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DOI: 10.1055/s-0042-1742287
Meditative and Mindfulness-Focused Interventions in Neurology: Principles, Science, and Patient Selection
Funding K.M.K. was supported by the National Institutes of Health (NIH) under Grant 1K23AT011043-01A1; F.A.J. was supported by NIH (K76AG064390).![](https://www.thieme-connect.de/media/sin/202202/lookinside/thumbnails/10-1055-s-0042-1742287_210033-1.jpg)
Abstract
A growing body of research suggests that meditative- and mindfulness-focused interventions may improve neuropsychiatric symptoms that commonly occur in a range of neurological disorders. In this article, the principles of meditation and mindfulness are first defined, as well as briefly describing the neurobiological mechanisms implicated in these interventions. Thereafter, a range of meditative- and mindfulness-focused interventions are detailed, along with their supporting evidence to treat neuropsychiatric symptoms in neurological conditions (e.g., headache, movement disorders, chronic pain, etc.). Overall, these interventions warrant further investigation among individuals with neurological conditions. When recommending these interventions, health care professionals must consider a combination of structural (e.g., insurance reimbursement) and patient factors (e.g., ability to tolerate a group setting).
Publication History
Article published online:
09 February 2022
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References
- 1 Wahbeh H, Elsas SM, Oken BS. Mind-body interventions: applications in neurology. Neurology 2008; 70 (24) 2321-2328
- 2 Cramer H, Ward L, Saper R, Fishbein D, Dobos G, Lauche R. The safety of yoga: a systematic review and meta-analysis of randomized controlled trials. Am J Epidemiol 2015; 182 (04) 281-293
- 3 Farias M, Maraldi E, Wallenkampf KC, Lucchetti G. Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatr Scand 2020; 142 (05) 374-393
- 4 Walsh R, Shapiro SL. The meeting of meditative disciplines and Western psychology: a mutually enriching dialogue. Am Psychol 2006; 61 (03) 227-239
- 5 Bishop SR, Lau M, Shapiro S. et al. Mindfulness: a proposed operational definition. Clin Psychol (New York) 2004; 11: 230-241
- 6 Lau MA, Bishop SR, Segal ZV. et al. The Toronto Mindfulness Scale: development and validation. J Clin Psychol 2006; 62 (12) 1445-1467
- 7 Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment 2006; 13 (01) 27-45
- 8 Kiken LG, Garland EL, Bluth K, Palsson OS, Gaylord SA. From a state to a trait: trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Pers Individ Dif 2015; 81: 41-46
- 9 Tomlinson ER, Yousaf O, Vittersø AD, Jones L. Dispositional mindfulness and psychological health: a systematic review. Mindfulness (N Y) 2018; 9 (01) 23-43
- 10 Zeidan F, Salomons T, Farris SR. et al. Neural mechanisms supporting the relationship between dispositional mindfulness and pain. Pain 2018; 159 (12) 2477-2485
- 11 Quaglia JT, Braun SE, Freeman SP, McDaniel MA, Brown KW. Meta-analytic evidence for effects of mindfulness training on dimensions of self-reported dispositional mindfulness. Psychol Assess 2016; 28 (07) 803-818
- 12 Shelov DV, Suchday S, Friedberg JP. A pilot study measuring the impact of yoga on the trait of mindfulness. Behav Cogn Psychother 2009; 37 (05) 595-598
- 13 Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KM. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med 2012; 42 (03) 485-495
- 14 Kang Y, Gruber J, Gray JR. Mindfulness and de-automatization. Emot Rev 2013; 5: 192-201
- 15 Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies - republished article. Behav Ther 2016; 47 (06) 869-885
- 16 Sauer S, Baer RA. Mindfulness and decentering as mechanisms of change in mindfulness-and acceptance-based interventions. In: Baer RA. ed. Assessing Mindfulness and Acceptance Processes in Clients. Oakland: Context Press; 2010: 25-50
