Effects of Mindfulness-Based Stress Reduction on Experimental Pain Sensitivity and Cortisol Responses in Women With Early Life Abuse: A Randomized Controlled Trial

Abstract

Objective: Early life abuse (ELAb) initiates pathophysiological cascades resulting in long-term maladaptive stress responsivity, hyperalgesia, and an increased risk of psychopathology. Mindfulness-based stress reduction (MBSR) is effective in modifying psychological and somatic symptoms; thus, we predicted that MBSR would be particularly efficacious for women with ELAb.

Method: Medically healthy women (mean age = 31 years) with or without a history of early (≤13 years) physical or sexual abuse provided self-report measures and were tested in the laboratory before and after randomization to standard MBSR (n = 52) or social support (SSG) (n = 60) for 8 weeks. The laboratory procedure involved pain testing using the cold pressor and temporal summation of heat pain (indexing central sensitization) procedures, and exposure to the Trier Social Stress Test. Plasma cortisol in response to the experimental protocol was assessed as area under the curve (AUC).

Results: The interventions differentially impacted pain sensitivity and cortisol AUC for women with ELAb, as MBSR increased the temporal summation of heat pain intensity ratings (p = .024) and reduced cortisol AUC (p = .004). For women without ELAb, MBSR decreased cold pressor tolerance (p = .045) and decreased the temporal summation of heat pain intensity ratings relative to SSG (p = .024). Both MBSR and SSG improved depression symptoms and emotion regulation abilities (p values < .001); however, MBSR was associated with greater benefits in describing emotions (p = .008) and impulse control (p = .017) for women with ELAb.

Conclusions: Women with ELAb benefited from MBSR-specific improvements in central sensitization, mindfulness skills, and emotion regulation abilities. This is the first study to examine the efficacy of MBSR in modifying affective and somatic symptoms based on ELAb status and provides evidence for considering ELAb in tailoring treatment approaches.Trial Registration: ClinicalTrials.gov Identifier: NCT01995916; https://ichgcp.net/clinical-trials-registry/NCT01995916.

Conflict of interest statement

Conflicts of Interest

The authors have no conflicts of interest to disclose.

Copyright © 2020 by the American Psychosomatic Society.

Figures

Figure 1.

Schematic of laboratory testing session pre- and post-intervention. Order of pain tests was counterbalanced. TSST: Trier Social Stress Test.

Figure 2.

Effect of intervention on cold pressor tolerance in women with or without ELAb. Graph illustrates cold pressor tolerance (seconds) pre- and post-intervention for women with (gray) or without (black) early life abuse (ELAb). Means are adjusted for stressful life events (RSLE score). Error bars reflect standard error.

Figure 3.

Effect of intervention on temporal summation slope of heat pain intensity ratings in women with or without ELAb. Graph illustrates temporal summation slope pre- and post-intervention for women with (gray) or without (black) early life abuse (ELAb). Means are adjusted for stressful life events (RSLE score). Error bars reflect standard error.

Figure 4.

Effect of intervention on cortisol during the experimental session in women with or without ELAb. Graph depicts cortisol area under the curve (AUC) pre-intervention and post-intervention for women with (gray) or without (black) early life abuse (ELAb). Means are adjusted for stressful life events (RSLE score). Error bars reflect standard error.