Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients

Abstract

Introduction: Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment.

Methods: Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group.

Results: While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one's emotional state.

Conclusions: An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.

Keywords: Anxiety; back pain; depression; frontal lobe; functional magnetic resonance imaging; mindfulness; stress.

Figure 1

Pre‐ and post‐intervention survey measure means (±SE) presented by group with dashed lines representing clinical norms. (A) Beck Depression Inventory‐II (BDI‐II): Preintervention, the mindfulness‐based stress reduction (MBSR) group scored in the “borderline clinical depression” category, and the Reading control (RCon) group scored in the “mild mood disturbance” category. Postintervention, both groups improved, dropping the MBSR group into the “mild mood disturbance” category and the RCon group to the “normal disturbances” category. Categories based on a five‐level severity system. (B) BDI‐II Somatic‐Affective Subscale: The MBSR group showed significant improvement. (C) BDI‐II Cognitive Subscale: The MBSR group showed a trend towards improvement and the RCon group showed significant improvement. (D) Oswestry Low Back Pain Disability Questionnaire: Preintervention both groups scored in the “moderate disability” category. Postintervention the MBSR group significantly improved but both groups remained in the “moderate disability” category. (E) State‐Trait Anxiety Inventory (STAI): PreIntervention, both groups scored below clinically significant symptoms for state anxiety; the MBSR group reported a higher mean level of anxiety than the RCon group (P = 0.03). Postintervention, neither group showed changes in state anxiety. *P < 0.05; ^# P < 0.10.

Figure 2

Sadness induction task blood oxygen‐level‐dependent signal changes: (A) Regions of interest template: ventrolateral prefrontal cortices (vlPFC) left (yellow) and right (teal); anterior insula left (green) and right (magenta); subgenual anterior cingulate cortex (sgACC) left (red) and right (blue); dorsomedial prefrontal cortices left (data not shown) and right (white). The mindfulness‐based stress reduction (MBSR) group showed significant increases in left sgACC (B), right sgACC (C), and left vlPFC (D) from pre‐ to post‐intervention. (E) In the MBSR group, postintervention activation in left sgACC positively correlated with sad intensity ratings of task images used to induce sad mood. *P < 0.05.