Mediators and Moderators of two online interventions for managing pain, fear of progression and functional ability in rheumatoid arthritis.
Louise Sharpe, Rachel E. Menzies, Jack Boyse, Madelyne A Bisby, Bethany Richmond, Jemma Todd, Amy-Lee Sesel, Blake F Dear
Behaviour Research and Therapy February 2025 DOI: 10.1016/j.brat.2024.104676 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Secondary analysis of a randomized trial Peer reviewed |
|---|---|
| Sample size | 194 |
| Population | People with rheumatoid arthritis |
| Interventions | Online mindfulness-based stress reduction Cognitive-behaviour therapy |
| Duration | 8-week intervention with five lessons; follow-up to six months |
| Topics | Meditation |
| Keywords | Chronic pain Cognitive-behaviour therapy Disability Fear of progression Online therapy Rheumatoid arthritis |
| Key findings | Mindfulness-based stress reduction was more effective than cognitive-behaviour therapy for fear of progression among participants with low pain severity, and for functional ability among those with high baseline trait mindfulness. Changes in fear of progression during treatment fully mediated the effect of treatment group on functional ability six months later. No significant mediators or moderators were identified for pain severity. |
Abstract
This is a secondary analysis of a trial comparing online mindfulness-based stress reduction with cognitive-behaviour therapy for people with rheumatoid arthritis. Both interventions were administered over eight weeks with five lessons and accompanied by weekly therapist contact. For the purposes of this study, we investigated the pain severity, fear of progression and functional ability as the outcome variables because the treatments had differential effects on these three outcomes but had equivalent effects on other variables. We examined mediators and moderators of relative treatment efficacy of mindfulness based stress reduction (n = 91) versus cognitive-behaviour therapy (n = 103) for these outcomes. For pain severity, no significant mediators or moderators were identified. However, amongst those with low pain severity, mindfulness-based stress reduction was more efficacious than cognitive-behaviour therapy for fears of progression. Furthermore, mindfulness-based stress reduction was more efficacious than cognitive-behaviour therapy for functional ability for those with high trait mindfulness at baseline. Changes in fear of progression during treatment fully mediated the effect of treatment group on functional ability over follow-up. While both online mindfulness-based stress reduction and cognitive-behaviour therapy were efficacious for people with rheumatoid arthritis, mindfulness-based stress reduction was more effective in reducing fears of progression and improving functional ability for those with low levels of pain severity and high levels of mindfulness at baseline, respectively. These results highlight the importance of treating fear of progression for people with rheumatoid arthritis as reductions in fears of progression over treatment led to improvements in functional ability six months later.
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
Cites 7
- Using Self-Report Assessment Methods to Explore Facets of Mindfulness Assessment January 27, 2006
- A synthesis of meta-analyses of mindfulness-based interventions in pain. Pain August 14, 2023
- Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study. Journal of Medical Internet Research March 2, 2021
- 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
- Weekly Change in Mindfulness and Perceived Stress in a Mindfulness‐Based Stress Reduction Program Journal of Clinical Psychology July 1, 2012
and 2 more in the library