A randomized-controlled trial comparing relative effects of mindfulness-based interoceptive exposure focus versus distraction on cold-pressor induced pain

Pain can positively be influenced by the control or direction of attention, e.g. attention diversion from or focusing on pain. The Mindfulness-based Interoceptive Exposure Task (MIET) is an easy to learn and simple to apply interoceptive desensitization method using a sensory focus strategy. This study investigates the distinct effects of sensory-focus and distraction on experimental pain reduction. One hundred and sixty participants (mean age = 24 years, 71 % female) were randomized to a MIET, distraction or passive control condition. Cold pain tolerance, intensity and aversiveness were assessed during task performance and compared to baseline. The MIET and distraction task both improved pain tolerance while reducing pain intensity and aversiveness. Even considering individual pain baselines, both tasks were effective for pain intensity and the MIET for pain tolerance, in particular. Dispositional mindfulness, measured by the Five Factor Mindfulness Questionnaire (FFMQ), and pain-related fear, measured by the Fear of Pain Questionnaire, served as distinct predictors of the pain-reducing MIET effect. Individuals with lower mindful awareness and nonreactivity on the FFMQ appeared to benefit more from the MIET method, particularly for pain tolerance. Higher fear of pain reduced the effect of the MIET on pain intensity but not on pain tolerance. This study demonstrates the efficacy of attention directing tasks on pain processing and shows distinct advantages of an exposure-based mindfulness task on pain tolerance and intensity.