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.
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.
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DOI：
10.1097/j.pain.0000000000000635
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发表时间：
2016-11
期刊：
影响因子：
7.4
通讯作者：
Cherkin DC
中科院分区：
文献类型：
--
作者：
Turner JA;Anderson ML;Balderson BH;Cook AJ;Sherman KJ;Cherkin DC
认知行为疗法（CBT）被认为可以通过减少患者的灾难化和增加患者管理疼痛的自我效能来改善慢性疼痛问题。基于正念的减压（MBSR）被认为通过增加正念和疼痛接受度而使慢性疼痛患者受益。然而，很少有人知道这些治疗机制变量如何相互关联，或者它们是否受到MBSR与CBT的不同影响。在一项随机对照试验中，我们比较了20-70岁慢性腰痛（CLBP）成人（N = 342）的MBSR，CBT和常规护理（UC），我们检查了（1）灾难化，自我效能，接受和正念指标之间的基线关系;（2）3个治疗组中这些指标的变化。在基线时，灾难化与自我效能、接受和正念的3个方面（无反应、无判断和有意识地行动;所有P值<0.01）呈负相关。接受与自我效能（P < 0.01）和正念（P值< 0.05）措施呈正相关。与CBT或UC相比，MBSR治疗后灾难性减少略多（综合P = 0.002）。与UC相比，两种治疗在52周时减少灾难化方面均有效（综合P = 0.001）。在整个随机样本和参加过8次MBSR或CBT中的≥6次的参与者的子样本中，MBSR和CBT之间的差异在52周内很少，规模很小，临床意义值得怀疑。结果表明，灾难化，自我效能，接受和正念的措施重叠，以及MBSR和CBT对CLBP患者这些措施的类似影响。
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 chronic pain patients 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 versus CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20-70 years with chronic low back pain (CLBP) (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 (non-reactivity, non-judging, 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 post-treatment 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 sub-sample 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 CLBP.
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影响因子：
4.1
作者：
Burns, JW;Glenn, B;Lofland, K
通讯作者：
Lofland, K
影响因子：
4
作者：
Akerblom, Sophia;Perrin, Sean;McCracken, Lance M.
通讯作者：
McCracken, Lance M.
影响因子：
3.6
作者：
Cusens, Bryany;Duggan, Geoffrey B.;Burch, Vidyamala
通讯作者：
Burch, Vidyamala
影响因子：
4
作者：
Fish, Rosemary A.;Hogan, Michael J.;McGuire, Brian E.
通讯作者：
McGuire, Brian E.
DOI：
10.1001/jama.2016.2323
发表时间：
2016-03-22
期刊：
JAMA
影响因子：
--
作者：
Cherkin DC;Sherman KJ;Balderson BH;Cook AJ;Anderson ML;Hawkes RJ;Hansen KE;Turner JA
通讯作者：
Turner JA