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Using MBCT in a Chronic Pain Setting: A Qualitative Analysis of Participants’

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DOI: 10.1007/s12671-014-0363-6

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Using MBCT in a Chronic Pain Setting:
A Qualitative Analysis of Participants’
Experiences

Kirsty M. Moore & Michelle E. Martin

Mindfulness

ISSN 1868-8527
Volume 6
Number 5

Mindfulness (2015) 6:1129-1136

DOI 10.1007/s12671-014-0363-6

1 23
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 Author's personal copy
Mindfulness (2015) 6:1129–1136
DOI 10.1007/s12671-014-0363-6

ORIGINAL PAPER

Using MBCT in a Chronic Pain Setting: A Qualitative Analysis

of Participants’ Experiences
Kirsty M. Moore & Michelle E. Martin

Published online: 7 November 2014

# Springer Science+Business Media New York 2014

Abstract An estimated 20 % of the global population experi- Introduction

ences chronic pain, and comorbidity with emotional disorders
such as depression is high. While the use of mindfulness-based Chronic pain is an enormous problem globally, with one in 10
cognitive therapy (MBCT) as an intervention for recurrent adults diagnosed every year and global prevalence estimated
depression is escalating in both popularity and evidence-based at one in five adults (Goldberg and McGee 2011). Pain that
success, MBCT is being increasingly utilised in a range of areas persists or recurs for more than 3 months is termed chronic
including chronic pain management. The current study was (International Association for the Study of Pain 2004). In
designed to conceptualise chronic pain patients’ perceived ben- Australia, the Bettering the Evaluation and Care of Health
efits of an MBCT programme. Semi-structured interviews were (BEACH) programme found that almost 20 % of general
conducted with 17 chronic pain patients who had participated in practitioner (GP) consultations related to individuals with
MBCT group training within a public hospital pain unit be- chronic pain, and individuals with chronic pain attended their
tween 8 and 50 months previously. The recorded interviews GP five times more frequently than those without the condi-
were transcribed and interpreted using thematic analysis to tion (Semple and Hogg 2012). Chronic pain is estimated to
identify key themes in participants’ comments. Four overarch- cost the Australian economy $34 billion per annum (Access
ing themes were extracted: patients’ belief in the programme, Economics Pty Ltd 2007) and has significant effects on a
patients’ perception of control, patients’ struggles and patients’ person’s physical and psychological well-being.
acceptance of the presence of pain. Participants who perceived Results of an Australian population study by Blyth et al.
benefits from the MBCT programme were most motivated to (2001) were analogous to global data (Goldberg and McGee
continue mindfulness practice. Identifying patients’ perspec- 2011), with chronic pain reported by 17.1 % of males and
tives on their pain and the benefits of ongoing mindfulness 20.0 % of females. Serious consequences including depres-
practice following participation in an MBCT group intervention sion, suicidality, unemployment and social relationship strain
provided opportunity to discuss ways to best assist patients in have resulted from experiencing chronic pain (International
developing and consolidating their practice. Clinical and re- Association for the Study of Pain 2004). Conversely, comor-
search implications are discussed. bid physical and mental health conditions comprise an impor-
tant set of contributing factors to the risk of developing chron-
ic pain (Dominick et al. 2012) and, in turn, much poorer
Keywords MBCT . Mindfulness . Chronic pain . health-related quality of life (Linton and Bergbom 2011).
Depression . Mindfulness practice Unquestionably, chronic pain and associated prevalent comor-
bid physical and mental health conditions have costly conse-
quences for the individual, the community, the economy and
K. M. Moore (*)
Department of Psychology, University of Adelaide, Adelaide, health care services (Access Economics Pty Ltd 2007).
SA 5005, Australia On a positive note, a more comprehensive view of pain is
e-mail: kirsty@activepsych.com emerging, resulting in the development of strategies, plans and
programmes to address provision of adequate and effective pain
M. E. Martin
Pain Management Unit, Royal Adelaide Hospital, Adelaide, management. Specialised hospital pain management units, pain
SA 5000, Australia management networks, education and resources and a National
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1130 Mindfulness (2015) 6:1129–1136

