Abstract
Migraine is one of the leading causes of disability worldwide. Third wave therapies, such as Mindfulness Based Cognitive Therapy for Migraine (MBCT-M), have proven efficacious in reducing headache-related disability. However, research is needed to better understand the change mechanisms involved in these third-wave therapies. Acceptance is a fundamental component of third wave therapies, and more research is warranted on the role of pain acceptance in MBCT-M. It is also valuable to understand the independent roles of the two components of pain acceptance—pain willingness (PW) and activity engagement (AE). The current study is a secondary analysis of a randomized control trial of MBCT-M. Sixty participants were included in the study (MBCT = 31; WL/TAU = 29). Baseline correlations between overall pain acceptance, PW, AE, and headache-related disability were run. Mixed models assessed change from baseline to one-month post-treatment and treatment-by-time interaction for overall pain acceptance, PW, and AE. Mixed models also assessed maintenance of changes at 6-month follow-up in the MBCT-M group. Longitudinal mediation models assessed whether change in pain acceptance, PW, and AE mediated the relationship between treatment and change in headache-related disability. Pain acceptance, PW, and AE were all negatively correlated with headache-related disability at baseline. Pain acceptance, PW, and AE all significantly increased over time in both the waitlist/ treatment-as-usual group (WL/TAU) and the MBCT-M group. Only AE increased more in the MBCT group than the WL/TAU group. Change in pain acceptance, PW, and AE all significantly mediated the relationship between MBCT and change in headache-related disability. The study supports the importance of pain acceptance, specifically the activity engagement component, in MBCT-M.
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Funding
This work was supported by the International Headache Academy—Research Award; U.S. Department of Health and Human Services, National Institutes of Health, National Center for Advancing Translational Sciences—UL1TR001073; U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Neurological Disorders and Stroke—K23 NS096107; Yeshiva University—Hollander Seed Fund. Trial prospectively registered at clinicaltrials.gov: NCT02443519.
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Best, R.D., Ozmeral, A., Grinberg, A.S. et al. Pain acceptance as a change mechanism for mindfulness-based cognitive therapy for migraine. J Behav Med 47, 471–482 (2024). https://doi.org/10.1007/s10865-024-00475-5
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DOI: https://doi.org/10.1007/s10865-024-00475-5