The relative efficacy of mindfulness versus distraction: The moderating role of attentional bias

Abstract Background This study investigated whether the ability to disengage quickly from pain‐related stimuli moderated the relative efficacy of a mindfulness‐based intervention versus distraction in response to an experimental pain task. Methods Participants ( n = 100) completed a dot probe task with eye tracking and were then randomized (2:2:1) to receive a mindfulness‐based interoceptive exposure task (MIET), distraction instructions or no instructions (control group) before engaging in the cold pressor test. Results Participants who were allocated to the MIET condition reported a significantly higher pain threshold and distress than the distraction group, although not significantly higher than the control group. Those in the MIET group had improved tolerance compared to both the distraction and control groups. Difficulty disengaging from pain‐related stimuli, as measured by the duration of the first fixation on sensory words, was found to moderate the relative efficacy of mindfulness versus distraction in terms of pain threshold and distress, but not tolerance. Those with difficulty disengaging from sensory pain words benefited less from the MIET. Duration of first fixation on sensory and affective pain words were highly correlated, and duration of first fixation on affective pain words also moderated the relative efficacy of MIET and distraction on threshold, but not distress. Conclusions These results show that a single brief session of a mindfulness task was sufficient to change an acute pain experience in comparison with a distraction task, and that those who disengaged quickly from pain words benefited most. Significance This study demonstrated the efficacy of a novel, exposure‐based mindfulness technique for pain tolerance and showed that those who disengaged easily from pain stimuli benefited most. This brief task could be clinically useful, particularly for those who are not overly focused on their pain symptoms.