Pain Strategy (NPS) have been developed and resourced na- improvements in symptoms, there remains substantial dispar-
tionally and in fact internationally (Cousins 2012). ity between what is espoused clinically and what is known
The use of mindfulness in the chronic pain field has gained empirically about the benefits of ongoing practice compliance
momentum since the original programmes run by Jon Kabat- (Vettese et al. 2009). Consequently, further qualitative and
Zinn in the late 1970s. Chronic Pain Australia (www. experimental evaluation on the relationship of homework
chronicpainaustralia.org.au), a prominent support compliance to mindfulness programme outcomes is warranted
organisation, endorses the mindful approach that ‘working to more clearly substantiate the role of ongoing practice.
with your pain instead of fighting against it’ is an effective Qualitative and mixed-method approaches have proven
chronic pain management strategy (Chronic Pain Australia valuable in understanding the potential benefits of MBCT.
2012). Mindfulness is a form of self-awareness in which an These approaches allow the elicitation of people’s individual
individual focusses their complete attention on the present experiences and map pertinent research issues (Williams and
moment and actively engages in present experiences (Kabat- Moorey 1989). By interviewing participants in an MBCT
Zinn 2003). Improved pain tolerance as a result of mindful- course, Langdon et al. (2011) sought to understand processes
ness training has been demonstrated in some research, with by which people continue practicing mindfulness following an
the main approaches being mindfulness-based stress reduction MBCT course and those which contribute to practice decline.
(MBSR) and acceptance and commitment therapy (ACT; They found that a range of factors contributed, including peo-
McCracken 1998; Hayes et al. 1999). Morone et al. (2008a) ple’s beliefs about mindfulness, effort, commitment, group
suggested mindfulness meditation based on MBSR may lead support and possible differences attributed to age. Qualitative
to improvement in pain acceptance and physical function after content analysis of participant diary entries from participants in
they that found older adults with chronic lower back pain who an 8-week mindfulness programme also reflected beneficial
participated in a mindfulness meditation group significantly effects of mindfulness meditation on pain, attention, sleep and
improved on the Chronic Pain Acceptance Questionnaire. A achieving well-being (Morone et al. 2008b).
study exploring the indirect benefits of an emotion-focussed A grounded theory approach was employed by Mason and
group on patients with rheumatic diseases which incorporated Hargreaves (2001) to explore the MBCT experiences of seven
learning methods intended to enhance awareness found that study participants. Although several themes were identified that
emotional well-being and coping behaviour were enhanced may be relevant for preventing depressive relapse (e.g. ‘coming
(Zangi et al. 2011). A recent systematic review and meta- to terms’, ‘warning bells’ and ‘bringing it into everyday’), the
analysis of acceptance-based interventions for the treatment majority of participants were interviewed immediately after
of chronic pain suggested that MBSR and ACT are not supe- course completion, without extended opportunity to utilise their
rior to cognitive behaviour therapy (CBT) but deemed good learned skills (Allen et al. 2009; Mason and Hargreaves 2001).
alternatives (Veehof et al. 2011). Consequently, this study was unable to accurately reflect the
In the health arena, the use of other specific approaches longer term effectiveness of MBCT. More recently, Finucane
such as mindfulness-based cognitive therapy (MBCT) has and Mercer (2006) studied MBCT using a mixed-method ap-
increased in recent years. Research into the benefits of proach, highlighting participation in a group as a validating
MBCT in areas such as pain, diabetes and cancer has drawn experience and emphasising the importance of ongoing support
significant interest (Day et al. 2014; Sharplin et al. 2010; van for participants beyond group completion (Finucane and
Son et al. 2014). Founded by Segal et al. (2002), MBCT is a Mercer 2006). Unfortunately, the 3-month post-MBCT com-
psychological therapy blending features of mindfulness tech- pletion timeframe for interviews of the 13 participants is also
niques with cognitive therapy. Designed as an intervention to likely to have limited the application of the findings regarding
prevent recurrent depression, MBCT programmes consist of the long-term effectiveness of MBCT.
eight weekly group-based classes with weekly assignments to In an interpretative phenomenological analysis, Williams
be done outside of session. The MBCT programme is de- et al. (2011) used semi-structured interviews 3 months post-
signed to teach participants to develop awareness of and treatment to explore patients’ experiences of MBCT for hy-
accept their thoughts and feelings without judgment and to pochondriasis and their subsequent self-managed practice. Of
disengage from cognitive distortions. Consequently, partici- relevance, patients reported awareness of barriers to
pants develop more adaptive ways of dealing with negative experiencing change, including motivation and ability to
experiences to enable them to respond to things rather than maintain ongoing practice. Participants in studies by Mason
react to them. Continued mindfulness practice is recommend- and Hargreaves (2001) and Finucane and Mercer (2006) also
ed following MBCT course completion. Based on the theory reported that their mindfulness skills developed following
of Segal et al. (2002), more positive outcomes should result completion of the MBCT programme. Whilst these studies
from higher frequency and duration of mindfulness practice. contributed much to our understanding, in each case, the
While Carmody and Baer (2008) found a significant positive follow-up interviews were held only 3 months after comple-
relationship between total formal meditation practiced and tion of the MBCT programme, therefore not providing the
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Mindfulness (2015) 6:1129–1136 1131

