title: The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.
abstract: OBJECTIVE
  This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).
  
  
  METHODS
  A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N=24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.
  
  
  RESULTS
  Pain acceptance emerged as a significant mediator of the group-interference relation (p<.05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p<.05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.
  
  
  CONCLUSIONS
  Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.
authors.affiliation: School of Psychology, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: m.day@uq.edu.au.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Day
authors.affiliation: Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA.
authors.forename: Beverly E
authors.initials: BE
authors.lastname: Thorn
mesh_terms: D015928:Cognitive Behavioral Therapy; D006261:Headache / Q000628:therapy*; D006801:Humans; D064866:Mindfulness; D010146:Pain / Q000523:psychology*; D059408:Pain Management
keywords: Headache; Mechanisms; Mediation; Mindfulness-based cognitive therapy; Pain acceptance; Theory