Mindfulness and Cognitive-behavioral Interventions for Chronic Pain: Differential Effects on Daily Pain Reactivity and Stress Reactivity

Objective: This study compared the impact of cognitive-behavioral therapy for pain (CBT-P), mindful awareness and acceptance treatment (M), and arthritis education (E) on day-to-day pain- and stress-related changes in cognitions, symptoms, and affect among adults with rheumatoid arthritis (RA).

Method: 143 RA patients were randomized to one of the three treatment conditions. CBT-P targeted pain coping skills; M targeted awareness and acceptance of current experience to enhance coping with a range of aversive experiences; and E provided information regarding RA pain and its management. At pre- and post-treatment, participants completed 30 consecutive evening diaries assessing that day's pain, fatigue, pain-related catastrophizing and perceived control, morning disability, and serene and anxious affects.

Results: Multilevel models compared groups in the magnitude of within-person change in daily pain- and stress-reactivity from pre- to post-treatment. M yielded greater reductions than did CBT-P and E in daily pain-related catastrophizing, morning disability, and fatigue, and greater reductions in daily stress-related anxious affect. CBT-P yielded less pronounced declines in daily pain-related perceived control than did M and E.

Conclusions: For individuals with RA, M produces the broadest improvements in daily pain- and stress-reactivity relative to CBT-P and E. These findings also highlight the utility of a diary-based approach to evaluating the treatment-related changes in responses to daily life.