The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.
Melissa A Day, Beverly E Thorn
Complementary Therapies in Medicine April 2016 DOI: 10.1016/j.ctim.2016.01.002 (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 | 24 |
| Population | Individuals with headache pain at the Kilgo Headache Clinic or psychology clinic |
| Intervention | Mindfulness-based cognitive therapy (MBCT) |
| Topics | Meditation |
| Keywords | Headache Mechanisms Mediation Mindfulness-based cognitive therapy Pain acceptance Theory |
| Key findings | Pain acceptance significantly mediated the relationship between treatment group and pain interference, with activity engagement emerging as a significant mediator while pain willingness did not meet criteria for mediation. The theorized mediating roles of pain catastrophizing and headache management self-efficacy were not supported, as neither significantly predicted pain interference. The authors suggest pain acceptance, specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement during MBCT for headache pain. |
Abstract
This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy). A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N=24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted. Pain acceptance emerged as a significant mediator of the group-interference relation (p<.05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p<.05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference. Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.
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 15
- Mechanism of Action of Mindfulness-Based Interventions for Pain Relief-A Systematic Review. Journal of Integrative and Complementary Medicine December 1, 2024
- A Critical Review and 10-Year Update on Prospects for a Clinical Science of Mindfulness-Based Intervention Mindfulness July 7, 2026
- Potential mediators of the effects of clinical hypnosis, mindfulness meditation, and pain education on chronic pain in Veterans. Journal of Pain January 6, 2026
- Delivering Mindfulness-Based Interventions for Insomnia, Pain, and Dysfunctional Eating Through a Text Messaging App: Three Randomized Controlled Trials Investigating the Effectiveness and Mediating Mechanisms (Preprint) May 6, 2021
- Addressing chronic pain and suicide risk using Mindfulness-Based Cognitive Therapy: Rationale, design and baseline characteristics. Contemporary Clinical Trials November 1, 2025
and 10 more in the library
Cites 3
- The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology 2003
- Toward a theoretical model for mindfulness-based pain management. Journal of Pain July 2014
- Acceptance-based interventions for the treatment of chronic pain: a systematic review and meta-analysis. Pain March 2011