One of the most frustrating myths I encounter about cognitive behavioral therapy is that it is all about changing thoughts. Since I have already covered why this is incorrect in previous posts, I’ll instead talk about one part of cognitive behavioral therapy that I particularly enjoy and is not about changing thoughts: reducing barriers to medical and mental health care. When therapists work on this with an individual client, we call it problem solving. But psychologists often study the structural barriers to getting care. I’ll use an example from my own work on mindfulness for chronic low back pain.

First, here is a little background. Chronic low back pain is very common and is, unfortunately, a common cause of disability. Mindfulness is a form of meditation that involves focusing on the present moment, trying to be nonjudgmental, not trying to change anything and paying attention to one thing at a time. Several studies have shown that mindfulness can be helpful for chronic low back pain.

However, accessing mindfulness therapy has been challenging for people with chronic low back pain so my colleagues and I decided to study what barriers could be preventing people from accessing this treatment.

For this study, 457 people with chronic low back pain read a description of a typical Mindfulness-Based Stress Reduction treatment. They answered questions about their confidence for participating in the treatment, their attitudes about the treatment and what their friends and family might think about the treatment. We compared their confidence, attitudes and perceptions about friends and family to whether they would be willing to participate in a mindfulness course for their back pain. Analyses suggested that confidence for learning mindfulness was most strongly associated with willingness to participate in the course.

Image by Patrizia08 from Pixabay

In another part of this study, participants were randomly assigned to read different descriptions of a Mindfulness-Based course for low back pain. One fourth read a description of the standard course, another fourth read a description with testimonials and a more rigid course, the next group read a description with scientific evidence and a flexible course and the last group read a description with testimonials and a flexible course. We then compared their attitudes, confidence and perceptions about friends and family think for the four different versions. Overall, the different descriptions of mindfulness did not affect confidence, attitudes or any other belief about the mindfulness course. Confidence and whether participants would find the mindfulness course personally helpful were associated with willingness to try the course.

This study suggests potential barriers to using mindfulness for chronic low back pain and several potential solutions. Providing logistical options for mindfulness courses (online, in-person) could improve confidence for using mindfulness. Mindfulness can also be a tricky skill to learn so providing different techniques could help improve confidence as people are more likely to find a technique that works for them. Information on how the course can benefit patients could improve whether the participants feel the course would benefit them.

For those who want to try mindfulness for their chronic low back pain, I recommend checking with your doctor first. It is best to work with a psychologist or therapist trained in mindfulness therapy who has experience treating people with chronic pain. Classes are also an option. If none of these are accessible, there are several apps available. However, most of these apps will say what they have is mindfulness but it is actually relaxation exercises.

A key way to tell whether an app or meditation recording is mindfulness or not is whether it tries to change something like tension or stress levels. One of the key distinctions of mindfulness is being in the present moment without trying to change it. So if the app is focused too much on change, then it likely is not mindfulness. While mindfulness can be an effective option for chronic low back pain, make sure to check that the treatment you are getting is actually mindfulness.