Table 4:
Depressive symptoms (PHQ-8): Adjusted mean change and treatment effects at 8 weeks for subgroups defined by baseline characteristics.
| Adjusted mean change at 8 weeks | Treatment effect* | |||||
|---|---|---|---|---|---|---|
| UC | CBT | MBSR | CBT-UC | MBSR-UC | CBT-MBSR | |
| Baseline characteristic | Mean (95% CI) | Mean (95% CI) | Mean (95% CI) |
P-value† Mean (95% CI) |
P-value† Mean (95% CI) |
P-value† Mean (95% CI) |
| Overall | −0.11 (−0.68, 0.45) | −2.23 (−2.82, −1.63) | −1.58 (−2.18, −0.98) | −2.11 (−2.94, −1.29) | −1.47 (−2.30, −0.63) | −0.65 (−1.49, 0.20) |
| Age at baseline | 0.57 | 0.96 | 0.53 | |||
| <60 yrs | 0.13 (−0.53, 0.78) | −2.16 (−2.87, −1.45) | −1.35 (−2.08, −0.62) | −2.29 (−3.25, −1.32) | −1.48 (−2.46, −0.49) | −0.81 (−1.83, 0.21) |
| ≥60 yrs | −0.69 (−1.88, 0.49) | −2.44 (−3.55, −1.34) | −2.22 (−3.32, −1.13) | −1.75 (−3.37, −0.13) | −1.53 (−3.15, 0.09) | −0.22 (−1.78, 1.34) |
| Gender | 0.83 | 0.98 | 0.85 | |||
| Male | −0.16 (−1.33, 1.02) | −2.40 (−3.32, −1.48) | −1.65 (−2.61, −0.68) | −2.24 (−3.73, −0.75) | −1.49 (−3.01, 0.03) | −0.75 (−2.08, 0.59) |
| Female | −0.08 (−0.72, 0.57) | −2.12 (−2.89, −1.36) | −1.55 (−2.33, −0.77) | −2.05 (−3.05, −1.04) | −1.47 (−2.48, −0.46) | −0.58 (−1.67, 0.52) |
| Education | 0.16 | 0.85 | 0.12 | |||
| Less than bachelor’s degree | 0.32 (−0.61, 1.26) | −2.57 (−3.57, −1.57) | −1.08 (−1.97, −0.18) | −2.89 (−4.26, −1.52) | −1.40 (−2.70, −0.11) | −1.49 (−2.83, −0.15) |
| Bachelor’s degree | −0.38 (−1.09, 0.33) | −2.07 (−2.79, −1.34) | −1.94 (−2.76, −1.13) | −1.69 (−2.71, −0.66) | −1.56 (−2.64, −0.49) | −0.12 (−1.21, 0.97) |
| Functional limitations | 0.11 | 0.23 | 0.73 | |||
| mRDQ <14 | −0.24 (−0.92, 0.43) | −1.89 (−2.63, −1.14) | −1.37 (−2.11, −0.64) | −1.64 (−2.64, −0.64) | −1.13 (−2.13, −0.13) | −0.51 (−1.55, 0.52) |
| mRDQ ≥14 | 0.21 (−0.85, 1.28) | −2.86 (−3.88, −1.84) | −2.03 (−3.11, −0.94) | −3.07 (−4.51, −1.62) | −2.24 (−3.74, −0.74) | −0.83 (−2.29, 0.63) |
| Pain bothersomeness | 0.60 | 0.28 | 0.60 | |||
| <7 | −0.39 (−1.1, 0.33) | −2.30 (−3.01, −1.60) | −1.51 (−2.25, −0.76) | −1.92 (−2.94, −0.90) | −1.12 (−2.16, −0.08) | −0.8 (−1.82, 0.23) |
| ≥7 | 0.36 (−0.58, 1.30) | −2.03 (−3.12, −0.94) | −1.72 (−2.76, −0.69) | −2.39 (−3.82, −0.96) | −2.08 (−3.48, −0.69) | −0.31 (−1.81, 1.19) |
| Depressive symptoms | 0.04 | 0.01 | 0.62 | |||
