Changes in cognitive appraisal in a randomized controlled trial of mindfulness‐based cognitive therapy for patients with migraine

Objective This study is a secondary analysis evaluating changes in cognitive fusion and pain catastrophizing over 8 weeks of mindfulness‐based cognitive therapy for migraine (MBCT‐M) intervention versus waitlist/treatment as usual. Background Migraine is a common disabling neurological condition. MBCT‐M combines elements of cognitive behavioral therapy with mindfulness‐based approaches and has demonstrated efficacy in reducing migraine‐related disability. Methods A total of 60 adults with migraine completed a 30‐day run‐in before randomization into a parallel design of either eight weekly individual MBCT‐M sessions (n = 31) or waitlist/treatment as usual (n = 29): participants were followed for 1 month after. Participants completed the Pain Catastrophizing Scale (PCS) and the Cognitive Fusion Questionnaire (CFQ) at Months 0, 1, 2, and 4. Results The PCS scores decreased more in the MBCT‐M group (mean [SD] at baseline = 22.5 [9.6]; at Month 4 = 15.1 [8.8]) than in the waitlist/treatment as usual group (mean [SD] at baseline = 24.9 [9.0]; at Month 4 = 22.5 [10.4]) from Month 0 to 4 (β = −7.24, p = 0.001, 95% confidence interval [CI] −11.39 to −3.09). The CFQ (mean [SD] baseline = 27.6 [8.0]; at Month 4 = 25.0 [8.0]) did not change significantly from Month 0 to 4 (β = −1.2, p = 0.482, 95% CI −4.5 to 2.1). Parallel mediation analyses indicated that decreases in the PCS and CFQ together (β = −6.1, SE = 2.5, 95% CI −11.6 to −1.8), and the PCS alone (β = −4.8, SE = 2.04, 95% CI −9.1 to −1.1), mediated changes in headache disability in the MBCT‐M treatment completer group (n = 19). Conclusion In this study, pain catastrophizing showed strong promise as a potential mechanism of MBCT‐M. Future research should continue to explore cognitive appraisal changes in mindfulness‐based interventions.