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.

Different patients with chronic low back pain may benefit from different psychosocial treatments depending on their baseline characteristics. In a secondary analysis of a trial comparing cognitive therapy, mindfulness meditation, and mindfulness-based cognitive therapy for 69 adults, moderation analyses found that baseline pain catastrophizing, brain state (theta power on electroencephalogram), and mindful non-reactivity each predicted which treatment yielded greater improvement in pain intensity, depression, or physical function. For example, higher catastrophizing favored mindfulness meditation for pain intensity, while lower catastrophizing favored mindfulness-based cognitive therapy. The findings support the possibility that patient-treatment matching could optimize outcomes.

Study at a glance

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 pre-treatment assessment of hypothesized moderators: pain catastrophizing, brain state as assessed by electroencephalogram, mindful observing, and non-reactivity. 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 non-reactivity was associated with greater improvement in physical function in MM while higher non-reactivity 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.