Does Mindfulness Improve After Heart Coherence Training in Patients With Chronic Musculoskeletal Pain and Healthy Subjects? A Pilot Study.
BACKGROUND
Mindfulness and heart coherence training (HCT) training are applied increasingly in the treatment of patients with chronic musculoskeletal pain (CMP). Questionnaires have been developed to assess changes in mindfulness but no gold standard is available.


OBJECTIVE
Explore the relationship between changes in mindfulness scores and changes in heart coherence after 3 sessions of HCT in patients with CMP and in healthy subjects.


METHODS
Ten patients with CMP and 15 healthy subjects were trained in self-regulation with the use of HCT following a standardized stress relief program developed by the HeartMath Institute. A heart coherence-score (HC-score) was constructed with scores ranging from 0-100 with higher scores reflecting more heart rate variability (HRV) coherency. Change scores, Spearman correlation coefficients, and Wilcoxon Signed Rank test were calculated to test relationships and differences between HC-score, the Mindfulness Attention and Awareness Scale (MAAS) and Five Facet Mindfulness Questionnaire (FFMQ). A new questionnaire was constructed to explore on which mindfulness-related domains patients with CMP report changes after HCT.


RESULTS
Increases were present on HC-score in healthy subjects (P<.01) and in patients (P<.01) between baseline and follow-up. Effect sizes on change on the MAAS and FFMQ were low. Weak (r<0.25) and non-significant correlations were observed in change scores between HC-score and MAAS or FFMQ. Patients reported significant favorable differences on 6 mindfulness related domains in the new questionnaire: breathing rhythm, physical awareness, positive or negative emotions, recognition of stressful situations, thoughts, and tendency to actively self-regulate.


CONCLUSIONS
In this pilot study, mindfulness as assessed by the MAAS and FFMQ does not appear to improve after HCT. HRV coherency, MAAS, and FFMQ measure different constructs and are weakly related. It is of great importance to choose and develop valid measures that reflect patients' states of mindfulness. Content and face validity of measures of mindfulness may be considered in the light of performance-based measures.
Saxion Universities of Applied Sciences, School of Health, Enschede, Netherlands (Dr Soer).
Remko
R
Soer
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Netherlands (Ms de Jong).
Annemieke B
AB
de Jong
University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Netherlands (Mr Hofstra).
Bert L
BL
Hofstra
University of Groningen, University Medical Center Groningen, Groningen Spine Center, Netherlands (Dr Preuper).
Henrica R Schiphorst
HR
Preuper
University of Groningen, University Medical Center Groningen, Groningen Spine Center, Netherlands (Dr Reneman).
Michiel F
MF
Reneman
Mindfulness; acceptance and commitment therapy; chronic pain; heart coherence training; heart rate variability