Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

Hearn, Jasmine Heath; Finlay, Katherine Anne

doi:10.1038/s41393-018-0090-2

Cited by 82Mindfulness and Compassion InterventionsDigital Mental Health InterventionsCancer survivorship and care

Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

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Hearn, Jasmine Heath, Finlay, Katherine Anne·2018·Spinal Cord

DOI 10.1038/s41393-018-0090-2

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Abstract

Study design Between-subjects, randomized controlled feasibility study.Objectives Populations with reduced sensory and motor function are at increased risk of depression, anxiety and pain, and may be less geographically mobile. This study explored the efficacy and feasibility of web-based mindfulness training for people with spinal cord injury (SCI).Setting UK community sample.Methods Participants were randomly allocated to an 8-week online mindfulness intervention (N = 36), or to internet-delivered psychoeducation (N = 31). Depression symptom severity was the primary outcome. Secondary outcomes included anxiety, quality of life (QoL), pain perception, pain catastrophizing and mindfulness. Measures were taken before (T1), at completion of, (T2), and 3 months following the intervention (T3).Results At T2, ten participants discontinued mindfulness training, and five discontinued psychoeducation. Dropouts were of significantly older age. Nine participants were lost to follow-up. Mindfulness reduced depression significantly more than psychoeducation at T2 (mean difference = -1.50, 95% CI [-2.43, -0.58]) and T3 (mean difference = -2.34, 95% CI [-3.62, -1.10]). Anxiety, pain unpleasantness and catastrophizing were significantly reduced compared with psychoeducation. Total mindfulness scores, and all facets of mindfulness except observing were significantly higher following mindfulness training. At follow-up, reductions in anxiety and catastrophizing persisted.Conclusions Internet-delivered mindfulness training offers unique benefits and is viable for people with reduced sensory awareness. Future work should explore the feasibility of combined education and mindfulness training. The use of brief interventions shows promise in maximizing participant retention.

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Mindfulness is a stress-buffering strategy that can reduce psychological distress, depression, pain and worry associated with living with chronic illness.
“Mindfulness has been implicated as a stress-buffering strategy which can reduce the psychological distress, depression, pain and worry associated with living with chronic illness [3–5].”
From Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment (2021) · cites this paper as [4]
The Effect of the intervention section (page unavailable) reports reduced depression, anxiety, pain unpleasantness and pain catastrophizing after mindfulness training in people with spinal cord injury. The paper does not establish mindfulness as a stress-buffering strategy or report a reduction in worry, and its trial findings do not extend to chronic illness generally. (LLM, conf=0.86)
Experimental — accuracy not yet measured
One study provided the best available evidence of benefits for depression, anxiety, pain-related outcomes and quality of life, supported by detailed statistical analyses showing significant results with medium to large effect sizes.
“One study provided the best available evidence of benefits for depression, anxiety, pain-related outcomes and QoL, supported by detailed statistical analyses showing significant results with medium to large effect sizes [20].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
The Effect of the intervention section reports statistically significant improvements in depression, anxiety, pain unpleasantness, and pain catastrophizing, with effect sizes and confidence intervals. It also reports no significant group differences in any quality-of-life domain at intervention completion. The paper does not establish that it provides the “best available” evidence; its explicit reference to medium-to-large effect sizes in the Discussion describes an earlier evaluation, not this trial. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Mindfulness training for individuals with SCI may initiate cognitive reappraisal through increased present-moment awareness and acceptance of emotions, reduced experiential and behavioral avoidance, and less negative judgment, contributing to relieving depression and anxiety disorders.
“Mindfulness training for individuals with SCI may initiate cognitive reappraisal through increased present-moment awareness and acceptance of emotions, reduced experiential and behavioral avoidance, and less negative judgment, contributing to relieving depression and anxiety disorders [20].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Emerging studies applying MABIs among individuals with SCI suggest positive effectiveness on both psychological and physical health-related outcomes.
“There are emerging studies applying MBAIs among individuals with SCI, suggesting positive effectiveness on both psychological (e.g., anxiety, depression, and stress) and physical (e.g., functional independence) health-related outcomes [15, 19, 20].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
The Effect of the intervention section reports improvements in depression, anxiety, and pain unpleasantness among people with SCI receiving mindfulness training. This supports positive psychological and pain-related outcomes, but the paper does not establish the sentence’s examples of reduced stress or improved functional independence; its physical quality-of-life result was not significant. (LLM, conf=0.86)
Experimental — accuracy not yet measured
All participants were wheelchair users, resident in the UK, and reported high levels of mindfulness above non-expert clinical populations on the Five Facet Mindfulness Questionnaire.
“All participants were wheelchair users, resident in the UK, and reported high levels of mindfulness above that of non-expert clinical populations on the Five Facet Mindfulness Questionnaire (see Hearn & Finlay [4] for comparison).”
From Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment (2021) · cites this paper as [4]

