Mindfulness physical therapy, pain management, rehabilitation

Mindfulness and Rheumatoid Arthritis

In a study examining pain and changes in cognitions, symptoms and affect, Davis and colleagues randomized 143 women diagnosed with rheumatoid arthritis to mindfulness and acceptance treatment, cognitive behavioral therapy or arthritis education.1 Pre- to post-treatment, mindful awareness and acceptance treatment yielded greater reductions in pain-related catastrophizing, fatigue, morning disability and stress-related anxious affect relative to CBT and arthritis education. Authors suggest that teaching individuals to calmly observe adverse experiences can make them more skilled at detecting subtle affective cues. This ability to be aware of initial shifts in affect may, in turn, enable them to regulate responses to pain and stress before symptoms become severe. They also propose mindfulness-based treatment may yield benefits by helping people to diminish hypervigilance and cognitive elaboration to threatening experiences.

Awareness is a necessary step in the self-regulation of patients’ reactions to pain and stress. I have found that patients benefit not only from observing subtle affective cues as the authors describe, but also from noticing subtle physical ones, such as an initial increase in muscle tension or shift to a shallow breathing pattern. Patients can only self-regulate sensations, emotions and thoughts if they are aware of them. In my experience, training in mindful awareness offers patients a practical road map for building the skillful body awareness necessary to reduce maladaptive reactions that amplify pain and distress.

1Davis MC, Zautra AJ, Wolf LD, et al. Mindfulness and cognitive-behavioral interventions for chronic pain: Differential effects on daily pain reactivity and stress reactivity. J Consult Clin Psychol. 2015 Feb;83(1):24-35.