Mechanisms of Mindfulness Meditation, Cognitive Therapy, and Mindfulness-based Cognitive Therapy for Chronic Low Back Pain
Abstract
Objectives: This study evaluated theoretically derived mechanisms and common therapeutic factors to test their role in accounting for pain-related outcome change during group-delivered cognitive therapy, mindfulness meditation, and mindfulness-based cognitive therapy for chronic low back pain. Methods: A secondary analysis of a pilot randomized controlled trial was used to explore the primary mechanisms of pretreatment to posttreatment changes in pain control beliefs, mindful observing, and pain catastrophizing, and the secondary common factor mechanisms of therapeutic alliance, group cohesion, and amount of at-home skill practice during treatment. The primary outcome was pain interference; pain intensity was a secondary outcome. Results: Large effect size changes in the 3 primary mechanisms and the outcome variables were found across the conditions. Across all 3 treatment conditions, change in pain control beliefs and pain catastrophizing were significantly associated with improved pain interference, but not pain intensity. Therapeutic alliance was significantly associated with pain intensity improvement and change in the therapy-specific mechanisms across the 3 conditions. Mindful observing, group cohesion, and amount of at-home practice were not significantly associated with changes in the outcomes. Discussion: Cognitive therapy, mindfulness meditation, and mindfulness-based cognitive therapy for chronic low back pain were all associated with significant changes in the primary mechanisms to a similar degree. Change in perceived pain control and pain catastrophizing emerged as potential “meta-mechanisms” that might be a shared pathway that contributes to improved pain-related outcomes across treatments. Further, strong working alliance may represent a critical therapeutic process that both promotes and interacts with therapeutic techniques to influence outcome.
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The average frequency and duration of informal practice was less than that of formal practice, which contrasts with results of several previous studies.
“The average frequency and duration of informal practice was less than that of formal practice. This contrasts with results of several previous studies.”
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Self-citationWilson, M. K., Wilson, D., Searle, A., & Mackintosh, S. F. (2025) · Journal of Pain · doi:10.1016/j.jpain.2024.104774 · Cited by 3 · see citing works
The Role of Mindfulness Therapy in the Treatment of Chronic Pain
Biao, D., Umoh, K., Qiguang, C., Xiaole, W., Ting, F., Yuqian, Y., Jinchao, Z., & Fushui, L. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01284-w · Cited by 3 · see citing works
“Individuals with chronic pain often experience a significant emotional burden, including the sensations brought about by pain and to restructure their cognitive processes and content of pain catastrophizing [ 76 ].”
The role of the patient–clinician relationship in Chronic Pain Interventions: A systematic review
Pasini, I., Donisi, V., Veneziani, E., Lucia, A. D., Humphris, G. M., Schweiger, V., Perlini, C., & Piccolo, L. D. (2026) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2026.112643 · Cited by 2 · see citing works
Edwards, K. A., Reed, D. E., Anderson, D. R., Harding, K. A., Turner, A. P., Soares, B., Suri, P., & Williams, R. M. (2023) · PM&R · doi:10.1002/pmrj.12912 · Cited by 2 · see citing works
“For example, Mindfulness-based Cognitive Therapy (MBCT) integrates mindfulness meditation practices with cognitive restructuring and behavioral techniques and has demonstrated similar outcomes to mindfulness and CBT-only interventions.(72) Mindfulness-Based Stress Reduction (MBSR) was among the early psychological tre…”
MethodMani, R., Adhia, D. B., Awatere, S., Gray, A. R., Mathew, J., Wilson, L. C., Still, A., Jackson, D., Hudson, B., Zeidan, F. Z., et al. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2023.1271839 · Cited by 2 · see citing works
Jensen, M. P., Robles, S., Nash, M. G., May, S. J., Ehde, D. M., Day, M. A., Gottlieb, O., Sugarman, L. I., & Alschuler, K. N. (2025) · Multiple Sclerosis Journal · doi:10.1177/13524585251329820 · Cited by 2 · see citing works
“More research is needed to identify the shared and unique mechanisms of hypnotic-and mindful-ness-based approaches on fatigue, 38,39 as well as to identify possible factors that predict who might benefit more from one or the other.”
Self-citationThe new generation of psychological treatments for pain: characteristics and critical appraisal
McDermott, K. A., & Keefe, F. J. (2026) · Pain · doi:10.1097/j.pain.0000000000003993 · Cited by 1 · see citing works
Lee, K., Gim, W.-S., & Park, S. W. (2023) · Current Psychology · doi:10.1007/s12144-023-05154-3 · Cited by 1 · see citing works
“In addition, mindfulness-based intervention is effective in improving pain catastrophizing related to anxiety in patients with CLBP (Day et al., 2020) and negative emotions related to pain (Luiggi-Hernandez et al., 2018).”
MEDITAÇÃO EM PACIENTES COM DORES CRÔNICAS: UMA REVISÃO SISTEMÁTICA
Neta, Z. A. M. (2022) · Arquivos do Mudi · doi:10.4025/arqmudi.v26i1.62010
Psychological interventions in patients with chronic low back pain: a scoping review
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Mindfulness and virtual reality technology in the treatment of chronic back pain
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A Chinese Guideline for the Diagnosis and Treatment of Chronic LOW Back Pain (2024 Edition)
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Exploring the role of pain catastrophizing in anxiety and depression among breast cancer survivors
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“[5] Among these factors, pain catastrophizing (PC) is one of the most important psychological aspects of pain that has a significant role in greater disability.”
Kılınç, N. Ö. (2026) · Health Sciences Quarterly · doi:10.26900/hsq.3158
Taylor, S. L., Calvert, C., Haley, A. C., Evans, R., Adamowicz, J. L., Allen, K. D., Brønfort, G., Cross, L. J. S., Goldsmith, E. S., Grant, A. D., et al. (2026) · Annals of Behavioral Medicine · doi:10.1093/abm/kaag061
- Authors
- Day, M. A., Ward, L. C., Thorn, B. E., Burns, J., Ehde, D. M., Barnier, A. J., Mattingley, J. B., & Jensen, M. P.
- Affiliations
- University of Alabama (US)
- School of Psychology
- Rush University Medical Center (US)
- Macquarie University (AU)
- The University of Queensland (AU)
- Corresponding author
- Day, Melissa A.
- Ward, L. Charles
- Mattingley, Jason B.
- ORCID
- Venue
- The Clinical Journal of Pain
- Published
- 2020-07-17
- Volume
- 36
- Issue
- 10
- Pages
- 740-749
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W3043967928
- Cited by
- 50
- References
- 71
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 8 · 2023: 13 · 2022: 8 · 2021: 7
- FWCI
- 4.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- mindfulness meditation, cognitive therapy, mindfulness-based cognitive therapy, chronic low back pain, pain catastrophizing, therapeutic relationship, group cohesion, pain interference, pain intensity, mechanisms of change, common factors
- MeSH terms
- Humans, Psychotherapy, Group, Cognitive Behavioral Therapy, Treatment Outcome, Low Back Pain, Meditation, Chronic Pain, Mindfulness
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