- 17 Levin ME, Luoma JB, Haeger JA. Decoupling as a mechanism of change in mindfulness and acceptance: a literature review. Behav Modif 2015; 39 (06) 870-911
- 18 Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 2011; 6 (06) 537-559
- 19 Tang YY, Hölzel BK, Posner MI. The neuroscience of mindfulness meditation. Nat Rev Neurosci 2015; 16 (04) 213-225
- 20 Vago DR, Silbersweig DA. Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness. Front Hum Neurosci 2012; 6: 296
- 21 Chiesa A, Calati R, Serretti A. Does mindfulness training improve cognitive abilities? A systematic review of neuropsychological findings. Clin Psychol Rev 2011; 31 (03) 449-464
- 22 Guendelman S, Medeiros S, Rampes H. Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Front Psychol 2017; 8: 220
- 23 Chiesa A, Serretti A, Jakobsen JC. Mindfulness: top-down or bottom-up emotion regulation strategy?. Clin Psychol Rev 2013; 33 (01) 82-96
- 24 Fissler M, Winnebeck E, Schroeter T. et al. An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness 2016; 7: 1170-1181
- 25 Chen WG, Schloesser D, Arensdorf AM. et al. The emerging science of interoception: sensing, integrating, interpreting, and regulating signals within the self. Trends Neurosci 2021; 44 (01) 3-16
- 26 Farb N, Daubenmier J, Price CJ. et al. Interoception, contemplative practice, and health. Front Psychol 2015; 6: 763
- 27 Mennin DS, Fresco DM. What, me worry and ruminate about DSM-5 and RDoC? The importance of targeting negative self-referential processing. Clin Psychol (New York) 2013; 20 (03) 258-267
- 28 Kabat-Zinn J. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. 1st ed.. New York, NY: Hyperion; 1994
- 29 Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, And Illness. New York, NY: Delacorte Press; 1990
- 30 Segal ZV, Williams JMG, Teasdale J. Mindfulness-Based Cognitive Therapy for Depression: a New Approach to Preventing Relapse. New York, NY: Guilford Press; 2002
- 31 Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res 2004; 57 (01) 35-43
- 32 Garland EL, Manusov EG, Froeliger B, Kelly A, Williams JM, Howard MO. Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial. J Consult Clin Psychol 2014; 82 (03) 448-459
- 33 Park ER, Traeger L, Vranceanu AM. et al. The development of a patient-centered program based on the relaxation response: the Relaxation Response Resiliency Program (3RP). Psychosomatics 2013; 54 (02) 165-174
- 34 Dossett ML, Fricchione GL, Benson H. A new era for mind-body medicine. N Engl J Med 2020; 382 (15) 1390-1391
- 35 Wayne PM, Kaptchuk TJ. Challenges inherent to t'ai chi research: part I–t'ai chi as a complex multicomponent intervention. J Altern Complement Med 2008; 14 (01) 95-102
- 36 Ni X, Liu S, Lu F, Shi X, Guo X. Efficacy and safety of Tai Chi for Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2014; 9 (06) e99377
- 37 Jain FA, Fonagy P. Mentalizing imagery therapy: theory and case series of imagery and mindfulness techniques to understand self and others. Mindfulness (N Y) 2020; 11 (01) 153-165
- 38 Anheyer D, Leach MJ, Klose P, Dobos G, Cramer H. Mindfulness-based stress reduction for treating chronic headache: A systematic review and meta-analysis. Cephalalgia 2019; 39 (04) 544-555
- 39 Wells RE, O'Connell N, Pierce CR. et al. Effectiveness of mindfulness meditation vs headache education for adults with migraine: a randomized clinical trial. JAMA Intern Med 2021; 181 (03) 317-328
- 40 Seminowicz DA, Burrowes SAB, Kearson A. et al. Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes. Pain 2020; 161 (08) 1837-1846
- 41 Andrasik F, Grazzi L, D'Amico D. et al. Mindfulness and headache: a “new” old treatment, with new findings. Cephalalgia 2016; 36 (12) 1192-1205
- 42 Grazzi L, D'Amico D, Raggi A. et al. Mindfulness and pharmacological prophylaxis have comparable effect on biomarkers of inflammation and clinical indexes in chronic migraine with medication overuse: results at 12 months after withdrawal. Neurol Sci 2017; 38 (Suppl. 01) 173-175
