Comparison of the Effectiveness of a Combined Treatment Based on Virtual Reality and Mindfulness with a Short-Term Mindfulness Intervention on Pain Catastrophizing in Individuals with Spinal Cord Injury

Abstract

This study aimed to compare the effectiveness of a combined virtual reality and mindfulness treatment with a short-term mindfulness intervention in reducing pain catastrophizing among individuals with spinal cord injury. The study was conducted in two phases. The first phase involved content validation of the combined virtual reality and mindfulness treatment protocol, while the second phase employed a quasi-experimental pretest–posttest design with a control group and a two-month follow-up. Five psychology experts familiar with cognitive-behavioral interventions and virtual reality were purposively selected for the content-validation phase. In the second phase, the population comprised individuals with quadriplegic spinal cord injury attending rehabilitation and supportive centers in Fars Province. Forty-five eligible participants were selected through purposive sampling and randomly assigned to three groups: combined virtual reality and mindfulness treatment (n=15), short-term mindfulness intervention (n=15), and control (n=15). Both experimental groups received eight 14-minute intervention sessions, whereas the control group received no intervention. Pain catastrophizing was assessed using the Pain Catastrophizing Scale developed by Sullivan et al. Data were analyzed using repeated-measures analysis of variance and Bonferroni post-hoc tests. Repeated-measures analysis demonstrated a significant main effect of time on pain catastrophizing (F=27.918, p<0.001, η²=0.333) and a significant time × group interaction (F=4.409, p<0.001, η²=0.191). A significant between-group difference was also observed (p<0.001). Bonferroni comparisons indicated significant reductions in pain catastrophizing from pretest to posttest and from pretest to follow-up in both intervention groups (p<0.05), whereas posttest-to-follow-up differences were nonsignificant (p>0.05), indicating maintenance of treatment effects. Moreover, the combined virtual reality and mindfulness treatment produced a significantly greater reduction in pain catastrophizing than the short-term mindfulness intervention (p<0.05). Both interventions effectively reduced pain catastrophizing in individuals with spinal cord injury, and their effects were maintained at follow-up. However, the combined virtual reality and mindfulness treatment demonstrated greater effectiveness, suggesting that this multimodal approach may represent a useful intervention for psychological and rehabilitation programs targeting pain-related maladaptive cognitions in individuals with spinal cord injury.