Group, videoconference-delivered cognitive therapy, behavioral activation, and mindfulness meditation all produced medium-to-large reductions in pain interference for adults with chronic low back pain, with gains maintained at 3- and 6-month follow-ups. The three treatments showed similar effectiveness, with no significant differences between them except that behavioral activation improved sleep disturbance more than mindfulness meditation from pre- to post-treatment. Effect sizes for secondary outcomes were generally small to medium across all conditions. These findings indicate that telehealth-delivered psychological treatments are effective for chronic low back pain and can expand access to evidence-based care.
Among 328 U.S. military veterans with chronic pain, three psychological changes helped explain why clinical hypnosis, mindfulness meditation, and pain education all reduced pain intensity and interference: greater willingness to tolerate pain, increased engagement in valued activities despite pain, and reduced catastrophizing. A fourth factor—working alliance with the therapist—was linked to pain reduction only for those receiving clinical hypnosis. Catastrophizing played a larger role in mindfulness training's effects, while pain willingness mattered more for hypnosis's effect on pain interference. The findings suggest that treatments targeting thoughts about pain, avoidance, valued activities, and therapeutic alliance may improve outcomes, but replication is needed.