Between-subjects, randomized controlled feasibility study.
Populations with reduced sensory and motor function are at increased risk of depression, anxiety and pain, and may be less geographically mobile. This study explored the efficacy and feasibility of web-based mindfulness training for people with spinal cord injury (SCI).
UK community sample.
Participants were randomly allocated to an 8-week online mindfulness intervention (N = 36), or to internet-delivered psychoeducation (N = 31). Depression symptom severity was the primary outcome. Secondary outcomes included anxiety, quality of life (QoL), pain perception, pain catastrophizing and mindfulness. Measures were taken before (T1), at completion of, (T2), and 3 months following the intervention (T3).
At T2, ten participants discontinued mindfulness training, and five discontinued psychoeducation. Dropouts were of significantly older age. Nine participants were lost to follow-up. Mindfulness reduced depression significantly more than psychoeducation at T2 (mean difference = −1.50, 95% CI [−2.43, −0.58]) and T3 (mean difference = −2.34, 95% CI [−3.62, −1.10]). Anxiety, pain unpleasantness and catastrophizing were significantly reduced compared with psychoeducation. Total mindfulness scores, and all facets of mindfulness except observing were significantly higher following mindfulness training. At follow-up, reductions in anxiety and catastrophizing persisted.
Internet-delivered mindfulness training offers unique benefits and is viable for people with reduced sensory awareness. Future work should explore the feasibility of combined education and mindfulness training. The use of brief interventions shows promise in maximizing participant retention.
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Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil. 2015;96:133–40.
Ullrich PM, Lincoln RK, Tackett MJ, Miskevics S, Smith BM, Weaver FM. Pain, depression, and health care utilization over time after spinal cord injury. Rehabil Psychol. 2013;58:158–65.
Norrbrink Budh C, Kowalski J, Lundeberg T. A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. J Rehabil Med. 2006;38:172–80.
Boldt I, Eriks-Hoogland I, Brinkhof MW, de Bie R, Joggi D, von Elm E. Non-pharmacological interventions for chronic pain in people with spinal cord injury. Cochrane Database Syst Rev. 2014. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009177.pub2/abstract.
Hearn JH, Cotter I, Fine P, Finlay KA. Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience. Disabil Rehabil. 2015;37:2203–11.
Kabat-Zinn J. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, NY: Dell; 1990.
Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S. Mindfulness based interventions in multiple sclerosis—a systematic review. Bmc Neurol. 2014;14:1–9.
Kingston J, Chadwick D, Meron C, Skinner TC. A pilot randomized comparison trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activity. J Psychosom Res. 2007;62:297–300.
Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol: Sci Pract. 2003;10:125–43.
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. J Consult Clin Psychol. 2004;72:31–40.
Skinner TC, Roberton T, Allison GT, Dunlop S, Bucks RS. Experiential avoidance, mindfulness and depression in spinal cord injuries: a preliminary study. Aust J Rehabil Couns, The. 2010;16:27–35.
Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol. 2006;62:373–86.
National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. NICE Guideline [NG41]. NICE, London. 2016. https://www.nice.org.uk/guidance/ng41/chapter/Recommendations#information-and-support-484for-patients-family-members-and-carers. Accessed 23 Jan 2018.
Dowd H, Hogan MJ, McGuire BE, Davis MC, Sarma KM, Fish RA, et al. Comparison of online mindfulness-based cognitive therapy intervention with online pain management psychoeducation; a randomized controlled study. Clin J Pain. 2015;31:517–27.
Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and sign. Pain. 2001;92:147–57.
Burch V, Penman D. Mindfulness for health: a practical guide to relieving pain, reducing stress and restoring wellbeing. London: Piatkus; 2013.
Donnelly C, Eng JJ, Hall J, Alford L, Giachino R, Norton K, et al. Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord. 2008;42:302–7.
Tenforde AD, Hefner JE, Kodish-Wachs JE, Iaccarino MA, Paganoni S. Telehealth in physical medicine and rehabilitation: a narrative review. Phys Med Rehabil. 2017;9:S51–S58.
Cusens B, Duggan GB, Thorne K, Burch V. Evaluation of the Breathworks mindfulness-based pain management programme: effects on well-being and multiple measures of mindfulness. Clin Psychol Psychother. 2010;17:63–78.
Henriksson J, Wasara E, Ronnlund M. Effects of eight-week web-based mindfulness training on pain intensity, pain acceptance, and life satisfaction in individuals with chronic pain. Psychol Rep. 2016;119:586–607.
Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106:337–45.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.
Woolrich RA, Kennedy P, Tasiemski T. A preliminary psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) in 963 people living with a spinal cord injury. Psychol Health Med. 2006;11:80–90.
World Health Organization. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28:551–8.
Lude P, Kennedy P, Elfström M, Ballert CS. Quality of life in and after spinal cord injury rehabilitation: a longitudinal multicenter study. Top Spinal Cord Inj Rehabil. 2014;20:197–207.
Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13:27–45.
Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–32.
Osman A, Barrios FX, Kopper BA, Hauptmann W, Jones J, O’Neill E. Factor structure, reliability, and validity of the Pain Catastrophizing Scale. J Behav Med. 1997;20:589–605.
Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S. Mindfulness based interventions in multiple sclerosis—a systematic review. Bmc Neurol. 2014;14:15.
Dorstyn D, Mathias J, Denson L. Efficacy of cognitive behaviour therapy for the management of psychological outcomes following spinal cord injury: a meta-analysis. J Health Psychol. 2011;16:374–91.
Melville KM, Casey LM, Kavanagh DJ. Dropout from internet-based treatment for psychological disorders. Br J Clin Psychol. 2010;49:455–71.
Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression: systematic review. J Med Internet Res. 2009;11:e13
Hearn JH, Finlay KA, Fine PA. The devil in the corner: a mixed-methods study of metaphor use by those with spinal cord injury-specific neuropathic pain. Br J Health Psychol. 2016;21:973–88.
Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6:537–59.
This trial is registered with the ISRCTN, reference number ISRCTN14165286. The authors would like to express their thanks to all of the participants for their involvement and feedback throughout the project, Breathworks for their provision of the course, and staff at The National Spinal Injuries Centre for their ongoing support.
Conflict of interest
The authors declare that they have no conflict of interest.
This study was approved by The University of Buckingham School of Science and Postgraduate Medicine Ethics Committee, the NHS Health Research Authority (ref: 14/SC/1424), the local Research and Development office, and The National Spinal Injuries Centre. The trial was registered prospectively with an International Standard Randomised Controlled Trial Number (ISRCTN14165286).
All participants provided informed consent and were debriefed following completion of the study. Ongoing support was offered by the researchers, and staff from the centre providing the online course. All patient identifiable information and their corresponding data files were stored separately on a password-protected computer at The Psychology Department at the University of Buckingham. All applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
About this article
Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial
Archives of Physical Medicine and Rehabilitation (2019)
Spinal Cord Series and Cases (2019)
The Journal of Pain (2018)