Development of Mindfulness-Based Cognitive therapy for Pain (MBCT-Pain)

Development of Mindfulness-Based Cognitive therapy for Pain (MBCT-Pain) Beverly Thorn, Ph.D., ABPP SBM Symposium Mindfulness Meditation and Behaviora...
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Development of Mindfulness-Based Cognitive therapy for Pain (MBCT-Pain) Beverly Thorn, Ph.D., ABPP

SBM Symposium Mindfulness Meditation and Behavioral Medicine April 23, 2009

Acknowledgments: Collaborators Melissa Day, B.S.* Steve Hickman, Psy.D.** Rochelle Voth, Ph.D.** *The University of Alabama, Department of Psychology **University of California San Diego, Center for Mindfulness

Objectives:  Discuss rationale for MBCT-pain  Discuss adaptation of MBCT (Segal, Williams & Teasdale, 2002) for pain management  Discuss potential shared and unique mechanisms of CBT, MBSR & MBCT  Discuss ongoing feasibility trial

The Problem of Chronic Pain  Pain costs $100 billion annually in lost workdays, medical expenses, and other benefit costs (National Institute for Occupational Safety & Health, 2005).  Psychological factors (especially, catastrophizing, fear of pain, depression) are important in determining a patient’s experience of pain (see Sullivan, Thorn et al., 2001).

CBT as an Efficacious Treatment for Chronic Pain  Cognitive-behavioral therapy (CBT) is a well-established efficacious pain management approach for multiple chronic pain conditions (Dixon et al. 2007; Hoffman et al. 2007; Morley et al. 1999; 2008; Keefe et al. 2005; Ostelo et al. 2006; Lackner et al. 2004; Turner et al. 2005).

MBSR as an Efficacious Treatment for Pain and Stress  Mindfulness Based Stress Reduction (MBSR) shows promising efficacy data in a number of chronic medical disorders including chronic pain (Kabat-Zinn et al., 1985; Sephton et al., 2007; Grossman et al. 2007; Reibel et al., 2001).

MBCT as Efficacious for Relapse Prevention in Depression  Mindfulness-Based Cognitive Therapy (MBCT) is efficacious for preventing depression relapse, and specifically addresses ruminative and catastrophic thinking (Williams et al., 2006; Teasdale et al., 2002; Ma et al., 2004; Kenny et al., 2007; Coelho et al., 2007).

MBCT for Chronic Pain?  A few studies have applied MBCT to other populations (OCD, anxiety, eating disorders)  But….no published work to date on MBCT for chronic pain  Surprising given the separate efficacy data for CBT and MBSR

Why MBCT instead of MBSR?  MBCT explicitly incorporates cognitive therapy components  Efficacy data for CBT–pain is strong  Relative expertise of the investigator is in CBT

Process of Adaptation of MBCT for Pain o Establish mindfulness practice o Read Segal, Williams & Teasdale (2002) & attend ½ day workshop o Attend week-long MBCT training workshop o Adapt MBCT manual (Segal, Williams & Teasdale, 2002), incorporating Thorn (2004) Cognitive Therapy for Chronic Pain & KabatZinn (1992) Full Catastrophe Living o Record meditation CDs o Conduct feasibility trial

1. Establish Mindfulness Practice

2. Read Segal, Williams & Teasdale, 2002

Insert Segal Book slide

3. Attend week-long MBCT Training

Thanks to Steve Hickman, Rochelle Voth, & Zindel Segal -and UCSD Center for Mindfulness

4. Adapt MBCT Manual  Kudos and thanks to Melissa Day!

Kabat-Zinn, J. (1992). Full Catastrophe Living.

Insert Kabat-Zinn book slide

Thorn, B.E. (2004). Cognitive Therapy for Chronic Pain: A Step-by-Step Guide, Guilford Publications.

Questions:  Can we use MBCT as a value-added component of cognitive-behavioral therapy?  To add what value to CBT?  Is the approach feasible for chronic pain  Is the MBCT manual realistic?

MBCT as a Cognitive-Behavioral Technique – Are the Buddhist Trappings Necessary?

Value added to CBT?  Cognitive therapy is not just about restructuring/changing maladaptive thoughts  Cognitive therapy takes the patient out of “automatic pilot” and “reactivity”  Cognitive therapy provides a means for emotion regulation ? Cognitive therapy provides a mechanism for acceptance

Emotion Regulation – Crucial Piece for Pain – Can MBCT Enhance?

Acceptance – Growing Importance in Pain – Can MBCT Provide?

Is the Approach Feasible for Chronic Pain?

Is the Manual Realistic?  2 hr sessions?  4-5 activities per session?  Mindfulness of breath  “mini-lectures”  Sitting meditation  Cognitive therapy activity  Summary, homework assignment, mindfulness of breath  Less concept, more cognitive exercises?  Yoga or “mindful movement”?

Ongoing Initial Pilot of Manual  6 post-CBT or EDU patients completing 12-month follow-up  Rural, low-literacy, high spirituality  Pre-post pain-related measures (pain intensity, pain interference quality of life, disability), acceptance, mindfulness

Where to Next    

Manual refinement Small RCT with wait-list Large RCT with attention control Eventual RCT comparing MBCT to CBT

Thank You!

Thank You!