Cognitive‐affective changes mediate the mindfulness‐based intervention effect on endometriosis‐related pain and mental health: A path analysis approach

Abstract

AbstractBackgroundThere is poor knowledge about the therapeutic mechanisms of the conservative interventions for endometriosis. We hypothesized that the effects of a brief mindfulness‐based intervention (bMBI) on pelvic pain intensity (PPI), pain unpleasantness (PU) and quality of life mental health (QoL‐MH) are mediated by direct and indirect paths of changes in pain catastrophizing (PC), positive affect (PA) and negative affect (NA).MethodsA secondary analysis of a pilot randomized controlled trial of women with endometriosis, assigned to standard medical treatment (n = 32) and standard medical treatment plus bMBI (n = 31). We tested a series of parallel and serial mediators (PC, PA and NA) of the relationship between bMBI and outcomes (PPI, PU and QoL‐MH).ResultsThe bMBI group demonstrated improvement in PA (Cohen's f2 = 0.12 [0.01, 0.36]), decreases in NA (Cohen's f2 = 0.06 [0.00, 0.24]) and PC (Cohen's f2 = 0.16 [0.02, 0.42]). The PC reduction mediated the effect of the bMBI on PPI and PU directly; however, the PC effect through PA increase mediated the PU marginally but not PPI changes. bMBI effect on Qol‐MH was mediated directly by PA and NA. The PC improved Qol‐MH through PA increase and Pain decrease but not via NA.ConclusionsOur findings showed that bMBI impacts pain through changes in pain‐related cognitive‐affective factors. bMBI can improve QoL‐MH by multiple pathways, including but not limited to pain reduction, highlighting the independent potential of improvement in affect to restore mental health in endometriosis.SignificanceBrief mindfulness‐based intervention improves endometriosis pain through pain‐related cognitive‐affective factors and quality of life mental health via pain and affect changes unrelated to pain.