Mechanisms of change in depression and anxiety within a mind-body activity intervention for chronic pain
Open accessAbstract
Background Chronic pain is challenging and costly to treat. Depression and anxiety co-occur with chronic pain. Identifying psychosocial mechanisms contributing to emotional outcomes among chronic pain patients can inform future iterations of this intervention.Methods We examined explanatory mechanisms of change in emotional distress following a mind-body and activity intervention among 82 participants (21 - 79 years old, 65.85% female, 80.48% White). With depression and anxiety as outcomes, we hypothesized that potential mediators would include pain catastrophizing, mindfulness, and pain resilience. We used mixed-effects modeling to assess the indirect effects of time on each outcome variable through hypothesized mediators simultaneously.Results Improvements in depression from baseline to post-treatment were most explained by pain catastrophizing (b = -2.53, CI = [-3.82, -1.43]), followed by mindfulness (b = -1.21, CI = [-2.15, -0.46]), and pain resilience (b = -0.76, CI = [-1.54, -1.66]). Improvements in anxiety from baseline to post-treatment were most explained by pain catastrophizing(b = -2.16, CI = [-3.45, -1.08]) and mindfulness (b = -1.51, CI = [-2.60, -0.65]), but not by pain resilience, (b = -0.47, CI = [-1.26, 0.17]).Limitations Findings are limited by the lack of a control group, relatively small sample, and two timepoints. However, findings can guide future mind-body intervention efficacy testing trials.Conclusions Pain catastrophizing and mindfulness appear to be important intervention targets to enhance emotional functioning for chronic pain patients, and should be considered simultaneously in interventions for chronic pain.
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Prior studies by Vranceanu's team showed that pain catastrophizing, kinesiophobia, mindfulness, and pain resilience are mediators of mental and physical health in people with chronic pain.
“This study complements prior studies performed by Vranceanu’s team [51,52] which showed that pain catastrophizing, kinesiophobia, mindfulness, and pain resilience are mediators of mental and physical health in people with chronic pain.”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [52]
The Discussion (page unavailable) reports that pain catastrophizing, mindfulness, and pain resilience mediated improvements in depression; catastrophizing and mindfulness also mediated improvements in anxiety. The paper does not establish kinesiophobia as a mediator or test mediation of physical-health outcomes, and it explicitly says pain resilience did not mediate anxiety. (LLM, conf=0.89)
Experimental — accuracy not yet measuredPain acceptance addresses pain catastrophizing and kinesiophobia.
“pain acceptance addresses: (1) pain catastrophizing, which is an exaggerated cognitive or emotional response to actual or anticipated pain [51-53], and (2) kinesiophobia, which is the avoidance of activities or movements due to excessive anxiety that it will cause pain or injury [54].”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [52]
The Introduction describes pain catastrophizing as negative beliefs about pain, and the Discussion says the intervention addressed it by restructuring pain-related thoughts. The paper mentions pain acceptance as a psychological factor an intervention might target, but does not establish that pain acceptance itself addresses catastrophizing. The separate kinesiophobia clause cites [54], not this source. (LLM, conf=0.80)
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Cheng, A. L., Agarwal, M., Armbrecht, M. A., Abraham, J., Calfee, R. P., & Goss, C. W. (2023) · JMIR Formative Research · doi:10.2196/51422 · Cited by 10 · see citing works
“This study complements prior studies performed by Vranceanu’s team [51,52] which showed that pain catastrophizing, kinesiophobia, mindfulness, and pain resilience are mediators of mental and physical health in people with chronic pain.”
Result
- Authors
- Grunberg, V. A., Mace, R. A., Bannon, S. M., Greenberg, J., Bakhshaie, J., & Vranceanu, A.-M.
- Affiliations
- Harvard University (US)
- Corresponding author
- Vranceanu, Ana-Maria
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 292
- Pages
- 534-541
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC8282750
- OpenAlex
- W3168794396
- Cited by
- 13
- References
- 57
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (1K23AT010653-01A1, 1R34AT009356-01A1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic pain, depression, anxiety, mind-body interventions, pain catastrophizing, mindfulness, pain resilience, mechanisms of change, emotional distress, psychosocial interventions
- MeSH terms
- Adult, Aged, Anxiety, Depression, Female, Humans, Male, Middle Aged, Young Adult, Catastrophization, Chronic Pain, Mindfulness
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