opportunity for longer term effects to be explored. Allen et al. on participants’ qualitative feedback, it was intended as part of
(2009) used a longer 12-month timeframe to follow up par- a larger study incorporating quantitative data collected at
ticipants (n=20) and explore their experience of MBCT and various times following the MBCT intervention. Those par-
its value as a relapse prevention programme for recurrent ticipants who responded expressing their interest in participat-
depression, identifying control, acceptance, relationships and ing in this qualitative study were contacted by telephone, and a
struggle as four overarching themes. date and time to meet were arranged. Forty-three per cent (n=
To date, evidence suggests that mindfulness may have a role 17) of MBCT group participants agreed to participate in an
to play in managing patients experiencing chronic pain (e.g. interview held at the unit. One to one interviews were con-
Chiesa and Serretti 2010; Elabd 2011; Kingston et al. 2007; ducted over a 5-week period. Participants ranged in age from
Morone et al. 2008a). Various programmes have been used in 34 to 79 years with a mean age of 54.6 years. The majority
the pain field including MBSR and ACT, and formats such as (82 %) of participants were female. Both written and oral
MBCT have drawn interest in recent times. MBCT is taught in information was provided, and informed consent was obtained
a group programme integrating mindfulness skills, placing from all participants before they entered the study, including
emphasis on the cognitive understanding and framework of consent to record interviews. The study aimed to be ‘clinically
experiences. Given that pain catastrophising has been identified representative’, so no inclusion/exclusion criteria were
as a cognitive pain variable related to psychological distress enforced. Ethical approval for the study was attained through
(Severeijns et al. 2001), and the strong evidence base for CBT the Hospital Research Ethics Committee and the University
in managing emotional difficulties, if effective and acceptable Human Research Ethics Committee (HREC).
to patients, potential advantages of incorporating MBCT in
chronic pain management are worthy of further investigation. Measures
This exploratory pilot study endeavoured to understand the
experiences of chronic pain patients in an MBCT group and Semi-structured interviews were conducted in the hospital
the factors that contribute to enabling or blocking ongoing pain unit by one researcher between 8 and 50 months after
mindfulness practice. A qualitative approach was adopted participants had completed the MBCT programme.
utilising data from structured interviews conducted 8 to Participants were initially asked general questions enquiring
50 months after completion of the course. Factors that assist about their journey to join the MBCT programme such as,
and/or hinder chronic pain patients to continue mindfulness ‘What is your story of how and why you were introduced to
practice following participation in the group were also ex- the MBCT program?’ They were then invited to answer more
plored with a view to understanding ways to assist patients in specific questions regarding their participation, expectations,
developing and consolidating their practice. perceived benefits and continued practice, for example, ‘What
do you notice when you do not practice mindfulness, formally
or informally?’ and ‘How do you think you have changed
Method over time in your ability to cope with your pain? Do you
believe mindfulness has contributed to any changes?’
Participants The interviewer had minimal knowledge of the MBCT
programme and had not facilitated any of these groups.
The MBCT programme was implemented in a South MBCT group facilitators did not participate in the interviews
Australian public hospital pain unit in a series of consecutive in any way. Although interviews were highly structured, the
small groups, spanning a 2-year period. Participants with a interviewer was responsive to issues as they arose using
history of chronic pain and engaged with that unit were invited reflective listening techniques (Stiles 1993) and aimed to
to participate in the MBCT programme. Predominantly, pa- allow participants’ views to be comprehensively explored.
tients with emotional difficulties such as depression, anxiety Interviews lasted between 22 and 65 min (mean 38 min) and
disorders or stress-related conditions were invited. The inter- were audio-recorded, then transcribed verbatim. The audio
vention was led by a trained MBCT facilitator (a qualified interviews were checked against the transcripts to ensure
senior clinical psychologist from the hospital and clinical accuracy. All data were de-identified to ensure confidentiality.
lecturer) and followed the manualised programme described
by Segal et al. (2002). Data Analysis

