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.

中文翻译：

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疼痛接受作为偏头痛正念认知治疗的改变机制

摘要

偏头痛是全世界残疾的主要原因之一。第三波疗法，例如基于正念的偏头痛认知疗法 (MBCT-M)，已被证明可以有效减少头痛相关的残疾。然而，需要进行研究来更好地了解这些第三波疗法所涉及的变化机制。接受是第三波疗法的基本组成部分，需要对疼痛接受在 MBCT-M 中的作用进行更多研究。了解疼痛接受的两个组成部分——疼痛意愿（PW）和活动参与（AE）的独立作用也很有价值。本研究是对 MBCT-M 随机对照试验的二次分析。该研究包括 60 名参与者（MBCT = 31；WL/TAU = 29）。研究了总体疼痛接受度、PW、AE 和头痛相关残疾之间的基线相关性。混合模型评估了从基线到治疗后一个月的变化以及治疗期间的总体疼痛接受度、PW 和 AE 的相互作用。混合模型还评估了 MBCT-M 组 6 个月随访时变化的维持情况。纵向中介模型评估了疼痛接受度、PW 和 AE 的变化是否介导了治疗与头痛相关残疾变化之间的关系。基线时疼痛接受度、PW 和 AE 均与头痛相关残疾呈负相关。随着时间的推移，等待名单/照常治疗组 (WL/TAU) 和 MBCT-M 组的疼痛接受度、PW 和 AE 均显着增加。仅 AE 在 MBCT 组中比 WL/TAU 组增加更多。疼痛接受度、PW 和 AE 的变化均显着调节 MBCT 与头痛相关残疾变化之间的关系。该研究支持了 MBCT-M 中疼痛接受的重要性，特别是活动参与部分。