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!