Procedure Key themes were identified and defined using thematic and
comparative analysis methodology (Braun and Clarke 2006).
An information sheet outlining the study was sent to all A realist methodological approach sought to examine the
MBCT programme participants (n=40) on the hospital pain semantic content of participants’ descriptions of their experi-
unit database. Although this exploratory pilot study focussed ences following participation in the MBCT group.
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1132 Mindfulness (2015) 6:1129–1136

Using the qualitative software package NVivo 9, the tran- had achieved following the MBCT course and ongoing mind-
scripts were independently coded by two researchers. Themes fulness practice as a strong motivator to continue practice. For
were identified or coded on the basis of the capacity for example,
specific thoughts or observations to ‘capture something im-
portant in relation to the overall research question’ (Braun and ‘It has improved my life.’
Clarke 2006, p. 82). Subsequent merging or differentiation of It (mindfulness) ‘gives the person a reason for being’.
themes allowed a hierarchical structure of overarching themes ‘I gauge success by how much you’ve done in a day and
and sub-themes to emerge, grounded in the verbatim transcript I find if I meditate and remain focussed with mindful-
data. As a final step, themes were considered in the context of ness that I actually give a lot more. And that’s self-
how consistently and articulately they represented the com- satisfying for me.’
plete data set and modified accordingly as required (Braun and
Clarke 2006). A rich description of the data was extracted Participants’ beliefs in the benefits of MBCT were also
using thematic analysis to extend our understanding of patient reflected by comments highlighting reduced pain or unpleas-
experiences beyond individual reflections. The credibility of ant experiences as a result of ongoing practice, for example,
the findings was checked by comparing two researchers’ ‘If I don’t do it, I feel more stressed and I feel more pain’.
separate analyses of the transcripts in an effort to cross- Relapse to returning pain and emotional difficulties was at-
validate the emergent hierarchical theme structure. There tributed to cessation of ongoing practice, for example, ‘Slowly
was approximately 85 % agreement between the two raters. it just gradually petered out and I found myself back to my old
Where there was disagreement, the raters discussed the coding self of depression and all that and finding it hard to get out of
until a consensus was reached. A number of themes emerged it. And then pain crept in more and I just couldn’t control it’.
from this process. Supporting the significance of belief in the benefits of
ongoing participation, one participant shared his explanation
for ceasing participation in booster MBCT groups and ongo-
ing practice, ‘I felt I probably got all I could get from them so I
Results didn’t participate any more with them’.

