Relieve Depression in Patients with Chronic Pain with Mindfulness-Based Cognitive Therapy (MBCT)
By John M. de Castro, Ph.D.
“By developing a routine meditation practice, clients can use the technique whenever they start to feel overwhelmed by negative emotions. When sadness occurs and starts to bring up the usual negative associations that trigger relapse of depression, the client is equipped with tools that will help them replace negative thought patterns with positive.” – Psychology Today
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.
Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.
Chronic pain is often accompanied with depression. The most commonly used mindfulness technique for the treatment of depression is Mindfulness-Based Cognitive Therapy (MBCT). MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. It is not known, however if MBCT is also effective for the depression accompanying chronic pain.
In today’s Research News article “A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6020018/ ), De Jong and colleagues recruited adult patients with chronic pain and who were also clinically depressed. They were randomly assigned to either receive an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT) or to a treatment as usual wait list control. The MBCT group met once a week for 2 hours in groups of 7 and also engaged in daily home practice. They were measured before and after training for depression, pain, quality of life, anxiety, and perceptions of improvement.
They found that in comparison to baseline and the wait list control group that the participants who received MBCT had a significant decrease in depression but not pain. Hence, MBCT was an effective treatment for depression for patients with chronic pain. It did so by not affecting the levels of pain experienced. So, the effectiveness of MBCT was due to influencing depression directly independent of pain. It should be noted that there was not an active control condition and the sample sizes were small. So, these results need to be replicated in a larger randomized controlled clinical trial with an active control. Regardless, the results are encouraging and extend the types of depressed patients helped by MBCT.
So, relieve depression in patients with chronic pain with Mindfulness-Based Cognitive Therapy (MBCT).
“Most importantly, I seemed to be developing a whole new relationship with my thoughts. It wasn’t that they’d really changed; they were still the same old wolf- and fire- and death-fearing thoughts, but I could see that they were simply that: thoughts. I did not have to judge them, act on them or indeed do anything very much about them.“ – Julie Myerson
CMCS – Center for Mindfulness and Contemplative Studies
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De Jong, M., Peeters, F., Gard, T., Ashih, H., Doorley, J., Walker, R., … Mischoulon, D. (2018). A Randomized Controlled Pilot Study on Mindfulness-Based Cognitive Therapy for Unipolar Depression in Patients with Chronic Pain. The Journal of Clinical Psychiatry, 79(1), 15m10160. http://doi.org/10.4088/JCP.15m10160
Chronic Pain (CP) is a disabling illness, often comorbid with depression. We performed a randomized controlled pilot study on mindfulness-based cognitive therapy (MBCT) targeting depression in a CP population.
Participants with CP lasting ≥ 3 months, DSM-IV Major Depressive Disorder (MDD), Dysthymic Disorder, or Depressive disorder NOS, and a Quick Inventory of Depression scale (QIDS-C16) score ≥ 6 were randomized to MBCT (n = 26) or waitlist (n = 14). We adapted the original MBCT intervention for depression relapse prevention by modifying the psychoeducation and Cognitive Behavioral Therapy (CBT) elements to an actively depressed chronic pain population. We analyzed an intent-to treat (ITT) and a per protocol sample; the per protocol sample included participants in the MBCT group who completed at least 4 out of 8 sessions. The change in the QIDS-C16 and Hamilton Rating Sale for Depression (HRSD17) were the primary outcome measures. Pain, quality of life and anxiety were secondary outcome measures. Data collection took place between January 2012 and July 2013.
Nineteen (73%) participants completed the MBCT program. No significant adverse events were reported in either treatment group. ITT analysis (n=40) revealed no significant differences. Repeated measures ANOVAs for the per protocol sample (n=33) revealed a significant treatment × time interaction (F (1, 31) = 4.67, p = 0.039, η2p = 0.13) for the QIDS-C16, driven by a significant decrease in the MBCT group (t (18) = 5.15, p < 0.001, d = 1.6), but not in the control group (t (13) = 2.01, p = 0.066). The HRSD17 scores did not differ significantly between groups. The study ended before the projected sample size was obtained, which might have prevented effect detection in some outcome measures.
MBCT shows potential as a treatment for depression in individuals with CP, but larger controlled trials are needed.