- 43 Grazzi L, Raggi A, D'Amico D. et al. A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache. Cephalalgia 2019; 39 (05) 655-664
- 44 Grazzi L, Sansone E, Raggi A. et al. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with chronic migraine: an effectiveness trial with a one-year follow-up. J Headache Pain 2017; 18 (01) 15
- 45 Anheyer D, Klose P, Lauche R, Saha FJ, Cramer H. Yoga for treating headaches: a systematic review and meta-analysis. J Gen Intern Med 2020; 35 (03) 846-854
- 46 Detert NB, Douglass L. Mindfulness MBSR/MBCT in a UK public health neurological service: depression, anxiety, and perceived stress outcomes in a heterogeneous clinical sample of ninety-eight patients with neurological or functional disorders. Neurodisabil Psychother 2014; 2: 137-156
- 47 Baslet G, Ehlert A, Oser M, Dworetzky BA. Mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy Behav 2020; 103 (Pt A): 106534
- 48 Baslet G, Dworetzky B, Perez DL, Oser M. Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness-based intervention case series. Clin EEG Neurosci 2015; 46 (01) 54-64
- 49 Thompson NJ, Patel AH, Selwa LM. et al. Expanding the efficacy of Project UPLIFT: distance delivery of mindfulness-based depression prevention to people with epilepsy. J Consult Clin Psychol 2015; 83 (02) 304-313
- 50 Panebianco M, Sridharan K, Ramaratnam S. Yoga for epilepsy. Cochrane Database Syst Rev 2017; 10: CD001524
- 51 Panjwani U, Selvamurthy W, Singh SH, Gupta HL, Thakur L, Rai UC. Effect of Sahaja yoga practice on seizure control & EEG changes in patients of epilepsy. Indian J Med Res 1996; 103: 165-172
- 52 Lundgren T, Dahl J, Yardi N, Melin L. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy Behav 2008; 13 (01) 102-108
- 53 Grossman P, Kappos L, Gensicke H. et al. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology 2010; 75 (13) 1141-1149
- 54 Simpson R, Simpson S, Ramparsad N, Lawrence M, Booth J, Mercer SW. Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. J Neurol Neurosurg Psychiatry 2019; 90 (09) 1051-1058
- 55 Ehde DM, Elzea JL, Verrall AM, Gibbons LE, Smith AE, Amtmann D. Efficacy of a telephone-delivered self-management intervention for persons with multiple sclerosis: a randomized controlled trial with a one-year follow-up. Arch Phys Med Rehabil 2015; 96 (11) 1945.e2-1958.e2
- 56 McCabe MP, Ebacioni KJ, Simmons R, McDonald E, Melton L. Unmet education, psychological and peer support needs of people with multiple sclerosis. J Psychosom Res 2015; 78 (01) 82-87
- 57 McLean G, Lawrence M, Simpson R, Mercer SW. Mindfulness-based stress reduction in Parkinson's disease: a systematic review. BMC Neurol 2017; 17 (01) 92
- 58 van der Heide A, Speckens AEM, Meinders MJ, Rosenthal LS, Bloem BR, Helmich RC. Stress and mindfulness in Parkinson's disease - a survey in 5000 patients. NPJ Parkinsons Dis 2021; 7 (01) 7
- 59 Ghielen I, Rutten S, Boeschoten RE. et al. The effects of cognitive behavioral and mindfulness-based therapies on psychological distress in patients with multiple sclerosis, Parkinson's disease and Huntington's disease: Two meta-analyses. J Psychosom Res 2019; 122: 43-51
- 60 Li F, Harmer P, Fitzgerald K. et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med 2012; 366 (06) 511-519
- 61 Song R, Grabowska W, Park M. et al. The impact of Tai Chi and Qigong mind-body exercises on motor and non-motor function and quality of life in Parkinson's disease: a systematic review and meta-analysis. Parkinsonism Relat Disord 2017; 41: 3-13
- 62 Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke 2013; 8 (06) 465-474
- 63 Wathugala M, Saldana D, Juliano JM, Chan J, Liew SL. Mindfulness meditation effects on poststroke spasticity: a feasibility study. J Evid Based Integr Med 2019; 24: X19855941
- 64 Zheng X, Wu X, Liu Z. et al. The influences of tai chi on balance function and exercise capacity among stroke patients: a meta-analysis. Evid Based Complement Alternat Med 2021; 2021: 6636847