Of the 17 MBCT participants interviewed, 15 said that they Attitude Many participants’ responses indicated their belief
maintained ongoing informal mindfulness practice. Of these, that a positive attitude towards ongoing mindfulness practice
nine said that their ongoing practice included a formal mind- was imperative to maintaining their practice. For example,
fulness practice component. One of the remaining two partic- ‘There’s something with my patience. With my being positive,
ipants indicated that he infrequently utilised mindfulness prac- just my outlook on life—did I say self-esteem? (And) my
tice, and the other said that he did not engage in any ongoing attitude’ and ‘I’ve got lots of beliefs that what you think about
practice. In analysis of the interview transcript data, four kind of grows, so if you constantly think about how bad
overarching themes were identified with regard to ongoing something is, then it usually ends up being worse than what
mindfulness practice for chronic pain patients. These were it is. So I suppose having positive thought to mindfulness is
‘patients’ beliefs in the programme’, ‘patients’ perception of probably really helpful’.
control’, ‘patients’ struggles’ and ‘patients’ acceptance of the An attitude of willingness, reinforced by an attitude of
presence of pain’. Narrative accounts and examples of each persistence and determined, disciplined commitment, was
theme in the data are provided. highlighted as beneficial to achieve pain management effec-
tively using MBCT and ongoing practice. For example, ‘I was
Patients’ Belief in the Programme not willing to give up on me, and life’ and ‘I’m determined to
keep going and I think discipline with how often you do it is
This overarching theme describes participants’ perceptions of the key’.
and beliefs in the effectiveness of MBCT as an intervention for
chronic pain. It also considers the contribution their attitudinal Patients’ Perception of Control
stance and broader faith was perceived to have on their suc-
cesses and/or difficulties in maintaining mindfulness practice As an overarching theme, this encompasses the extent to
in managing chronic pain. One participant summarised the which participants feel empowered to take control of their
impact of belief, ‘If you believe in it, it really does work.’ Two own behaviours and responses.
themes were identified under the overarching theme.
Acquiring and Developing Tools In many interviews, partic-
Motivation to Continue Practice (perceived benefits/ ipants referred to the practical skills that they had practised
costs) Participants described the positive benefits that they and acquired through the MBCT course as ‘tools’. ‘It’s
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Mindfulness (2015) 6:1129–1136 1133

another tool in the box.’ Feeling equipped with a broader Change in Perspective Having gained skills to empower them
selection of coping skills, they reported increased confidence to shift attentional focus, participants also highlighted their
in their ability to manage or control their pain. For example, discovery of new perspectives on how they viewed them-
selves and their own pain, for example,
‘gives me a sense of some control… given me a tool, a
skill, to be able to deal with things that are normally too ‘If I’m concentrating on my breathing, I’m concentrat-
uncomfortable or too frightening for me to deal with.’ ing on that and not so much on the stress that’s causing
me to get worked up.’
The increased sense of control provided by the ability to
choose how to manage pain was emphasised by participants
who acknowledged that they felt increased autonomy, for
Many spoke of no longer feeling like they were the only
example,
one suffering, as they broadened their focus and recognised
the experiences and views of others. For example, ‘There’s
‘It’s like gathering a toolbox, and suddenly having a
always somebody worse off than you. And I know there is.
new set of tools or more tools… there’s some fallen at
And that keeps me going too’.
the bottom of the box but some you use more often.’
Recognising and acknowledging the benefits of viewing
their pain experience differently were illustrated by partici-
Choosing to Take Action Again highlighting the empower- pants. For example, ‘It’s an alternative to letting the pain get
ment provided by expanding participants’ perception of their the upper hand. I don’t think you can control the pain but you
pain, participants reflected that MBCT had taught them that control the relationship to your pain. And that in turn influ-
they could make choices to take control of decisions and ences your experience of it’.
actions for their pain management.
Patients’ Struggles
‘It’s not necessarily what happens in your life but how
you deal with it…you’ve got the ability to control how This overarching theme describes a variety of stumbling
you respond to things.’ blocks, predominantly mentally, that participants faced in their
MBCT experiences. They described dissonance and friction
The actions taken by participants in response to their pain created by the inflated expectation that they would achieve
or early warning signs were varied, highlighting again the pain control compounded by overexertion in trying to achieve
usefulness of a ‘toolbox’ of available strategies. Ongoing this outcome. Conflicting time pressures were also highlight-
regular use of the mindfulness CDs provided in the course ed, as were the multitude of comorbid conditions commonly
had proven helpful for some participants, imagery was helpful faced by chronic pain patients.
for others, mindful focus on the breath was named by the
majority of participants, and attentional focus on sounds or Different Expectations Participants expressed mental conflict
nature was also useful for a number of participants. All of the created by their attempts not to think about pain para-
actions described were intentional, focussed responses, again doxically increasing their focus on the pain, for exam-
drawing attention to the power of deliberate choice in self- ple, ‘I’d go, “well, I don’t want to think about it, I’m
management of pain using MBCT strategies. trying not to, but now I’m thinking about not thinking
Simply stated, ‘Being in the present is the most important about that thing”’. Similarly, they spoke of their initial
thing I’ve got out of the group’. Another participant realised high expectations of the MBCT programme for their
the ‘sense’ of control that they had regained through MBCT, pain, subsequent anxiety and their difficulty accepting
‘It’s one thing that can’t be taken from me’. Ongoing disci- the limitations of MBCT. For example, ‘I’m fighting the
plined practice was indicated as helpful in gaining greater whole time because my belief was that eventually you would
control of one’s focus, ‘What was interesting for me was that find the answer to my back pain and fix it’ and ‘It is hard,
ability to control your mind when you practised. So that if I set especially at the beginning. I think the deterrent in the whole
aside that half an hour I could with a bit of effort and will make thing is the expectation and trying too hard’.
my mind stay where I wanted it to’.
For most participants, taking an active role in choosing to Conflicting Demands Difficulty in making time to practice
take action was a vital teaching of the MBCT programme. was commonly reported. Participants struggled to prioritise
‘You just need to keep doing stuff. To get up out of bed, to time to practice ahead of competing demands, for example,
have somewhere to go, to do something, to enjoy the compa-
ny, to engage—that’s what these courses are very important ‘I would like to start doing it more, but at the time I had
for.’ three little ones.’
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1134 Mindfulness (2015) 6:1129–1136

