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Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

Abstract

Study design

Between-subjects, randomized controlled feasibility study.

Objectives

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).

Setting

UK community sample.

Methods

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).

Results

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.

Conclusions

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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Acknowledgements

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.

Author information

Correspondence to Jasmine Heath Hearn.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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).

Informed consent

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.

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T2 Correlation Matrix

T3 Correlation Matrix

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