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An Online Mindfulness Intervention for Pain and Wellbeing by Jessica

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An Online Mindfulness Intervention for Pain and Wellbeing by Jessica An Online Mindfulness Intervention for Pain and Wellbeing by Jessica Noëlle Leov Thesis submitted for the Degree of Master of Health Sciences University of Otago May, 2015 Abstract Chronic pain is a prevalent health care issue that needs to be better addressed. Mindfulness techniques are a promising method to help individuals reduce the negative impact of chronic pain. Research has also indicated the effectiveness of delivering psychological interventions online for a variety of health problems including chronic pain. This thesis aimed to investigate presenting a mindfulness intervention for chronic pain via the internet. An online mindfulness intervention was developed and initially trialled in post joint arthroplasty patients. The failure to recruit adequate numbers and high dropout rates led to a qualitative study, which aimed to explore the lived experiences of individuals who had undergone a joint arthroplasty including: their thoughts and attitudes surrounding their pain, online treatments, and mindfulness. A third study trialled the intervention on a different population who potentially experience chronic pain, limb amputees, to investigate the user experience of the intervention structure and online resources. Taken together these studies demonstrated that this online intervention could be used to successfully deliver mindfulness techniques for chronic pain conditions. Qualitative results demonstrated that psychological treatments are currently underutilized in individuals experiencing chronic pain prior to joint arthroplasty. Online interventions could be feasibly delivered to these individuals to help with their pain management. ii Acknowledgements My deep gratitude goes first to my supervisors, Dr Nicola Swain and Dr Steve Gallagher. I am profoundly indebted to Dr Nicola Swain for her knowledge, guidance, and insight throughout the whole process. Likewise to Dr Steve Gallagher for his enthusiasm, wisdom and, expertise with all matters tech based. Thank you both for all your support. I am also incredibly grateful to Ella Barrett for her help with the data collection and analysis in study two, and Tessa Stewart for the data collection in study three. Further, I would like to thank Ellen Sima, Lindsey Horne, Michelle Helm, Carmen Lim, and Rachel Anson, for their sage advice on matters academic and otherwise. I am also immensely appreciative of the constant support and patience from Moz, Dad, Tom, Flick and my amazing friends. Finally to the wonderful individuals who graciously took part in each of the studies. Thank you for giving me your time, welcoming me into your homes, and sharing your experiences with me. This research was made possible because of you. I cannot thank you enough. iii Abstract ...................................................................................................................................... ii Acknowledgements .................................................................................................................. iii List of Figures ........................................................................................................................ x List of Abbreviations ............................................................................................................. xi Publications .......................................................................................................................... xii CHAPTER ONE ........................................................................................................................ 1 CHRONIC PAIN, MINDFULNESS AND ONLINE INTERVENTIONS ............................... 1 Defining Chronic Pain ............................................................................................................ 2 Chronic Pain Outcomes .......................................................................................................... 2 Treatments for chronic pain ................................................................................................... 3 Current psychological treatments for pain ............................................................................. 5 Self-regulatory approaches ..................................................................................................... 6 Cognitive Behaviour Therapy ................................................................................................ 6 Acceptance and Commitment Therapy .................................................................................. 7 Mindfulness for Pain .............................................................................................................. 8 Defining mindfulness ............................................................................................................. 8 Mindfulness Based Interventions ........................................................................................... 9 Mindfulness Mechanisms ..................................................................................................... 11 Attention regulation. ..................................................................................................... 11 Body Awareness. ......................................................................................................... 12 Emotion Regulation. ..................................................................................................... 13 Change in self-perspective. .......................................................................................... 14 Mechanisms in mindful pain regulation ............................................................................... 16 Mindfulness interventions for disease-specific chronic pain ............................................... 18 Chronic Pain. ............................................................................................................... 18 Fibromyalgia. ............................................................................................................... 20 Rheumatoid arthritis. .................................................................................................... 21 Chronic lower back pain. .............................................................................................. 22 Critiques of mindfulness interventions for chronic pain ...................................................... 23 Conclusions for MBI’s for pain interventions ..................................................................... 23 Internet Interventions for Pain ................................................................................................. 24 Benefits and challenges of online interventions ................................................................... 24 Types of online intervention ................................................................................................ 27 Online Interventions for pain ............................................................................................... 28 iv Online Mindfulness Interventions ........................................................................................ 32 Online mindfulness interventions for pain ........................................................................... 33 Conclusion of online interventions for chronic pain ............................................................ 34 The current studies ............................................................................................................... 34 CHAPTER TWO ..................................................................................................................... 36 ONLINE MINDFULNESS INTERVENTION FOR POST ARTHROPLASTY PAIN ......... 36 Hypotheses ........................................................................................................................... 38 The Online Mindfulness Course for Pain ................................................................................ 38 Time Period of the Course ................................................................................................... 39 Structure of the intervention sessions .................................................................................. 41 Platform ................................................................................................................................ 42 Method of content presentation ............................................................................................ 42 Questionnaires ...................................................................................................................... 44 McGill Pain Questionnaire (short form). ....................................................................... 44 Short Version of the Depression Anxiety Stress Scale (DASS-21). .............................. 45 Tampa Scale of Kinesiophobia-11 (TSK-11). ............................................................... 45 Pain Anxiety Symptoms Scale-20 (PASS-20). ............................................................. 45 Mindful Attention and Awareness Scale (MASS). ......................................................... 45 Brief Pain Inventory (BPI). ............................................................................................ 45 Online Mindfulness Course Content .................................................................................... 46 Introductory and Debrief Animations .................................................................................. 47 Case Studies. .............................................................................................................
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