Comprehensive sample characteristics were reported in one study, while other studies omitted important demographic information such as ethnicity and gender.
“Comprehensive sample characteristics, including participant age, gender, ethnicity, time since injury, and injury aetiology, were reported in one study [20] (see Table 1), whilst the other studies omitted important demographic information, such as ethnicity [6, 21, 22], and gender [23].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Risk of bias across the two randomised studies ranged from high to low, though neither was considered completely high quality.
“Risk of bias across the two randomised studies (Table 3) ranged from high to low, though neither were considered to be completely high quality [20, 23].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Mindfulness training was the central element of the intervention in two studies, while all others included mindfulness exercises as sub-components of interventions.
“Mindfulness training was the central element of the intervention in two studies [20, 21], whilst all others included mindfulness exercises as sub-components of interventions.”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Only one study supported anxiety reductions with statistical testing, indicating a medium-to-large effect immediately post-intervention and at three-month follow-up.
“However, only one study [20] supported this with statistical testing (p value, effect size, and 95% confidence intervals), which indicated a medium-to-large effect immediately post-intervention (η2p = .137), and at three-month follow-up (η2p = .112).”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Only one study blinded participants to the interventions, posing low risk of bias.
“Only one study blinded participants to the interventions, thereby posing low risk of bias [20].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
The provision of brief (ten minutes) mindfulness exercises via the internet proved a viable and accessible delivery format for an eight-week course.
“The provision of brief (ten minutes) mindfulness exercises via the internet proved a viable and accessible delivery format for an eight-week course [20].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Both randomised studies explicitly described how missing data and drop-out was managed, but only one presented results of between-group statistical comparisons.
“Both studies explicitly described how missing data and drop-out was managed, but only one study [20] presented results of between-group statistical comparisons.”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Only one study evaluated the efficacy of an intervention solely focused on mindfulness training.
“Only one study evaluated the efficacy of an intervention that was solely focused on mindfulness training [20].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Two studies assessed quality of life as an outcome, and no improvements were reported.
“Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported.”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Of four studies reporting pain and pain-related outcomes, only one reported significant improvement in pain unpleasantness and pain catastrophising immediately post-intervention.
“Of the four studies reporting on pain and pain-related outcomes, only one reported significant improvement in pain unpleasantness and pain catastrophising as a result of intensive mindfulness training immediately post-intervention [20]”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Only two studies measured pain catastrophising and quality of life.
“Despite their evidenced role in exacerbating pain and mood problems, only two studies measured pain catastrophising [20, 22] and QoL [6, 20].”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
In the study reporting significant pain-related improvement, pain catastrophising continued to improve at three-month follow-up with a large effect.
“At three-month follow-up, pain catastrophising continued to improve with a large effect (η2p = .239).”
From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [20]
Mindfulness-based interventions used in three included studies did not induce significant improvements in pain intensity for individuals with SCI.
“However, mindfulness-based interventions used in three included studies did not induce significant improvements in pain intensity for individuals with SCI [13, 20, 30].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Withdrawal rates in the intervention group ranged from 0% to 41.7% (average 16.7%).
“Withdrawal rates in the intervention group ranged from 0% [15, 34] to 41.7% [20] (average 16.7%).”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
The attendance rate in the intervention group ranged from 72.2% to 100% (average 82.4%).
“The attendance rate in the intervention group ranged from 72.2% [20] to 100% [15] (average 82.4%).”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Two studies, one ACT and one mindfulness-based intervention, showed statistically significant improvements in anxiety with medium effect sizes at post-intervention (η2p=0.137; Cohen's d=0.48) and three-month follow-up (η2p=0.112).
“two studies (one ACT and the other mindfulness-based intervention) showed statistical significance [20, 32] with medium effect sizes at post-intervention ( η 2 p=0.137; Cohen's d =0.48) and three-month follow-up ( η 2 p=0.112).”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Two studies, one ACT and one mindfulness-based intervention, showed statistically significant improvements in depression with large effect sizes at post-intervention (η2p=0.184; r=0.51) and three-month follow-up (η2p=0.223).
“two studies (one ACT and the other mindfulness-based intervention) showed statistical significance [20, 32], with large effect sizes at both post-intervention ( η 2 p=0.184; r =0.51) and three-month follow-up ( η 2 p=0.223).”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
One mindfulness-based pain management intervention study found significant reductions in pain unpleasantness (η2p=0.137) and pain catastrophizing (η2p=0.110) with medium effect size at post-intervention.
“one mindfulness-based pain management intervention study [20] found significant reductions in pain unpleasantness ( η 2 p =0.137) and pain catastrophizing (η 2 p=0.110) with medium effect size at post-intervention”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
The same mindfulness-based pain management study found continued significant reduction in pain catastrophizing with large effect size (η2p=0.239) at three-month follow-up.
“continued significant reduction in pain catastrophizing with large effect size (η 2 p=0.239) at three-month follow-up.”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
MABIs were delivered in mixed formats: face-to-face (n=4), online (n=3), hybrid (n=1), and on-site with virtual reality goggles (n=1).
“MABIs were delivered in mixed formats: face-to-face (n=4) for ACT [19, 31, 33, 34]; online (n=3) for ACT [32] and mindfulness-based interventions [13, 20] using videoconferencing or a web-based approach; hybrid (n=1) for mindfulness-based intervention [30]; and on-site with virtual reality goggles for dialectical behavioral therapy mindfulness skills training (n=1) [34].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Two RCTs were rated as strong quality; one RCT was rated as moderate quality; and the rest six studies were rated as weak quality, with reasons of high selection biases, non-random design, and lack of blinding and control for confounders.
“Two RCTs were rated as strong quality [20, 30]; one RCT [13] and was rated as moderate quality; and the rest six studies were rated as weak quality, with the reasons of having high selection biases, non-random design, and lack of blinding and control for confounders .”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Participants were recruited from communities (n=4), hospitals (n=2), and rehabilitation centers (n=3).
“Participants were recruited from communities (n=4) [13, 20, 30, 32]; hospitals (n=2) [15, 34]; and rehabilitation centers (n=3) [19, 31, 33].”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]
Mindfulness-based interventions in this review demonstrated significant immediate and prolonged effectiveness in reducing depression and anxiety among SCI patients.
“Both the ACT [32] and mindfulnessbased interventions [20] in this review demonstrated significant immediate and prolonged effectiveness in reducing depression and anxiety among SCI patients.”
From Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review. (2025) · cites this paper as [20]

