Moderators of the Effects of Telehealth Mindfulness-based Interventions for Chronic Pain

OBJECTIVES: Little is known about who benefits most from Mindfulness-Based Interventions (MBIs), and whether certain groups differentially benefit from different types of MBI formats (group-based versus non-group based). The present study uses data from a three-arm randomized controlled trial (ClinicalTials.gov ID: NCT04526158) of two MBIs (self-paced and group) to test moderating effects by gender and diagnoses of three mental health conditions (depression, anxiety, and post-traumatic stress disorder). METHODS: The sample consisted of 811 veterans with moderate to severe chronic pain, recruited from three Veterans Affairs sites from 2020 to 2022. Survey data were collected at baseline and three follow-up timepoints (10 weeks, 6 months, and 12 months). A responder analysis approach was used to measure clinically important changes. Outcomes were improvement from baseline in pain interference, pain intensity, anxiety, depression, PTSD, fatigue, sleep disturbance, physical function, and social functioning. RESULTS: The group MBI and self-paced MBI arms had higher rates of improvement in all outcomes compared to usual care. In the group MBI, women had greater improvement in pain severity and depression than men, and those with anxiety diagnoses had less improvement in PTSD than those without anxiety. DISCUSSION: Overall, both MBIs benefitted participants across subgroups, with limited evidence for differential effects by gender or mental health diagnoses. Further research is needed to more systematically determine whether MBIs can be optimized for key subgroups.