Mindfulness-Based Cognitive Therapy for the Treatment of Chronic Headache Pain

Cognitive Behavioral Therapy (CBT) is well established as an efficacious treatment for a wide variety of chronic pain conditions, including headache pain. A promising trend within the behavioral medicine field in recent years has been the integration of mindfulness into traditional treatment modalities and the development of innovative treatments based upon these principles. Mindfulness Based Stress Reduction (MBSR) maintains a patient-centered approach that focuses upon mindfulness meditation as the key mechanism to teach people how to cope with their pain, take better care of themselves, and to improve their overall quality of life. MBSR has successfully been utilized in a number of disorders including chronic pain 1,2,3 and in general medical populations 4 Mindfulness-Based Cognitive Therapy (MBCT),5 originally developed to target relapse prevention in major depression, is essentially a modification of MBSR to incorporate more traditional cognitive-behavioral interventions into the extant MBSR framework. Studies of MBCT support its efficacy in eliciting cognitive changes similar to those demonstrated in CBT, while still incorporating the more general salutary effects seen in MBSR,6,7,8,9,10While MBCT has been applied to other populations, there has been no published work to date adapting it to chronic pain patients. This is a surprising gap in the literature given the effectiveness of both CBT and mindfulness independently for chronic pain. Therefore, the present proposal seeks to begin to fill these gaps by testing the feasibility and efficacy of MBCT for chronic pain in a series of pilot groups.

Primary Specific Aims The proposed project is a feasibility study designed to test the MBCT protocol for chronic pain treatment and to provide pilot data to support subsequent research proposals to be submitted to the National Institutes of Health. In this initial trial the investigators will use patients with primary complaints of headache pain and treat them at a collaborating headache clinic. We selected this target population because headache pain is highly disabling and is the most common pain related complaint treated in medical practice. Furthermore, given the time frame of the study, it is more feasible to recruit patients where the PI has an established and ongoing collaborative relationship. The proposed project emphasizes the research area of health, medicine, and behavior.

Aim 1: To examine feasibility of the treatment, data will be collected regarding participant flow across each stage of the study design, including recruitment, participation, and drop-out rates, and percentage of sessions attended. Furthermore, pre-treatment expectations, post-treatment satisfaction, and global ratings of self-perceived improvement will be assessed.

Hypotheses: It is expected that the feasibility of MBCT, as measured by the above indicators, will be comparable to similar data for other psychosocial treatments for pain, such as CBT.

Aim 2: As an initial test of the efficacy of MBCT for chronic pain, the investigators will compare an immediate treatment condition to a delayed treatment (OT) control on pre- and post-intervention measures. Time constraints of the current project will necessitate follow-up assessment to be part of future proposals.