Content area
Full Text
Abstract
The present clinical trial aimed to compare mindfulness-based CBT (MCBT), VR-enhanced CBT, and treatment as usual, in terms of effectiveness and mechanisms of change. Outcomes referred to intensity of pain, associated emotional (e.g. anxiety, depression, anger) and cognitive (e.g. catastrophizing, absolutistic beliefs, rumination, fear of pain) problems, and vitality/quality of life. General irrational beliefs, pain- related irrational beliefs and awareness and pain-acceptance were introduced as mediators in the mechanisms of change analysis. A total of 68 patients participated in this trial (18 in the MCBT group, 25 in the CBT group and 25 in the control group - PHM). Results show that only the level of pain was significantly lower in the MCBT group than in the PHM group, but the results were not different from the CBT group. Effects were not mediated by the hypothesized variables. Clinical implications are further discussed.
Keywords: chronic back pain, cognitive-behavioral treatment of chronic back pain, mindfulness, mindfulness-based interventions for chronic back pain.
Introduction
Chronic pain is a major health care problem, while low back pain is one of the most frequent musculoskeletal disorders (Vos et al., 2012), affecting many aspects of everyday life, working life, emotional and social well-being, and quality of life. In a survey (Stewart et al., 2003), approximately 30% of people reported that, because of their back pain they were less able or unable to maintain an independent lifestyle and 40% said that their pain made them feel helpless and they could not function normally.
In the last decade, cognitive-behavioral therapy (CBT) research on pain posited that pain catastrophizing, erroneous beliefs that pain disables, fear of movement or re-injury, maladaptive coping strategies, and negative outcome expectancies contributed to the future pain outcomes, associated emotional problems, and treatment-related improvement in patients with chronic low back pain (Vlaeyen & Linton, 2000). Consequently, the selected cognitions and behaviors targeted for change in standard cognitive behavioral (back) pain interventions (Jensen et al., 2001) refer to: (1) decreasing patient`s catastrophizing beliefs (beliefs that pain disables them and signals harm) and maladaptive strategies of coping with pain; (2) increasing healthy coping with pain strategies and patient`s beliefs regarding their capacity to control pain. Currently, CBT is considered the "golden standard" for chronic pain.
Chronic pain patients have inbuilt ideas...