School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
Complement Ther Med. 2016 Apr;25:51-4. doi: 10.1016/j.ctim.2016.01.002. Epub 2016 Jan 13.
This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).
A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N=24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.
Pain acceptance emerged as a significant mediator of the group-interference relation (p<.05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p<.05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.
Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.
本研究旨在通过理论规定的机制来确定正念认知疗法（MBCT）是否可以改善头痛结局：（1）心理过程的变化，即疼痛接受；同时（2）认知内容的变化，即疼痛灾难化；头痛管理自我效能。
对一项比较 MBCT 与常规医学治疗、延迟治疗（DT）对照的随机对照试验进行二次分析。参与者为头痛患者，在 Kilgo 头痛诊所或心理诊所完成 MBCT 或 DT（N=24）。在治疗前后，对主要结局（疼痛干扰）和拟议的中介变量进行标准化测量，并计算变化分数。采用引导中介模型进行分析。
疼痛接受作为组间干扰关系的显著中介变量（p<.05）。检验接受亚量表的中介模型显示出这种效应的细微差别，活动参与作为一个显著的中介变量（p<.05），但由于从中介到结局的路径不显著，疼痛意愿不符合中介标准。由于这些变量都没有显著预测疼痛干扰，因此灾难化或自我效能模型的中介标准也未得到满足。
疼痛接受，特别是在疼痛中参与有价值的活动，可能是 MBCT 治疗头痛干预改善疼痛结局的关键机制。在本初步研究中，没有支持认知内容因素的理论中介作用。需要进行一项大型的、明确的试验来复制和扩展这些发现，以便简化和优化 MBCT 治疗头痛的方法。
