Mindfulness Therapy for Chronic Pain After Intimate Partner Violence

A Primary Care-Based Adaptation of MBCT for Chronic Pain After Intimate Partner Violence (MBCT-TIP): A Development and Feasibility Study

The goal of this clinical trial is to develop and test a new program called MBCT-TIP for adults with chronic pain and a history of intimate partner violence (IPV). MBCT-TIP combines mindfulness-based cognitive therapy with a trauma-informed approach to pain.

The main question this study aims to answer is:

Will MBCT-TIP be feasible and acceptable for adults with chronic pain and IPV histories?

Researchers will compare MBCT-TIP to a control - Health Enhancement Program (HEP). Comparing the two will help researchers see whether MBCT-TIP is feasible and acceptable for people with chronic pain and a history of IPV.

Participants will:

Attend 8 weekly group sessions, held in person, lasting about 1 hour each. Complete study assessments before starting the program, after finishing the program, and 3 months later

Chronic primary pain is highly prevalent among adults with histories of intimate partner violence (IPV), and existing behavioral pain treatments often perform poorly in this population because they do not address trauma-related mechanisms driving chronic pain in this population. Standard MBCT targets two pain-maintaining mechanisms - pain catastrophizing (PCS) and movement avoidance/kinesiophobia (TSK), but does not directly address trauma-related avoidance or include trauma-informed safety features.

MBCT-TIP retains MBCT's core pain-focused components and adds trauma-informed content aimed at trauma-related avoidance (measured via the Posttraumatic Avoidance Behavior Questionnaire (PABQ)).

By integrating MBCT-TIP into primary care, the most common point of contact for adults with chronic pain and IPV histories, this work has the potential to reduce pain interference and post-traumatic stress symptoms in a highly prevalent, often undertreated population

Inclusion Criteria:

• Age 18 or older
• Primary care patient at Fish Center or other Mass General Brigham (MGB) primary care clinic
• Diagnosis of chronic primary pain (≥3 months), per ICD-11 criteria
• Pain severity of ≥4 on the Numeric Pain Rating Scale (NRS)
• History of intimate partner violence (IPV), e.g., via the Abuse Assessment Screen (AAS)

Exclusion Criteria:

• Significant change in psychiatric medication or therapy in the past 3 months
• Untreated or poorly controlled severe mental health disorder(s)
• Active or high suicide risk in the past 90 days (via PHQ-9 item #9 or otherwise reported, with subsequent risk assessment as needed)
• Untreated or poorly controlled PTSD, as assessed by the Primary Care PTSD Screen or clinically by the primary care provider (PCP) or consulting psychiatrist
• Untreated or poorly controlled substance use disorder that, per patient self-report or the primary care team, would interfere with the ability to participate
• Moderate-to-severe cognitive impairment or inability to provide informed consent
• Inability to consistently participate in sessions
• Lack of verbal and written English fluency
• Otherwise deemed by referring PCP to be inappropriate for inclusion