Cognitive behavioral components of mindfulness in patients with chronic pain

Methods of mindfulness are gaining increasing popularity within the behavioral and cognitive therapies and appear helpful for a range of clinical problems, including chronic pain. Mindfulness, however, is not well understood from a scientific standpoint. The purpose of this study was to examine particular cognitive and behavioral processes underlying mindfulness. One hundred fifty patients seeking treatment for chronic pain (64% women; mean age 46.7 years, SD = 13.4) each completed a battery of questionnaires, including the 15-item Mindful Attention Awareness Scale (MAAS). Preliminary reliability and validity analyses supported the psychometric properties of the MAAS for patients with chronic pain. A confirmatory factor analysis provided incomplete support for a singe factor structure from the items of the MAAS. In turn, an exploratory factor analysis produced a four-factor solution and yielded subscales labeled Acting with Awareness, Present Focus, Responsiveness, and Social Awareness. Correlation analyses indicated that the Acting with Awareness and Present Focus subscales were significantly negatively related to multiple measures of patient distress and disability, such as depression, r = -.47, p < .001 and r = -.60, p < .001, and psychosocial disability, r = -.49, p < .001 and r = -.60, p < .001, respectively. In multiple regression analyses, after controlling for patient background variables, the Acting with Awareness and Present Focus subscales accounted for significant variance in measures of emotional, physical, social, and health-care-related functioning (average ΔR² = .17). In each case, a greater score on these subscales was associated with more positive functioning. Overall, the Present Focus component appeared to be the more important predictor. We suggest further study to explore and validate models of mindfulness-based processes. Preliminarily, patients with chronic pain who maintain greater awareness of their present situation, as opposed to thoughts of the past or future, may experience better functioning and well being.