- 65 Love MF, Sharrief A, Chaoul A, Savitz S, Beauchamp JES. Mind-body interventions, psychological stressors, and quality of life in stroke survivors. Stroke 2019; 50 (02) 434-440
- 66 Chan JSY, Deng K, Wu J, Yan JH. Effects of meditation and mind–body exercises on older adults' cognitive performance: a meta-analysis. Gerontologist 2019; 59 (06) e782-e790
- 67 Ng TKS, Fam J, Feng L. et al. Mindfulness improves inflammatory biomarker levels in older adults with mild cognitive impairment: a randomized controlled trial. Transl Psychiatry 2020; 10 (01) 21
- 68 Ng TKS, Slowey PD, Beltran D, Ho RCM, Kua EH, Mahendran R. Effect of mindfulness intervention versus health education program on salivary Aβ-42 levels in community-dwelling older adults with mild cognitive impairment: a randomized controlled trial. J Psychiatr Res 2021; 136: 619-625
- 69 Liu Z, Sun YY, Zhong BL. Mindfulness-based stress reduction for family carers of people with dementia. Cochrane Database Syst Rev 2018; 8: CD012791
- 70 Lavretsky H, Epel ES, Siddarth P. et al. A pilot study of yogic meditation for family dementia caregivers with depressive symptoms: effects on mental health, cognition, and telomerase activity. Int J Geriatr Psychiatry 2013; 28 (01) 57-65
- 71 Jain FA, Chernyak S, Nickerson L. et al. Mentalizing Imagery Therapy for depressed family dementia caregivers: Feasibility, clinical outcomes and brain connectivity changes. J Affect Disord Rep 2021; 5: 100155
- 72 Yang FC, Zamaria J, Morgan S. et al. How family dementia caregivers perceive benefits of a 4-week MIT mindfulness and guided imagery program: a pilot study. Prof Psychol Res Pract In press
- 73 Goldberg SB, Tucker RP, Greene PA. et al. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clin Psychol Rev 2018; 59: 52-60
- 74 Strauss C, Cavanagh K, Oliver A, Pettman D. Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder: a meta-analysis of randomised controlled trials. PLoS One 2014; 9 (04) e96110
- 75 Kuyken W, Warren FC, Taylor RS. et al. Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials. JAMA Psychiatry 2016; 73 (06) 565-574
- 76 van der Velden AM, Kuyken W, Wattar U. et al. A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clin Psychol Rev 2015; 37: 26-39
- 77 Seshadri A, Clark MM, Kung S. et al. Feasibility study of stress management and resiliency training (SMART) in patients with major depressive disorder. Prim Care Companion CNS Disord 2020; 22 (03) 19
- 78 Jain FA, Walsh RN, Eisendrath SJ, Christensen S, Rael Cahn B. Critical analysis of the efficacy of meditation therapies for acute and subacute phase treatment of depressive disorders: a systematic review. Psychosomatics 2015; 56 (02) 140-152
- 79 Cramer H, Lauche R, Langhorst J, Dobos G. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety 2013; 30 (11) 1068-1083
- 80 Wang F, Lee EK, Wu T. et al. The effects of tai chi on depression, anxiety, and psychological well-being: a systematic review and meta-analysis. Int J Behav Med 2014; 21 (04) 605-617
- 81 Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol 2010; 78 (02) 169-183
- 82 Khoury B, Sharma M, Rush SE, Fournier C. Mindfulness-based stress reduction for healthy individuals: a meta-analysis. J Psychosom Res 2015; 78 (06) 519-528
- 83 Haugmark T, Hagen KB, Smedslund G, Zangi HA. Mindfulness- and acceptance-based interventions for patients with fibromyalgia - a systematic review and meta-analyses. PLoS One 2019; 14 (09) e0221897
- 84 Vøllestad J, Nielsen MB, Nielsen GH. Mindfulness- and acceptance-based interventions for anxiety disorders: a systematic review and meta-analysis. Br J Clin Psychol 2012; 51 (03) 239-260
- 85 Park ER, Perez GK, Millstein RA. et al. A virtual resiliency intervention promoting resiliency for parents of children with learning and attentional disabilities: a randomized pilot trial. Matern Child Health J 2020; 24 (01) 39-53
