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.
Melissa A Day, B. Thorn, Dawn M Ehde, John W Burns, Amanda J. Barnier, Jason B. Mattingley, Natasha Matthews, M. Jensen
Journal of Pain 2019 DOI: 10.1016/j.jpain.2019.06.006 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 69 |
| Population | Adults with chronic low back pain |
| Interventions | Cognitive therapy Mindfulness-meditation Mindfulness-based cognitive therapy |
| Topics | Meditation |
| Key findings | Baseline pain catastrophizing, theta power, and non-reactivity moderated treatment response, suggesting that different patients are more or less likely to benefit from cognitive therapy, mindfulness meditation, or mindfulness-based cognitive therapy for chronic low back pain. |
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.
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 8
- Self-regulation training for people with knee osteoarthritis: a protocol for a feasibility randomised control trial (MiNT trial). Frontiers in Pain Research 2023
- State of the art in EEG signal features of mindfulness-based treatments for chronic pain. Neurological Sciences August 1, 2025
- Online mindfulness-based cognitive therapy as an adjuvant-treatment for Chinese patients with psoriasis: A randomized controlled trial JAAD International February 20, 2026
- Psychosocial factors associated with engagement and efficacy of mindfulness intervention in the classroom. PLoS One June 25, 2026
- Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain. Journal of Pain February 2023
and 3 more in the library
Cites 10
- Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study ☆ Pain June 4, 2007
- 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
- Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain November 2016
- Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review Cognitive Behaviour Therapy January 2, 2016
- Baseline brain activity predicts response to neuromodulatory pain treatment. Pain Medicine December 1, 2014
and 5 more in the library