Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer - explorative analyses from a randomized controlled trial.
Maja Johannsen, Mia S O'Toole, M O'Connor, Anders B Jensen, Robert Zachariae
Acta oncologica February 2017 DOI: 10.1080/0284186x.2016.1268713 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 129 |
| Population | Women treated for breast cancer reporting persistent pain |
| Intervention | Mindfulness-based cognitive therapy (MBCT) |
| Duration | Post-intervention, three, and six months follow-up |
| Measures | 11-point numeric rating scale for pain intensity, Hospital Anxiety and Depression Scale (HADS), Experiences in Close Relationships Short Form (ECR-SF), Toronto Alexithymia Scale (TAS-20) |
| Topics | Meditation |
| Key findings | Attachment avoidance was the only statistically significant moderator of MBCT's effect on pain intensity, with higher avoidance predicting a larger reduction in pain. Radiotherapy showed a non-significant trend toward a smaller MBCT effect. The authors conclude that attachment avoidance, and potentially radiotherapy, may help identify patients who benefit most from MBCT, but stress that the exploratory results are preliminary. |
Abstract
Mindfulness-based intervention has been found efficacious in reducing persistent pain in women treated for breast cancer. Little, however, is known about possible moderators of the effect. We explored clinical and psychological moderators of the effect on pain intensity previously found in a randomized controlled trial of mindfulness-based cognitive therapy (MBCT) with women treated for breast cancer with persistent pain. A total of 129 women treated for breast cancer reporting persistent pain were randomized to MBCT or a wait-list control. The primary outcome of pain intensity (11-point numeric rating scale) was measured at baseline, post-intervention, three, and six months follow-up. Proposed clinical moderators included age, axillary lymph node dissection (ALND), radiotherapy, and endocrine treatment. Psychological moderators included psychological distress [the Hospital Anxiety and Depression Scale (HADS)], the adult attachment dimensions anxiety and avoidance [the Experiences in Close Relationships Short Form (the ECR-SF)], and alexithymia [the Toronto Alexithymia Scale (TAS-20)]. Multi-level models were used to test moderation effects over time, i.e. time × group × moderator. Only attachment avoidance (p = 0.03, d = 0.36) emerged as a statistically significant moderator. Higher levels of attachment avoidance predicted a larger effect of MBCT in reducing pain intensity compared with lower levels attachment avoidance. None of the remaining psychological or clinical moderators reached statistical significance. However, based on the effect size, radiotherapy (p = 0.075, d = 0.49) was indicated as a possible clinical moderator of the effect, with radiotherapy being associated with a smaller effect of MBCT on pain intensity over time compared with no radiotherapy. Attachment avoidance, and potentially radiotherapy, may be clinically relevant factors for identifying the patients who may benefit most from MBCT as a pain intervention. Due to the exploratory nature of the analyses, the results should be considered preliminary.
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
- Mindfulness Based Therapy in Cancer Patients: Meta-Analysis Asian Pacific Journal of Cancer Care August 27, 2021
- Long-term treatment outcomes of mindfulness-based cognitive therapy for fatigue in patients with inflammatory bowel disease: Results of a randomized controlled trial. Journal of Psychosomatic Research December 1, 2024
- Mindfulness-Based Cognitive Therapy for Fatigue in Patients with Inflammatory Bowel Disease: Results of a Randomized Controlled Trial Mindfulness 2023
- Effects of Mindfulness-Based Therapy for Cancer Patients: A Systematic Review and Meta-analysis. Journal of clinical psychology in medical settings June 2022
- Predictors and moderators of outcomes in mindfulness-based cognitive therapy intervention for early breast cancer patients. Palliative & Supportive Care April 2022
and 3 more in the library
Cites 5
- Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress Complementary health practice review April 1, 2008
- Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. Journal of Clinical Oncology October 1, 2016
- Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors. Supportive Care in Cancer October 2016
- Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Journal of Clinical Oncology August 20, 2016
- The Role of Mindfulness-Based Stress Reduction on Perceived Stress: Preliminary Evidence for the Moderating Role of Attachment Style Journal of Cognitive Psychotherapy August 1, 2009