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Exploring Cancer Patients’ Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation
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A Systematic Review of the Adherence to Home-Practice Meditation Exercises in Patients with Chronic Pain
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“%) completed ≥ 5 out of 7 weeks of homework (excellent) Hearn and Finlay (2018) [63] M = 6 days per week MCompleters (8 weeks) = 960 (SD = 0) The course delivered two 10-min audio-guided meditations each day, on 6 out of 7 days a week, for 8 weeks.”
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The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study
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Effect of a Mindfulness and Motivational Interviewing-Oriented Physical-Psychological Integrative Intervention for Community-Dwelling Spinal Cord Injury Survivors: A Mixed-Methods Randomized Controlled Trial
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The Effects of a New Integrated and Multidisciplinary Cognitive Rehabilitation Program Based on Mindfulness and Reminiscence Therapy in Patients with Parkinson’s Disease and Mild Cognitive Impairment: A Pilot Study
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Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review
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Prevalence, severity, and self-management of depressive mood among community-dwelling people with spinal cord injury in Nepal
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Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research
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Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study.
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Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions
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Should Non-Pharmacological and Non-Surgical Interventions be Used to Manage Neuropathic Pain in Adults With Spinal Cord Injury? – A Systematic Review
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Online psychosocial intervention for persons with spinal cord injury: A meta-analysis
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Grieving a disrupted biography: an interpretative phenomenological analysis exploring barriers to the use of mindfulness after neurological injury or impairment
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Digital psychosocial interventions for individuals with spinal cord injury: a scoping review
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Guidelines for chronic pain in adult spinal cord injury population: Scoping review
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Virtually delivered Mindfulness-Oriented Recovery Enhancement (MORE) reduces daily pain intensity in patients with lumbosacral radiculopathy: a randomized controlled trial
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Cognitive behaviour therapy in adults with spinal cord injury: A scoping review
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Effectiveness of Behavioral and Pharmacologic Interventions for Depressive Symptoms After Spinal Cord Injury: Findings From a Systematic Review
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Meta-Analysis: The Use of Mindfulness-Based Cognitive Therapy for Depression Symptoms
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Meditation-Based Therapies for Chronic Neuropathy: A Systematic Review and Meta-Analysis
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Participation Education Intervention for People With SCI From LMIC: A Pilot Randomized Clinical Trial
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The Role of Mindfulness-Based Interventions in Treating Depression among Population Subgroups
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Utilizing Double Machine Learning to Discern Risk Factors for Preoperative Depression Among Anterior Cervical Discectomy and Fusion (ACDF) Patients
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Additional file 1 of Immediate impact of Mindfulness-Based Cognitive Therapy (MBCT) among women with breast cancer: a systematic review and meta-analysis
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Recommendations for adapting an online mindfulness program for people living with spinal cord injury: results from a pilot online survey with an integrated knowledge translation approach
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Participant perspectives on a multimodal program for neuropathic pain after spinal cord injury
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The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury—Results of a randomized controlled trial
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Multidimensional Effects of Telemedicine on Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Development and effectiveness of a mindfulness-based cognitive therapy for individuals with spinal cord injury: Changes in quality of life and inflammatory biomarkers
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Prevalence and psychosocial interventions of mental disorders following traumatic spinal cord injury: a systematic review and meta-analysis based on knowledge graphs
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A Chinese Guideline for the Diagnosis and Management of Chronic Post-Traumatic Pain (2023 Edition)
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Scoping review of equity considerations in digitally enabled patient education interventions for self-managing chronic musculoskeletal pain
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Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial
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Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review
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Mindfulness-based intervention for adults with spinal cord injury: study protocol for a multicenter randomized controlled trial
Wang, S., Luo, N., Wu, Z., Hu, X., Xu, W., Li, C., Gao, H., Yang, X., Meng, T., Huang, L., et al. (2026) · BMC Psychology · doi:10.1186/s40359-026-05430-4
Online Psychosocial Intervention for Persons with Spinal Cord Injury: A Meta-Analysis
Blackport, D., Ahrens, J., Sequeira, K., Teasell, R. W., Loh, E., Mehta, S., & Hadjistavropoulos, H. D. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.07.487 · Cited by 1 · see citing works
Feasibility and Acceptability of an App-Based Mindfulness Meditation Intervention for People with Spinal Cord Injury and Chronic Pain.
Korupolu, R., Ratcliff, C. G., Lohiya, S., Taylor, H. B., Li, R., & Robinson‐Whelen, S. (2026) · PubMed · doi:10.46292/sci25-00038

