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Mindfulness-Based Cognitive Therapy and Persistent Pain in Women Treated for Primary Breast Cancer: Exploring Possible Statistical Mediators - Results from a Randomized Controlled Trial

Johannsen, Maja MSc; O’Connor, Maja PhD; O’Toole, Mia Skytte PhD; Jensen, Anders Bonde PhD; Zachariae, Robert DMSc
The Clinical Journal of Pain: Post Acceptance: May 05, 2017
doi: 10.1097/AJP.0000000000000510
Original Article: PDF Only


To investigate possible statistical mediators in a randomized controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) on pain intensity in women treated for primary breast cancer.


The sample consisted of 129 women treated for breast cancer, presenting with persistent pain, who were randomly assigned to MBCT or a wait-list control. We previously reported a statistically significant and robust effect of MBCT on pain intensity (11-point Numeric Rating Scale), which was included as the primary outcome. Proposed mediators were mindfulness (the Five Facet Mindfulness Questionnaire, FFMQ), self-compassion (the Short-Form Self-Compassion Scale, SCS-SF), and pain catastrophizing (the Pain Catastrophizing Scale, PCS). Measurement points included baseline (T1), post-intervention (T2), 3 month (T3) and 6 month (T4) follow-up. All indirect effects of the mediators were tested in separate Multi-Level Models (MLMs), using the product-of-coefficients-approach with bias-corrected confidence intervals (95% BSCI). The statistically significant mediators were then included in a multiple mediator model.


Statistically significant indirect effects were found for mindfulness non-reactivity (B=−0.17, BSCI [−0.32 to −0.04]) and pain catastrophizing (B=−0.76, BSCI [−1.25 to −0.47]). No statistically significant indirect effect was found for self-compassion (B=−0.09, BSCI [−0.30 to 0.04]). In a multiple mediator model, including mindfulness non-reactivity and pain catastrophizing, only pain catastrophizing remained statistically significant (B=−0.72, BSCI [−1.19 to −0.33]), explaining 78% of the effect.


The results of the present study may have clinical implications. An increased focus on the proposed mediators may optimize the clinical use of MBCT for persistent pain in women treated for breast cancer.

Funding This study has been generously supported by The Danish Cancer Society (R49-A2564-11-S15), Aase & Ejnar Danielsens Fund (10-000938), Einar Willumsens Memorial Fund (6000073), Wedell-Borg Wedellborgs Fund (24-15-2), and Radiumstationens Research Fund (AR3466_01).

Conflicts of interests: None to declare.

Reprints: Maja Johannsen, MSc, Unit for Psychooncology and Health Psychology, Dept. of Oncology, Aarhus University Hospital and Dept. of Psychology, Aarhus University, Bartholins Alle 9; Bld. 1340; DK-8000 Aarhus C, Denmark (e-mail:

Received November 25, 2016

Accepted April 23, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.