‘I found it very difficult to do it because of what was Discussion

going on in my life at the time.’
Over recent years, an increasing body of evidence has accu-
Comorbid Conditions A wide range of comorbid conditions mulated indicating that mindful meditation assists in improv-
were indicated in addition to the presenting chronic pain. ing psychological well-being and can help to relieve symp-
Many participants referred to ongoing depression or depres- toms associated with chronic pain (Elabd 2011). Given the
sive symptomatology. ‘I should come to the group sessions high prevalence of chronic pain in the global population
because then it would be better for me. I know all that, but you (Goldberg and McGee 2011) and the high comorbidity of
know, I just think sometimes depression gets the better of me chronic pain with depression (Arnow et al. 2006), further
I’m afraid. And it’s really hard to get over it.’ exploration of the potential of mindfulness therapies such as
Other comorbid conditions mentioned included eating dis- MBCT for chronic pain patients with associated emotional
orders, grief and loss, anxiety, stress, domestic violence, drug difficulties is well justified. Designed to aid in the prevention
and/or alcohol misuse, diabetes, post-polio syndrome and of depressive relapse (Piet and Hougaard 2011), and with
general psychological issues. The relevance and impact of early research suggesting benefits for reducing chronic pain
these comorbid issues were stated by some clients, with one symptoms (Veehof et al. 2011), the structured MBCT pro-
participant referring to, ‘a heart pain, an ache inside, grief, gramme has already shown great potential (Kranz et al. 2010;
something they carry that they can’t put in a sling’. She also Schütze et al. 2010).
observed that, ‘Most people are trying to manage their own This study highlighted aspects of chronic pain patients’
pain. Not just physical pain, but their own human pain’. perceived benefits of participation in an MBCT programme.
Several themed factors appeared to influence participants’
Patients’ Acceptance of the Presence of Pain engagement and commitment to ongoing mindfulness prac-
tice following participation in MBCT. These included their
This overarching theme captures the processes that enable belief in the effectiveness of MBCT as an intervention for
chronic pain patients to allow pain, both emotional and phys- chronic pain; the extent of participants’ perceived control over
ical, to coexist with them, accepting its presence without their pain management; mental, emotional and practical
resistance. struggles between conflicting thoughts and time demands
and participants’ acceptance of the presence of pain without
‘It’s sort of like saying “yes” to your situation rather than active resistance. These themes align with themes identified in
kicking and fighting it. Accepting it.’ previous qualitative MBCT studies, particularly the themes of
acceptance (Finucane and Mercer 2006; Mason and
Acceptance Participants embracing an attitude of acceptance Hargreaves 2001), struggle and control (Allen et al. 2009).
reported reduced distress and claimed to be able to ‘let the bad Acceptance and control were central to participants’ accounts
things go’. For example, ‘I may not be able to get rid of the of what assisted them to maintain mindfulness practice. The
pain, but at least I can let go of the anger that I have it, or concept of a toolbox of strategies that were accessible anytime
dislike that I have for it’. Another participant recollected the was repeatedly mentioned as part of discussions highlighting
pivotal moment when she moved to an accepting stance, increased ability to cope linked with increased sense of con-
recalling, ‘and the minute I let go of the anger, that was the trol. By learning skills and making changes, participants
time I started to grow, so yeah, that was a big moment in my maintained a sense of hope and continued ongoing practice.
life’. Describing it in a way similar to being granted permis- Pivotal to maintaining acceptance and control, participants’
sion to let go, participants said that they were freer to move beliefs regarding the perceived benefits of ongoing practice
forward from full immersion in their pain experiences when were paramount. Not surprisingly, participants attributing pos-
they had grasped the attitude of acceptance. For example, itive benefits to MBCT were strongly motivated to continue
‘And along you come to the pain clinic so you learn and practice. This relates strongly to previous research indicating a
you’ve got to make some changes, making changes is what correlation between consistent practice and improvements in
it’s all about, and you can’t do anything except move on from psychological well-being (Finucane and Mercer 2006).
where you were…You have to accept what’s happening right Conversely, participants were motivated to continue mindful-
now, not necessarily forget it, but just, okay, that’s happened, ness practice by the negative effects that they believed would
this is now, and we move on’. This complete acceptance was arise if practice was not maintained. Only two of the 17 chronic
encapsulated by the comment of one participant, ‘It just is pain patients interviewed reported rare or no ongoing mindful-
what it is. You just accept it and move on’. Not surprisingly, ness practice. One participant who believed that there was no
not all participants had reached this point, with a minority still more to be gained chose not to continue with booster sessions
unwilling to adopt this stance, for example, ‘I would like or formal ongoing practice. Conflicting demands resulted in a
someone to make a magic pill to make my pain go away’. struggle for most participants to set aside time to regularly
 Author's personal copy
Mindfulness (2015) 6:1129–1136 1135

