Enhancing Chronic Disease Self-Management through Yoga: Effects of Mindfulness and Self-Efficacy for People with Chronic Pain

Background and Purpose: The number of individuals in the United States living with chronic disease is rapidly increasing; resulting in millions of people suffering from chronic pain. Social workers, across a variety of settings, are regularly in contact with individuals living with chronic illness and prolonged pain.  Chronic disease self-management is a common treatment for ongoing management of chronic pain, and yoga is an emerging intervention for improving pain.  While these interventions independently have been shown to develop self-efficacy and mindfulness, both predictors of improved disease specific health outcomes and pain, they have not been studied in combination.  The purpose of this study was to investigate the effect of a yoga-enhanced chronic disease self-management intervention on self-efficacy and mindfulness among individuals with chronic pain.

Methods: This study was a secondary data analysis of a yoga-enhanced chronic disease management randomized control feasibility trial.  Sixty (N=60) participants with chronic pain were recruited for the trial; half participated in the intervention (2 yoga sessions for 8 weeks) in combination with self-management, and half continued with usual care (self-management only).  Data was collected at baseline and 8 weeks for mindfulness and self-efficacy.  Outcome measures were collected using the Mindfulness Attention and Awareness Scale (MAAS) and the Chronic Pain Self-Efficacy Scale (CPSS). Regression analysis was used to assess significant differences in self-efficacy and mindfulness change scores by intervention group controlling for baseline characteristics.

Results: Self-efficacy improved for yoga participants (10.18±16.70) and decreased (-.61±15.01) for the usual care control group.  Minimal changes in mindfulness were reported by the yoga group (.17±.86) and usual care (-.025±.75). The change in self-efficacy for yoga participants was statistically significant (ß= 8.638, p <.05), but mindfulness was not (ß = .129, p=.530, n.s.).

 Conclusions and Implications: Social workers commonly practice with individuals with chronic disease and pain, and need to be aware of treatment programs and interventions available. Improvements in self-efficacy and mindfulness are closely linked with better health outcomes across a variety of chronic conditions.  Our findings indicate that yoga-enhanced chronic disease self-management improves self-efficacy among individuals with chronic pain. However, we were unable to identify increased mindfulness after intervention.  This preliminary work suggests that yoga may augment standard chronic disease self-management programs.  Social workers should consider the addition of complementary practices, such as yoga, for ongoing chronic disease management among people with chronic pain. In particular, medical social workers may advocate for enhanced programing to improve health outcomes for their patients with chronic pain.