Potential mediators of the effects of clinical hypnosis, mindfulness meditation, and pain education on chronic pain in Veterans.
Mark P Jensen, Marcia A Ciol, Kevin J Gertz, Dawn M Ehde, Shahin Hakimian, Melissa A Day, Mark W Pettet, Aaron P Turner, Colin G Sarabosing, Rhonda M Williams
Journal of Pain January 6, 2026 DOI: 10.1016/j.jpain.2025.106176 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized clinical trial Peer reviewed |
|---|---|
| Sample size | 328 |
| Population | Veterans of the US Armed Forces with chronic pain |
| Interventions | Clinical hypnosis Mindfulness meditation training Pain education |
| Duration | 8 in-person group sessions |
| Topics | Meditation |
| Keywords | Chronic pain Clinical hypnosis Cognitive therapy Mechanisms Mediation |
| Registration | NCT02653664 |
| Key findings | Greater pain willingness, engagement in valued activities despite pain, and reduced catastrophizing mediated reductions in pain intensity and interference across all three treatments, while working alliance mediated pain reduction only for clinical hypnosis. |
Abstract
Psychological interventions have reliable but modest effects on chronic pain outcomes, but our understanding of the mechanisms that underlie these effects remains limited. This paper presents the findings from a series of secondary analyses using data from a randomized clinical trial (clinicalTrials.gov, NCT02653664). Three hundred and twenty-eight Veterans of the US Armed Forces with chronic pain were randomized to receive clinical hypnosis, mindfulness meditation training, or pain education via 8 in-person group sessions. Of 17 candidate mediator variables assessed before and after treatment, 10 changed with treatment. Three of these were associated significantly with reductions in pain intensity and interference across all three treatment conditions: greater willingness to tolerate pain, greater engagement in valued activities despite pain, and reduced catastrophizing. A fourth candidate mediator assessed during treatment (working alliance) was significantly associated with reductions in pain intensity for those receiving clinical hypnosis. When comparing effects between treatments, catastrophizing appeared to play a larger role for the effects of mindfulness training on pain intensity and interference, and pain willingness appeared to play a larger role in the effect of therapeutic hypnosis on pain interference. Further research is needed to validate the reliability of the mediators identified in this study. If the findings from the current study replicate in other samples, they would support the importance of focusing treatment on thoughts about pain, pain avoidance, engagement in valued activities, and working alliance. PERSPECTIVE: Three psychological variables were identified as being possible mediators of the beneficial effects of mindfulness, clinical hypnosis, and pain education on pain. Additional research is needed to definitively test these variables as potential mediators of psychological pain treatments.
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
Cites 12
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- Construct Validity of the Five Facet Mindfulness Questionnaire in Meditating and Nonmeditating Samples Assessment February 29, 2008
- Pain acceptance as a change mechanism for mindfulness-based cognitive therapy for migraine. Journal of Behavioral Medicine June 1, 2024
- Hypnosis in psychotherapy, psychosomatics and medicine. A brief overview. Frontiers in Psychology 2024
- Changes in cognitive appraisal in a randomized controlled trial of mindfulness-based cognitive therapy for patients with migraine. Headache: The Journal of Head and Face Pain 2023
and 7 more in the library