Development of Mindfulness-Based
Cognitive therapy for Pain (MBCT-Pain)
Beverly Thorn, Ph.D., ABPP
SBM Symposium
Mindfulness Meditation and Behavioral Medicine
April 23, 2009
Acknowledgments: Collaborators
Melissa Day, B.S.*
Steve Hickman, Psy.D.**
Rochelle Voth, Ph.D.**
*The University of Alabama, Department of
Psychology
**University of California San Diego, Center for
Mindfulness
Objectives:
 Discuss rationale for MBCT-pain
 Discuss adaptation of MBCT (Segal,
Williams & Teasdale, 2002) for pain
management
 Discuss potential shared and unique
mechanisms of CBT, MBSR & MBCT
 Discuss ongoing feasibility trial
The Problem of Chronic Pain
 Pain costs $100 billion annually in lost
workdays, medical expenses, and other
benefit costs (National Institute for
Occupational Safety & Health, 2005).
 Psychological factors (especially,
catastrophizing, fear of pain,
depression) are important in
determining a patient’s experience of
pain (see Sullivan, Thorn et al., 2001).
CBT as an Efficacious
Treatment for Chronic Pain
 Cognitive-behavioral therapy (CBT) is
a well-established efficacious pain
management approach for multiple
chronic pain conditions (Dixon et al.
2007; Hoffman et al. 2007; Morley
et al. 1999; 2008; Keefe et al. 2005;
Ostelo et al. 2006; Lackner et al.
2004; Turner et al. 2005).
MBSR as an Efficacious
Treatment for Pain and Stress
 Mindfulness Based Stress Reduction
(MBSR) shows promising efficacy
data in a number of chronic medical
disorders including chronic pain
(Kabat-Zinn et al., 1985; Sephton et
al., 2007; Grossman et al. 2007;
Reibel et al., 2001).
MBCT as Efficacious for Relapse
Prevention in Depression
 Mindfulness-Based Cognitive
Therapy (MBCT) is efficacious for
preventing depression relapse,
and specifically addresses
ruminative and catastrophic
thinking (Williams et al., 2006;
Teasdale et al., 2002; Ma et al.,
2004; Kenny et al., 2007; Coelho
et al., 2007).
MBCT for Chronic Pain?
 A few studies have applied MBCT to
other populations (OCD, anxiety,
eating disorders)
 But….no published work to date on
MBCT for chronic pain
 Surprising given the separate
efficacy data for CBT and MBSR
Why MBCT instead of MBSR?
 MBCT explicitly incorporates cognitive
therapy components
 Efficacy data for CBT–pain is strong
 Relative expertise of the investigator
is in CBT
Process of Adaptation of MBCT for
Pain
o Establish mindfulness practice
o Read Segal, Williams & Teasdale (2002) &
attend ½ day workshop
o Attend week-long MBCT training workshop
o Adapt MBCT manual (Segal, Williams &
Teasdale, 2002), incorporating Thorn (2004)
Cognitive Therapy for Chronic Pain & KabatZinn (1992) Full Catastrophe Living
o Record meditation CDs
o Conduct feasibility trial
1. Establish Mindfulness Practice
2. Read Segal, Williams & Teasdale, 2002
Insert Segal Book slide
3. Attend week-long MBCT Training
Thanks to Steve
Hickman,
Rochelle Voth, &
Zindel Segal -and UCSD
Center for
Mindfulness
4. Adapt MBCT Manual
 Kudos and thanks to Melissa Day!
Kabat-Zinn, J. (1992). Full Catastrophe Living.
Insert Kabat-Zinn book slide
Thorn, B.E. (2004). Cognitive Therapy for Chronic Pain: A
Step-by-Step Guide, Guilford Publications.
Questions:
 Can we use MBCT as a value-added
component of cognitive-behavioral
therapy?
 To add what value to CBT?
 Is the approach feasible for chronic
pain
 Is the MBCT manual realistic?
MBCT as a Cognitive-Behavioral Technique
– Are the Buddhist Trappings Necessary?
Value added to CBT?
 Cognitive therapy is not just about
restructuring/changing maladaptive
thoughts
 Cognitive therapy takes the patient
out of “automatic pilot” and
“reactivity”
 Cognitive therapy provides a
means for emotion regulation
? Cognitive therapy provides a
mechanism for acceptance
Emotion Regulation – Crucial Piece for Pain
– Can MBCT Enhance?
Acceptance – Growing Importance in Pain – Can
MBCT Provide?
Is the Approach Feasible for
Chronic Pain?
Is the Manual Realistic?
 2 hr sessions?
 4-5 activities per session?
 Mindfulness of breath
 “mini-lectures”
 Sitting meditation
 Cognitive therapy activity
 Summary, homework assignment,
mindfulness of breath
 Less concept, more cognitive exercises?
 Yoga or “mindful movement”?
Ongoing Initial Pilot of Manual
 6 post-CBT or EDU patients
completing 12-month follow-up
 Rural, low-literacy, high spirituality
 Pre-post pain-related measures (pain
intensity, pain interference quality of
life, disability), acceptance,
mindfulness
Where to Next




Manual refinement
Small RCT with wait-list
Large RCT with attention control
Eventual RCT comparing MBCT to CBT
Thank You!
Thank You!