Authors: Hearn, J. H., & Finlay, K. A.
Affiliations: University of Buckingham (GB)
Corresponding author: Hearn, Jasmine Heath
ORCID: Hearn, Jasmine Heath
Finlay, Katherine Anne
Venue: Spinal Cord
Publisher: Springer Science and Business Media LLC
Published: 2018-03-26
Volume: 56
Issue: 8
Pages: 750-761
ISSN: 1362-4393 (ISSN-L)
1476-5624
DOI: 10.1038/s41393-018-0090-2
OpenAlex: W2790511170
Semantic Scholar: e0fb998c2eccffdee115c2a670addc7a49f5ad07
Cited by: 82
References: 37
Citations by year: 2026: 10 · 2025: 8 · 2024: 12 · 2023: 10 · 2022: 14 · 2021: 14 · 2020: 10 · 2019: 2 · 2018: 2
FWCI: 8.21
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Spinal Cord (publishedVersion)
PubMed (publishedVersion)
Buckingham E-Archive of Research (University of Buckingham) (acceptedVersion)
e-space (Manchester Metropolitan University) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: spinal cord injury, depression, chronic pain, pain catastrophizing, anxiety, quality of life, psychoeducation, feasibility, participant retention, online psychological intervention
MeSH terms: Adult, Anxiety, Depression, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Compliance, Patient Education as Topic, Quality of Life, Spinal Cord Injuries, Therapy, Computer-Assisted, Treatment Outcome, Internet, Catastrophization, Pain Perception, Chronic Pain, Mindfulness

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Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

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