- 86 Loprinzi CE, Prasad K, Schroeder DR, Sood A. Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer 2011; 11 (06) 364-368
- 87 Bhasin MK, Denninger JW, Huffman JC. et al. Specific transcriptome changes associated with blood pressure reduction in hypertensive patients after relaxation response training. J Altern Complement Med 2018; 24 (05) 486-504
- 88 Vranceanu AM, Riklin E, Merker VL, Macklin EA, Park ER, Plotkin SR. Mind-body therapy via videoconferencing in patients with neurofibromatosis: an RCT. Neurology 2016; 87 (08) 806-814
- 89 Cramer H, Lauche R, Anheyer D. et al. Yoga for anxiety: a systematic review and meta-analysis of randomized controlled trials. Depress Anxiety 2018; 35 (09) 830-843
- 90 So WWY, Lu EY, Cheung WM, Tsang HWH. Comparing mindful and non-mindful exercises on alleviating anxiety symptoms: a systematic review and meta-analysis. Int J Environ Res Public Health 2020; 17 (22) 8692
- 91 Hilton L, Hempel S, Ewing BA. et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Ann Behav Med 2017; 51 (02) 199-213
- 92 Garland EL, Hanley AW, Riquino MR. et al. Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: a randomized controlled trial. J Consult Clin Psychol 2019; 87 (10) 927-940
- 93 Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KM. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther 2016; 45 (01) 5-31
- 94 Jinich-Diamant A, Garland E, Baumgartner J. et al. Neurophysiological mechanisms supporting mindfulness meditation-based pain relief: an updated review. Curr Pain Headache Rep 2020; 24 (10) 56
- 95 Garland EL, Brintz CE, Hanley AW. et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Intern Med 2020; 180 (01) 91-105
- 96 Cramer H, Klose P, Brinkhaus B, Michalsen A, Dobos G. Effects of yoga on chronic neck pain: a systematic review and meta-analysis. Clin Rehabil 2017; 31 (11) 1457-1465
- 97 Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain 2013; 29 (05) 450-460
- 98 Hall A, Copsey B, Richmond H. et al. Effectiveness of tai chi for chronic musculoskeletal pain conditions: updated systematic review and meta-analysis. Phys Ther 2017; 97 (02) 227-238
- 99 Qaseem A, Wilt TJ, McLean RM. et al; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166 (07) 514-530
- 100 Shallcross AJ, Visvanathan PD, Sperber SH, Duberstein ZT. Waking up to the problem of sleep: can mindfulness help? A review of theory and evidence for the effects of mindfulness for sleep. Curr Opin Psychol 2019; 28: 37-41
- 101 Rusch HL, Rosario M, Levison LM. et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci 2019; 1445 (01) 5-16
- 102 Wang YY, Wang F, Zheng W. et al. Mindfulness-based interventions for insomnia: a meta-analysis of randomized controlled trials. Behav Sleep Med 2020; 18 (01) 1-9
- 103 Wang WL, Chen KH, Pan YC, Yang SN, Chan YY. The effect of yoga on sleep quality and insomnia in women with sleep problems: a systematic review and meta-analysis. BMC Psychiatry 2020; 20 (01) 195
- 104 Li H, Chen J, Xu G. et al. The effect of tai chi for improving sleep quality: a systematic review and meta-analysis. J Affect Disord 2020; 274: 1102-1112
- 105 McGuire C, Gabison J, Kligler B. Facilitators and barriers to the integration of mind–body medicine into primary care. J Altern Complement Med 2016; 22 (06) 437-442
- 106 Gawande R, Pine E, Griswold T. et al. Insurance-reimbursable mindfulness for safety-net primary care patients: a pilot randomized controlled trial. Mindfulness (N Y) 2019; 10 (09) 1744-1759
- 107 Ajzen I. Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior 1. J Appl Soc Psychol 2002; 32: 665-683
- 108 Scult M, Haime V, Jacquart J. et al. A healthy aging program for older adults: effects on self-efficacy and morale. Adv Mind Body Med 2015; 29 (01) 26-33
- 109 Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009; 9 (05) 745-758
- 110 Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995; 7: 524-532