| PHQ-8 <10 | 0.20 (−0.46, 0.86) | −1.45 (−2.16, −0.74) | −0.70 (−1.42, 0.01) | −1.65 (−2.62, −0.68) | −0.90 (−1.87, 0.08) | −0.75 (−1.75, 0.25). |
| PHQ-8 ≥10 | −1.78 (−3.44, −0.12) | −5.96 (−7.42, −4.50) | −5.83 (−7.45, −4.21) | −4.18 (−6.40, −1.97) | −4.04 (−6.34, −1.75) | −0.14 (−2.33, 2.05) |
| Depressive symptoms | 0.04 | 0.12 | 0.60 | |||
| PHQ-8 <5 | 0.74 (−0.14, 1.63) | −0.43 (−1.38, 0.52) | −0.02 (−0.96, 0.92) | −1.17 (−2.47, 0.13) | −0.77 (−2.01, 0.53) | −0.41 (−1.75, 0.93) |
| PHQ-8 ≥5 | −0.86 (−1.74, 0.03) | −3.95 (−4.83, −3.06) | −3.05 (−3.97, −2.12) | −3.09 (−4.34, −1.84) | −2.19 (−3.47, −0.91) | −0.90 (−2.18, 0.38) |
| Expected pain improvement | 0.83 | 0.90 | 0.73 | |||
| 1–2 (pain gone or much better) | −0.09 (−1.15, 0.97) | −2.35 (−3.49, −1.20) | −1.46 (−2.55, −0.37) | −2.26 (−3.80, −0.71) | −1.37 (−2.89, 0.15) | −0.88 (−2.46, 0.69) |
| 3–7 (pain worse, unchanged, or somewhat better) | −0.12 (−0.80, 0.56) | −2.18 (−2.89, −1.47) | −1.62 (−2.36, −0.88) | −2.05 (−3.04, −1.06) | −1.49 (−2.50, −0.49) | −0.56 (−1.58, 0.46) |
| Expected program helpfulness | 0.32 | 0.75 | 0.20 | |||
| <8 | 0.04 (−0.83, 0.91) | −2.50 (−3.32, −1.68) | −1.27 (−2.20, −0.34) | −2.54 (−3.73, −1.34) | −1.31 (−2.58, −0.04) | −1.23 (−2.46, 0.01) |
| ≥8 | −0.23 (−0.99, 0.52) | −1.93 (−2.78, −1.08) | −1.81 (−2.61, −1.01) | −1.69 (−2.84, −0.55) | −1.58 (−2.68, −0.47) | −0.12 (−1.29, 1.05) |
| Widespread pain | 0.58 | 0.95 | 0.62 | |||
| <4 | −0.44 (−1.45, 0.57) | −2.23 (−3.18, −1.29) | −1.84 (−2.79, −0.88) | −1.79 (−3.16, −0.42) | −1.40 (−2.78, −0.01) | −0.40 (−1.71, 0.92) |
| ≥4 | 0.05 (−0.65, 0.75) | −2.23 (−3.00, −1.45) | −1.40 (−2.19, −0.60) | −2.28 (−3.32, −1.24) | −1.45 (−2.50, −0.40) | −0.83 (−1.93, 0.27) |
| Anxiety | 0.13 | 0.98 | 0.13 | |||
| GAD-2 <3 | −0.35 (−0.97, 0.26) | −2.23 (−2.88, −1.59) | −1.90 (−2.57, −1.23) | −1.88 (−2.77, −0.99) | −1.55 (−2.46, −0.64) | −0.33 (−1.26, 0.59) |
| GAD-2 ≥3 | 1.35 (−0.16, 2.86) | −2.23 (−3.77, −0.7) | −0.16 (−1.65, 1.32) | −3.58 (−5.63, −1.54) | −1.51 (−3.53, 0.50) | −2.07 (−4.13, −0.01) |
| SOPA Disability | 0.73 | 0.18 | 0.10 | |||
| <2 | −0.21 (−0.92, 0.51) | −2.46 (−3.24, −1.68) | −1.18 (−1.99, −0.37) | −2.25 (−3.31, −1.19) | −0.97 (−2.05, 0.11) | −1.28 (−2.41, −0.16) |
| ≥2 | 0.04 (−0.89, 0.96) | −1.92 (−2.82, −1.02) | −2.08 (−2.99, −1.17) | −1.96 (−3.26, −0.66) | −2.12 (−3.43, −0.82) | 0.16 (−1.11, 1.44) |
| SOPA Harm | 0.27 | 0.89 | 0.36 | |||
| <2 | −0.36 (−1.21, 0.50) | −2.02 (−2.8, −1.25) | −1.73 (−2.55, −0.90) | −1.67 (−2.82, −0.51) | −1.37 (−2.57, −0.17) | −0.30 (−1.43, 0.83) |
| ≥2 | 0.08 (−0.68, 0.85) | −2.51 (−3.44, −1.59) | −1.40 (−2.30, −0.50) | −2.60 (−3.80, −1.39) | −1.49 (−2.67, −0.31) | −1.11 (−2.40, 0.18) |
| SOPA Control | 0.75 | 0.78 | 0.56 | |||
| <3 | 0.31 (−0.40, 1.03) | −1.89 (−2.63, −1.15) | −1.03 (−1.80, −0.26) | −2.20 (−3.23, −1.17) | −1.34 (−2.40, −0.28) | −0.86 (−1.94, 0.21) |
| ≥3 | −0.83 (−1.74, 0.07) | −2.77 (−3.72, −1.82) | −2.42 (−3.38, −1.45) | −1.93 (−3.25, −0.62) | −1.58 (−2.89, −0.28) | −0.35 (−1.70, 1.00) |
| SOPA Emotion | 0.12 | 0.64 | 0.30 | |||
| <3 | −0.39 (−1.11, 0.33) | −1.96 (−2.77, −1.15) | −1.72 (−2.51, −0.92) | −1.57 (−2.65, −0.49) | −1.33 (−2.40, −0.26) | −0.24 (−1.36, 0.88) |
| ≥3 | 0.34 (−0.59, 1.27) | −2.55 (−3.44, −1.66) | −1.40 (−2.35, −0.44) | −2.89 (−4.17, −1.61) | −1.74 (−3.05, −0.42) | −1.15 (−2.45, 0.14) |
| Pain self-efficacy | 0.55 | 0.67 | 0.88 | |||
| PSEQ <50 | 0.25 (−0.48, 0.98) | −2.01 (−2.83, −1.19) | −1.34 (−2.12, −0.57) | −2.26 (−3.36, −1.17) | −1.60 (−2.66, −0.53) | −0.67 (−1.79, 0.45) |
| PSEQ ≥50 | −0.69 (−1.60, 0.22) | −2.45 (−3.32, −1.58) | −1.92 (−2.87, −0.96) | −1.76 (−3.02, −0.51) | −1.23 (−2.54, 0.09) | −0.54 (−1.83, 0.76) |
| Pain catastrophizing | 0.81 | 0.77 | 0.61 | |||
| PCS <30 | 0.50 (−1.11, 2.11) | −1.33 (−3.09, 0.42) | −1.26 (−2.87, 0.34) | −1.83 (−4.20, 0.53) | −1.77 (−4.04, 0.51) | −0.07 (−2.44, 2.30) |
| PCS ≥30 | −0.21 (−0.82, 0.40) | −2.35 (−2.98, −1.72) | −1.62 (−2.28, −0.96) | −2.14 (−3.02, −1.26) | −1.41 (−2.31, −0.51) | −0.73 (−1.64, 0.18) |
| Pain acceptance | 0.89 | 0.55 | 0.65 | |||
| CPAQ-8 <32 | −0.17 (−0.96, 0.62) | −2.22 (−3.05, −1.38) | −1.37 (−2.25, −0.49) | −2.05 (−3.20, −0.90) | −1.2 (−2.39, −0.02) | −0.85 (−2.04, 0.35) |
| CPAQ-8 ≥32 | −0.06 (−0.89, 0.77) | −2.23 (−3.09, −1.37) | −1.77 (−2.62, −0.93) | −2.17 (−3.36, −0.98) | −1.71 (−2.89, −0.54) | −0.46 (−1.66, 0.75) |
| FFMQ-SF OB | 0.67 | 0.13 | 0.28 | |||
| <4 | −0.02 (−0.81, 0.78) | −2.30 (−3.10, −1.50) | −2.00 (−2.77, −1.23) | −2.28 (−3.41, −1.15) | −1.99 (−3.10, −0.88) | −0.29 (−1.40, 0.81) |
| ≥4 | −0.21 (−1.01, 0.59) | −2.14 (−3.02, −1.26) | −0.90 (−1.88, 0.08) | −1.93 (−3.12, −0.73) | −0.69 (−1.95, 0.58) | −1.24 (−2.55, 0.07) |
| FFMQ-SF AA | 0.93 | 0.60 | 0.54 | |||
| <4 | −0.04 (−0.72, 0.64) | −2.18 (−2.92, −1.43) | −1.34 (−2.09, −0.60) | −2.14 (−3.15, −1.13) | −1.31 (−2.31, −0.30) | −0.83 (−1.88, 0.22) |
| ≥4 | −0.27 (−1.33, 0.78) | −2.33 (−3.33, −1.32) | −2.05 (−3.11, −1.00) | 2.06 (−3.50, −0.61) | −1.78 (−3.27, −0.29) | −0.28 (−1.71, 1.15) |
| FFMQ-SF NR | 0.75 | 0.17 | 0.26 | |||
| <4 | −0.23 (−0.87, 0.41) | −2.32 (−3.03, −1.61) | −1.33 (−2.08, −0.59) | −2.09 (−3.05, −1.13) | −1.10 (−2.08, −0.13) | −0.99 (−2.02, 0.04) |
| ≥4 | 0.38 (−0.87, 1.64) | −2.02 (−3.11, −0.93) | −2.07 (−3.12, −1.02) | −2.40 (−4.07, −0.73) | −2.45 (−4.10, −0.80) | 0.05 (−1.44, 1.55) |
| FFMQ-SF NJ | 0.26 | 0.93 | 0.24 | |||
| <4 | 0.46 (−0.36, 1.28) | −2.13 (−3.05, −1.22) | −0.96 (−1.85, −0.07) | −2.60 (−3.80, −1.39) | −1.43 (−2.61, −0.24) | −1.17 (−2.43, 0.08) |
| ≥4 | −0.65 (−1.45, 0.15) | −2.30 (−3.09, −1.51) | −2.15 (−3.00, −1.30) | −1.65 (−2.76, −0.54) | −1.50 (−2.65, −0.35) | −0.15 (−1.29, 0.98) |
| Opioid use, past wk | 0.80 | 0.45 | 0.34 | |||
| No | −0.14 (−0.75, 0.47) | −2.21 (−2.84, −1.58) | −1.69 (−2.33, −1.06) | −2.07 (−2.95, −1.19) | −1.55 (−2.44, −0.67) | −0.52 (−1.41, 0.38) |
| Yes | 0.07 (−1.65, 1.79) | −2.34 (−4.19, −0.50) | −0.41 (−2.46, 1.63) | −2.41 (−4.90, 0.08) | −0.48 (−3.12, 2.16) | −1.93 (−4.68, 0.82) |
AA, Acting with Awareness; CBT, cognitive-behavioral therapy; CI, confidence interval; CPAQ-8, Chronic Pain Acceptance Questionnaire-8; FFMQ-SF, Five Facet Mindfulness Questionnaire-short form; GAD, Generalized Anxiety Disorder; MBSR, Mindfulness-Based Stress Reduction; NJ, Nonjudging; NR, Nonreactivity; OB, Observing; PCS, Pain Catastrophizing Scale; PHQ, Patient Health Questionnaire; PSEQ, Pain Self-Efficacy Questionnaire; mRDQ, modified Roland Disability Questionnaire; SOPA, Survey of Pain Attitudes; UC, Usual Care
Models adjust for age, sex, education, pain duration, and baseline PHQ-8 score
*
Treatment effect defined as the difference between the two treatment groups in the 8-week change on the outcome measure within a given subgroup. Treatment effect estimates are coded such that negative treatment effects favor CBT and MBSR in their comparisons with UC, and CBT in the comparison of CBT and MBSR.
†
P-value for test of differences between subgroups in treatment effects at 8 weeks
Bold font indicates large effect sizes of interest; only those with P < 0.002 were statistically significant after Bonferroni adjustment for multiple comparisons.