engage in practice, despite most claiming that it was beneficial. reduce pain catastrophising? What impact does MBCT have
Children, family, work and comorbid conditions were all cited on pain catastrophising and other cognitive processes? And,
as factors that hindered ongoing practice. Ultimately, though, it how does mindfulness potentially act as a moderating factor
seemed an ongoing struggle to accept that the presence of pain between acceptance of pain and pain catastrophising? In this
created the greatest obstruction to engaging in continued mind- exploratory study, participants’ qualitative feedback indicated
fulness practice. Given this finding, further exploration of the ongoing benefit in running MBCT groups for chronic pain
cognitive and emotional difficulties arising from such a struggle patients. Given how much is still uncertain about the mecha-
is fundamental in understanding such experiences, particularly nisms of MBCT, if group-based MBCT interventions are to
as it relates to the potential presence of pain catastrophising. As continue, further research is warranted. For the meantime, if,
a phenomenon, pain catastrophising is generally characterised as one participant reflected, participation in an MBCT group
by feelings of helplessness, active rumination and excessive programme ‘gives the person a reason for being’, there may
magnification of cognition and feelings, creating further psy- already be evidence enough for programmes to continue in the
chological distress (Severeijns et al. 2001). How then would interim.
mindfulness, as taught within an MBCT format, influence pain
catastrophising? Acknowledgments A scholarship awarded by the Nursing and Allied
Further research to empirically investigate the benefits of Health Scholarship and Support Scheme (NAHSSS), funded by the
booster sessions to consolidate learning and renew motivation Australian Federal Government Department of Health and Ageing, sup-
is recommended. Similar findings were reported by Finucane ported this work. Views in this paper do not necessarily represent those of
the NAHSSS, its Administrator, Services for Australian Rural and Re-
and Mercer (2006), highlighting the importance of ongoing mote Allied Health (SARRAH) and/or the Australian Government De-
support to counteract obstacles to continued mindfulness prac- partment of Health and Ageing.
tice. A review of the frequency and accessibility of booster
sessions should be undertaken, with further exploration of
participants’ reflections on the format and content of such
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