Attrition Rates in Mindfulness-Based Interventions for Chronic Pain: A Meta-Analysis

Attrition rates for mindfulness-based interventions (MBIs) for chronic pain average 30.1%, but vary widely depending on program structure. Stricter completion thresholds are linked to higher dropout: requiring at least six sessions to count as a completer yields a 49.7% attrition rate, versus 18% when only three sessions are required. Online delivery shows higher attrition (51.0%) than in-person delivery (25.6%), and individual formats have higher attrition than group formats. These findings suggest that modifying program structure—such as lowering session requirements, offering in-person sessions, and using group formats—could reduce participant withdrawal.

Study at a glance

Abstract

Abstract Objective Mindfulness-based interventions (MBIs) show promise in managing chronic pain but often require substantial time commitments, leading to high attrition rates and concerns about acceptability. This meta-analysis evaluated attrition rates in MBIs for chronic pain and explored factors contributing to participant withdrawal. Methods Following PRISMA guidelines, 44 studies (45 intervention conditions) were analysed. Data on attrition rates, program characteristics (e.g., delivery method, group vs. individual therapy, session duration), and participant demographics were extracted. Meta-analyses of proportions assessed moderators influencing attrition rates. Results The overall weighted mean attrition rate was 30.1% (95% CI: 24.5% to 37.3%) with substantial heterogeneity ( I² = 89.0%). Stricter completion thresholds (defined as the minimum number of sessions required to be considered a programme completer) were associated with higher attrition ( p < 0.001, R² = 28.1%), ranging from an 18% attrition rate for low thresholds (completion of ≥3 sessions required to be defined as a completer) to a 49.7% attrition rate for high thresholds (≥6 sessions). Online delivery showed higher attrition rates (51.0%) compared to in-person delivery (25.6%, p = 0.002, R² = 17.1%). Individually delivered MBIs were also linked to higher attrition compared to group formats ( β = 0.216, p = 0.039, R² = 5.5%). Conclusions Attrition rates for MBIs in chronic pain management vary widely. Higher attrition is associated with stricter completion criteria, online delivery, and individual formats. These findings highlight the need to optimise MBI programme structure to reduce attrition in MBIs for chronic pain management.