Education and Mindfulness – Research Evidence

Another short post, but one I intend to add to as I gather more research.

As the title of this post eludes to…..this is about Research Evidence in relation to treatments such as Education and Mindfulness.

Pain Physiology Education

Louw et al (2011)

  • Systematic Review to evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain.
  • Conclusions:
    • For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.

Van Oosterwijck et al (2013)

  • Design:
    • Double-blind RCT
  • Thirty Fibromyalgia patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education).
  • The primary outcome was the efficacy of the pain inhibitory mechanisms.
  • Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status.
  • Assessments were performed at baseline, 2 weeks, and 3 months follow-up.
  • Results:
    • After the intervention the experimental group:
      • Had improved knowledge of pain neurophysiology.
      • Worried less about their pain in the short term.
      • Long-term improvements in physical functioning, vitality, mental health, and general health perceptions were observed.
      • In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition compared with the control group.
    • Discussion:
      • These results suggest that FM patients are able to understand and remember the complex material about pain physiology.
      • Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

Mindfulness-Based Therapy

Schutze et al (2010)

  • Mindfulness:
    • Self-directed, non-reactive awareness of present-moment experience.
  • Hypothesis:
    • Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain.
  • Study design:
    • Two measures of mindfulness were used: the Mindful AttentionAwareness Scale and the Five-Factor Mindfulness Questionnaire.
    • 104 chronic pain outpatients at a multidisciplinary pain clinic in Australia completed the following self-report measures:
      • Pain intensity, negative affect, pain catastrophizing, pain-related fear, pain hypervigilance, and functional disability.
    • Results showed that:
      • Mindfulness significantly negatively predicts each of these variables.
      • Mindfulness uniquely predicts pain catastrophizing when other variables are controlled, and moderates the relationship between pain intensity and pain catastrophizing.
      • This is the first clear evidence substantiating the strong link between mindfulness and pain catastrophizing, and suggests mindfulness might be added to the fear-avoidance model.

Hofmann et al (2010)

  • Meta-Analytic Review
  • Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy.
  • Aim:
    • To conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples.
  • The search identified 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions.
  • Results:
    • Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety and mood symptoms from pre to post-treatment.
    • These effect sizes were robust, unrelated to publication year or number of treatment sessions, and were maintained over follow-up.
  • Conclusion:
    • These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.

Fjorback et al (2011)

  • Systematic Review of RCT’s
  • Mindfulness Based Stress Reduction (MBSR) improved mental health in 11 studies compared to wait list control or treatment as usual (TAU) and was as efficacious as active control group in three studies.
  • Mindfulness Based Cognitive Therapy (MBCT) reduced the risk of depressive relapse in two studies compared to TAU and was equally efficacious to TAU or an active control group in two studies.
  • Overall, studies showed medium effect sizes.
  • Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse.

Marchand (2012)

  • This paper provides an overview of three mindfulness interventions that have demonstrated effectiveness for psychiatric symptoms and/or pain.
  • The goal of this review is to provide a synopsis that practicing clinicians can use as a clinical reference concerning Zen meditation, mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT).
  • Mindfulness has been described as a practice of learning to focus attention on moment-bymoment experience with an attitude of curiosity, openness, and acceptance.
  • Studies indicate that MBSR and MBCT have broad-spectrum antidepressant and antianxiety effects and decrease general psychological distress.
  • MBCT is strongly recommended as an adjunctive treatment for unipolar depression.
  • The evidence suggests that both MBSR and MBCT have efficacy as adjunctive interventions for anxiety symptoms.
  • MBSR is beneficial for general psychological health and stress management in those with medical and psychiatric illness as well as in healthy individuals.
  • Finally, MBSR and Zen meditation have a role in pain management.

References:

Fjorback LO, Arendt M, Ornbøl E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011 Aug;124(2):102-19.

Hofmann SG, Sawyer AT, Witt AA and Oh D. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. J Consult Clin Psychol. 2010 April ; 78(2): 169–183.

Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011 Dec;92(12):2041-56.

Marchand WR. Mindfulness-based stress reduction, mindfulness-based cognitive therapy, and Zen meditation for depression, anxiety, pain, and psychological distress. J Psychiatr Pract. 2012 Jul;18(4):233-52.

Schütze R, Rees C, Preece M, Schütze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain. 2010 Jan;148(1):120-7.

Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, Nijs J. Pain Physiology Education Improves Health Status and Endogenous Pain Inhibition in Fibromyalgia: A Double-Blind Randomized Controlled Trial. Clin J Pain. 2013 Jan 30. [Epub ahead of print]

About the Author:

Mark is a Specialist Musculoskeletal Physiotherapist who consults at both Insight Physiotherapy and Pain Options, in Perth, Western Australia. He specialises in the assessment and management of persistent/chronic musculoskeletal pain. In addition to his clinical role he maintains regular involvement in education of the profession having held a Teaching Fellow position at the University of Western Australia for 10 years and regularly presenting at courses and seminars through the Australian Physiotherapy Association and private education sector. Mark is also a Facilitator for the Australian College of Physiotherapists Specialisation Training Program and a Branch Councillor on the Western Australian Branch of the Australian Physiotherapy Association.

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