An Empirical Examination of the Role of Common Factors of Therapy During a Mindfulness-based Cognitive Therapy Intervention for Headache Pain

Melissa A. Day, James Halpin, Beverly E. Thorn

It is often assumed that psychosocial pain treatments work because of specific active components of the intervention. The degree to which common factors may contribute to improved pain outcomes is not well researched. The purpose of this study was to examine client- and therapist-related common factors during a Mindfulness-Based Cognitive Therapy (MBCT) for headache pain trial. This study was a secondary analysis of a parallel-group, unblinded, randomized controlled trial in which MBCT was compared to a control. A series of linear regression models and one bootstrap mediation model were conducted with the sample of participants that completed MBCT (N=21). In-session client engagement was positively associated with treatment dose indicators of session attendance (P=0.038) and at-home meditation practice (P=0.027). Therapist adherence and quality were both significant predictors of post-treatment client satisfaction (P's=0.038 and 0.034, respectively). Therapist appropriateness was not significantly associated with any of the variables of interest (P's>0.05). Baseline pain intensity was positively associated with pre-treatment expectations and motivations (P=0.049) and working alliance (P=0.048), and working alliance significantly predicted post-treatment client satisfaction (P<0.001). Higher pre-treatment expectations and motivation significantly predicted greater improvement in pre- to post-treatment change in pain interference (P=0.016); however, this relation was fully mediated by baseline pain intensity (P<0.05). Common factors play an important role in improving pain outcomes and client satisfaction during a MBCT for headache pain intervention. Stimulating positive pre-treatment expectations and client motivation, as well as building strong rapport is an important component of treatment success.