Background of Study
The clinical problem that led to the study was the growth of the cases of chronic pain and the lack of options for its eradication. In other words, the knowledge of pain management techniques was insufficient for the successful management of the issue. The study describes a non-pharmaceutical, effective method of pain management that is able to increase the patients’ quality of life in several metrics without significant resource allocation on the individual, local, or state level.
The purpose of the study, apparent from the objectives formulated by the authors, was to determine the effectiveness of the cognitive behavioral therapy program with integrated mindfulness meditation (CBT) compared to waiting list controls in the reduction of pain intensity and to establish the association between mindfulness and acceptance and pain intensity reduction (Andersen & Vægter, 2016). The research questions can be inferred from the hypotheses formulated by the authors and are as follows:
Would the CBTm program reduce pain intensity and psychological distress compared to the control condition (Andersen & Vægter, 2016)?
Would the CBTm program increase the level of mindfulness and acceptance (Andersen & Vægter, 2016)?
Would the change in the level of mindfulness be associated with a reduction in pain intensity and psychological distress (Andersen & Vægter, 2016)?
Since the purpose of the study aims at pain intensity reduction, it is clearly related to the problem identified above.
Methods of Study
The benefits of the participants involved the possibility of improvement of pain management techniques. No risks aside from the relative inefficiency of the waiting list controls can be identified. The authors did not explicitly state either the benefits or the risks. The participants volunteered freely and confirmed their informed consent in a written form. The protocol of the research was approved by the review board of the University of Southern Denmark where the study was conducted.
The major independent variable identified by the authors was the level of mindfulness resulting from the CBTm program. The dependent variables included pain intensity, depression and anxiety, pain catastrophizing, acceptance, attention, and awareness. Importantly, the independent variable is neither identified nor explicitly defined. However, all of the dependent variables are defined in detail in a separate section. The data for the study was collected by administering the questionnaire to a group of patients recruited from a single multidisciplinary pain center in Denmark.
The data was collected at the baseline prior to the intervention as well as after the program’s termination. The authors did not provide a rationale for the chosen method of data collection. The time period for data collection was 13 weeks. The sequence of data collection started from letters of invitation sent to the participants, followed by the administration of the questionnaire with demographic data and the questions on pain intensity and previous experience with relaxation and mindfulness. After this, a 13-week CBTm program was delivered to the treatment group by two professional psychologists. After this, the second questionnaire was administered.
The data analysis method used in the study was a chi-square test for the evaluation of the baseline data and a sample t-test for continuous data. The rigor of the process was assured through several procedures, such as the screening of data for errors and missing values using the expectation-maximization algorithm, which revealed no deviations from normality (Andersen & Vægter, 2016). In addition, the Neuman-Klaus posthoc test was used to correct for the multiple comparisons (Andersen & Vægter, 2016). The ANOVA statistical platform was used for the analysis of data. No information is provided on the use of techniques meant to eliminate the effects of researcher bias.
Results of Study
The researchers interpret the findings by pointing to the reduction of depression, anxiety, and pain-catastrophizing in the treatment group associated with the participation in the CBTm program and associating the level of mindfulness and acceptance with the change in psychological distress and, to a lesser degree, depression. Within the scope of the study and regarding with regard to the rigor applied, the findings can be considered an accurate representation of reality. However, several limitations should be pointed out. First, the researchers used a relatively small sample, which is commonly considered insufficient for a quantitative study (Charan & Biswas, 2013).
The authors specifically address this limitation by pointing to the fact that the research in question was a pilot study, in which case the sample size is acceptable (Andersen & Vægter, 2016). Second, the study used a convenience sampling technique, employed a short follow-up time, and did not include randomization, which further decreases the applicability of the study for the population. Third, the research team reported a high level of drop-outs in the control group, which compromises the reliability of the data. Fourth, the treatment group showed a degree of familiarity with the mindfulness techniques, which is a likely confounding variable.
Despite the identified limitations, the findings were presented in a coherent manner and with sufficient clarity. The findings of the study are applicable primarily to the nursing practice since the identified benefits of the CBTm programs can directly benefit a large proportion of the population and thus improve patient outcomes and increase patient satisfaction rate. Once confirmed, the findings would also have implications for nursing administrators and educators, who could adjust the existing nursing policies and training programs for greater emphasis on mindfulness-based treatment.
The authors specify several areas for further research that can confirm their findings, such as studies performed on larger samples, employing better controls, more appropriate sampling techniques, and exploring the identified gaps in associations between the independent and dependent variables.
The study was approved by the review board of the University of Southern Denmark. The authors do not specify the measures provided to protect the privacy of the participants or the ethical considerations regarding the treatment or lack thereof. However, since both groups are known to receive traditional medical help for pain management, it would be reasonable to conclude that no harm could be anticipated from the lack of treatment. On the other hand, mindfulness-based interventions are not associated with adverse health effects (Gu, Strauss, Bond, & Cavanagh, 2015). Therefore, the ethical considerations regarding the harm of treatment can be safely dismissed.
The popularity of mindfulness- and meditation-based interventions is easily understood considering their non-intrusive nature and long-term improvements in patients’ quality of life. In this light, the quantifiable outcome in support of its effectiveness is a favorable result both for nursing practitioners and administrators. The former can benefit from the findings by modifying their methods of care and improving patient outcomes.
The latter can incorporate the results into the policies and guidelines for pain management applicable to individual organizations and healthcare networks. The non-pharmaceutical nature of the intervention in question aligns well with the patient perceptions of holistic care and enables nurses to promote self-care and sustainability among individuals and communities. While the results of the study need to be further verified, in their current form they outline a feasible direction for further inquiry and a promising area of development of the nursing discipline.
Andersen, T. E., & Vægter, H. B. (2016). A 13-weeks mindfulness based pain management program improves psychological distress in patients with chronic pain compared with waiting list controls. Clinical Practice and Epidemiology in Mental Health, 12, 49-58.
Charan, J., & Biswas, T. (2013). How to calculate sample size for different study designs in medical research? Indian Journal of Psychological Medicine, 35(2), 121.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1-12.