active treatments-CT, BA, and MM-with no inert control condition. Participants were N = 302 adults with CLBP, who were randomized to condition. The primary outcome was pain interference, and other secondary outcomes were also examined. The primary study end-point was post-treatment. Intent-to-treat analyses were undertaken for each time point, with the means of the changes in outcomes compared among the three groups using an analysis of variance (ANOVA). Effect sizes and confidence intervals are also reported. Medium-to-large effect size reductions in pain interference were found within BA, CT, and MM (ds from - .71 to - 1.00), with gains maintained at both follow-up time points. Effect sizes were generally small to medium for secondary outcomes for all three conditions (ds from - .20 to - .71). No significant between-group differences in means or changes in outcomes were found at any time point, except for change in sleep disturbance from pre- to post-treatment, improving more in BA than MM (d = - .49). The findings from this trial, one of the largest telehealth trials of psychological treatments to date, critically determined that group, videoconference-delivered CT, BA, and MM are effective for CLBP and can be implemented in clinical practice to improve treatment access. The pattern of results demonstrated similar improvements across treatments and outcome domains, with effect sizes consistent with those observed in prior research testing in-person delivered and multi-modal psychological pain treatments. Thus, internet treatment delivery represents a tool to scale up access to evidence-based chronic pain treatments and to overcome widespread disparities in healthcare. Clinicaltrials.gov, NCT03687762.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 2
- Integrating Immersive Virtual Reality Meditation into Palliative Oncology: A Randomized Trial Protocol for Evaluating Pain Relief and Quality of Life Healthcare January 21, 2026
- Feasibility, Acceptability and Modification of a Post-surgical Telehealth Mindfulness-Based Intervention to Enhance Recovery After Lumbar Spine Surgery: A Prospective Intervention Study. Global Advances in Integrative Medicine and Health 2025
Cites 5
- Meditation Programs for Psychological Stress and Well-being JAMA Internal Medicine January 6, 2014
- Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study ☆ Pain June 4, 2007
- Effects of Hypnosis vs Mindfulness Meditation vs Education on Chronic Pain Intensity and Secondary Outcomes in Veterans: A Randomized Clinical Trial Pain January 25, 2022
- A Pilot Randomized Controlled Trial Comparing Mindfulness Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain Pain Medicine November 1, 2019
- Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA