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Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial
Open accessAbstract
Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P< 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P= 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P= 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.
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“However, these effects do not seem to be maintained in the long term [32,42].”
From Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis (2024) · cites this paper as [42]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Rigorous RCTs comparing mindfulness-based interventions and CBT have failed to show differential treatment effects on a whole range of mechanisms, including dispositional mindfulness, reappraisal, self-efficacy, acceptance, catastrophizing, and positive and negative affect [11,73,74].”
From Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data (2017) · cites this paper as [73]
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“We previously reported that among the participants randomized to CBT or MBSR, those who completed at least 6 sessions had significantly higher pain self-efficacy scores at baseline.78”
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“Mindfulness interventions have been correlated with components of self-management, including self-efficacy [17] and intrinsic motivation [18], and may correlate with increased patient activation [19].”
From Online prenatal trial in mindfulness sleep management (OPTIMISM): Protocol for a pilot randomized controlled trial (2020) · cites this paper as [17]
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“In pain treatment, mindfulness, acceptance, and self-efficacy are recognized mechanisms in pain regulation (Turner et al., 2016).”
From The Development of Mindful-Based Dance Movement Therapy Intervention for Chronic Pain: A Pilot Study With Chronic Headache Patients (2021) · cites this paper as Turner et al., 2016
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“Within the same study, the MBSR and cognitive behavioral therapy groups demonstrated similar changes in therapeutic mechanisms including pain catastrophizing, pain acceptance, dispositional mindfulness, and self-efficacy [20].”
From Feasibility and Acceptability of an Abbreviated, Four-Week Mindfulness Program for Chronic Pain Management. (2020) · cites this paper as [20]
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“total practice hours mediate mindfulness trait changes, which in turn mediate mental health outcomes,38”
From Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder (2023) · cites this paper as [38]
Experimental — accuracy not yet measuredIn the citing paper
“Pain-related self-efficacy also mediates the relationship between pain and functioning in women with fibromyalgia pain 372.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [372]
In the citing paper
“However, the long-term benefits of MBSR on pain catastrophizing are questionable because group differences were no longer significant at follow-up,118”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [118]
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“A more recent study showed that MBSR produced greater reductions in pain catastrophizing in chronic low-back pain patients compared with cognitive-behavioral therapy (CBT) and standard of care.118”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [118]
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Citations
Cites
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Cited by
Sorted by citations
Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719
Psychological therapies for the management of chronic pain (excluding headache) in adults
Williams, A. C. D. C., Fisher, E., Hearn, L., & Eccleston, C. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007407.pub4 · Cited by 605
Whitlock, E. L., Diaz‐Ramirez, L. G., Glymour, M. M., Boscardin, W. J., Covinsky, K. E., & Smith, A. K. (2017) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2017.1622 · Cited by 421
The Role of Self-Efficacy on the Prognosis of Chronic Musculoskeletal Pain: A Systematic Review
Martinez-Calderon, J., Zamora-Campos, C., Navarro-Ledesma, S., & Luque-Suarez, A. (2018) · The Journal of Pain · doi:10.1016/j.jpain.2017.08.008 · Cited by 268
Schütze, R., Rees, C., Smith, A., Slater, H., Campbell, J. M., & O'Sullivan, P. (2018) · The Journal of Pain · doi:10.1016/j.jpain.2017.09.010 · Cited by 231
Metadata
- Authors
- Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C.
- Affiliations
- University of Washington (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Corresponding author
- Turner, Judith A.
- Venue
- Pain
- Published
- 2016-05-30
- Volume
- 157
- Issue
- 11
- Pages
- 2434-2444
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- PMC
- PMC5069124
- OpenAlex
- W2419193481
- Cited by
- 281
- References
- 60
- Citations by year
- 2026: 23 · 2025: 23 · 2024: 21 · 2023: 29 · 2022: 29 · 2021: 35 · 2020: 34 · 2019: 28 · 2018: 29 · 2017: 24 · 2016: 6
- FWCI
- 38.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Integrative Health (R01AT006226)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- mindfulness-based stress reduction, cognitive behavioral therapy, chronic low back pain, pain catastrophizing, self-efficacy, pain acceptance, mindfulness, therapeutic mechanisms, usual care comparison
- MeSH terms
- Adult, Aged, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Stress, Psychological, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Low Back Pain, Self Efficacy, Young Adult, Catastrophization, Chronic Pain, Mindfulness
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- Turner, J. A., Anderson, M. L., Balderson, B. H., Cook, A. J., Sherman, K. J., & Cherkin, D. C. (2016). Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain. https://doi.org/10.1097/j.pain.0000000000000635
