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.
Jessica A Chen, Melissa L Anderson, Daniel C Cherkin, Benjamin H Balderson, Andrea J Cook, Karen J Sherman, Judith A Turner
Journal of Pain February 2023 DOI: 10.1016/j.jpain.2022.09.014 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized controlled trial Preregistered Peer reviewed |
|---|---|
| Sample size | 297 |
| Population | Adults aged 20 to 70 years with chronic low back pain |
| Interventions | Mindfulness-based stress reduction (MBSR) cognitive-behavioral therapy (CBT) usual care |
| Duration | 8-week outcomes |
| Measures | modified Roland Disability Questionnaire, 0-10 numerical rating scale for pain bothersomeness, Patient Health Questionnaire-8 |
| Topics | Meditation |
| Keywords | Chronic back pain Cognitive-behavioral therapy Mindfulness-based stress reduction Predictors Treatment effect modifiers |
| Registration | NCT01467843 |
| Key findings | The nonjudging dimension of mindfulness moderated the relative effects of CBT versus MBSR on function and pain, while pain control beliefs and lower anxiety predicted improvement regardless of treatment. The authors suggest these findings point to directions for confirmatory research and provide reassurance that patients could reasonably expect to benefit from either treatment. |
Abstract
Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0-10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. TRIAL REGISTRATION: The trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PERSPECTIVE: Although few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.
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 3
- The relational dimension in mindfulness intervention effects: results of a randomized controlled trial of mindfulness-based childbirth and parenting. BMC Pregnancy and Childbirth May 10, 2025
- Mindfulness na terapia cognitiva: benefícios na redução da dor crônica - uma revisão sistemática STUDIES IN HEALTH SCIENCES August 4, 2025
- Mindfulness Based Pain Management (MBPM) for Chronic Pain: Long-Term Effects Journal of Contemporary Psychotherapy December 1, 2025
Cites 14
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- Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: A systematic review and network meta-analysis Evidence-Based Mental Health January 23, 2019
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and 9 more in the library