By John M. de Castro, Ph.D.
“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken
We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for a wide swath of humanity pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. Chronic pain accompanies a number of conditions. The most common form of chronic pain is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.
Pain involves both physical and psychological issues. Indeed, people with chronic pain are much more likely to become depressed and people with depression are much more likely to develop chronic pain. Mindfulness practices have been shown to be safe and beneficial in pain management and to reduce depression. But, how mindfulness training may reduce the depression accompanying chronic pain is not known. Mindfulness is known to improve the awareness of the sensations from the body. It is possible then that the reduction of depression about pain is produced by making the patient more aware of their bodies and thus better able to respond to any aversive states in the body.
In today’s Research News article “Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression.” See:
or see summary below or view the full text of the study at:
http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full
de Jong and colleagues recruited chronic pain patients with depression and randomly assigned them to receive either an 8-week Mindfulness-Based Cognitive Therapy (MBCT) plus the normal treatment provided to these patients or to receive only treatment as usual. They were measured for body awareness, pain catastrophizing, and depression before, during, and after the 8 weeks of treatment.
They found that the MBCT group had reduced depression and increased body awareness, especially in self-distracting and self-regulation. “Not-Distracting refers to not ignoring or distracting oneself from uncomfortable body sensations such as pain. Self-Regulation refers to the ability to control psychological distress by consciously attending to body sensations.” Hence MBCT significantly improved the chronic pain patient’s ability to control their pain by paying attention to it. Using a sophisticated statistical technique of mediation analysis, they were able to determine that the effects of mindfulness on depression were completely mediated by its effect on body awareness.
These results are interesting and important. It is well established that mindfulness training and MBCT in particular are very effective in reducing depression. The present findings, though, demonstrate that its ability to reduce the depression produced by chronic pain is due to improved body awareness. This may seem counterintuitive that increasing the awareness of body pain would improve the depression produced by the pain. But, denying pain by ignoring it or by distracting oneself from it doesn’t work and actually increases its pain’s impact by increasing worry and rumination. Directly addressing the pain and seeing it as it is, makes it easier to cope with it.
So, improve body awareness and reduce depression due to pain with mindfulness.
“MBCT helps participants learn how to recognize their sense of being and see themselves as separate from their thoughts and moods. This disconnect can allow people to become liberated from thought patterns in which the same negative messages may be replayed over and over. . . . In general, MBCT attempts to give participants the necessary tools to combat depressive symptoms as they arise. People who learn these skills may then be able to revert to these methods in times of distress or when faced with potentially overwhelming situations.” – Goodtherapy.org
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
de Jong M, Lazar SW, Hug K, Mehling WE, Hölzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D and Gard T (2016) Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front. Psychol. 7:967. doi: 10.3389/fpsyg.2016.00967
Abstract
Body awareness has been proposed as one of the major mechanisms of mindfulness interventions, and it has been shown that chronic pain and depression are associated with decreased levels of body awareness. We investigated the effect of Mindfulness-Based Cognitive Therapy (MBCT) on body awareness in patients with chronic pain and comorbid active depression compared to treatment as usual (TAU; N = 31). Body awareness was measured by a subset of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scales deemed most relevant for the population. These included: Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, and Self-Regulation. In addition, pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). These scales had adequate to high internal consistency in the current sample. Depression severity was measured by the Quick Inventory of Depressive Symptomatology-Clinician rated (QIDS-C16). Increases in the MBCT group were significantly greater than in the TAU group on the “Self-Regulation” and “Not Distracting” scales. Furthermore, the positive effect of MBCT on depression severity was mediated by “Not Distracting.” These findings provide preliminary evidence that a mindfulness-based intervention may increase facets of body awareness as assessed with the MAIA in a population of pain patients with depression. Furthermore, they are consistent with a long hypothesized mechanism for mindfulness and emphasize the clinical relevance of body awareness.
http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full