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Published Findings on our Mindfulness-based Pain Management Programmes

The positive outcomes of our Breathworks programmes have been demonstrated in a number of published psychological papers. A variety of studies have assessed both the short term and long term effects of our courses, collecting a wealth of quantitative and qualitative research. Below is a summary of the research so far.


  1. Quantitative Published Studies
  2. Qualitative Published Studies
  3. Other Studies

Quantitative Published Studies

1. Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program.

Brown & Jones (2013) - Human Pain Research Group, University of Manchester Salford Royal NHS Foundation Trust, Salford, UK

Abstract here

This study, conducted by the Human Pain Research Group (within the Clinical Neurosciences Group at the University of Manchester), investigated the therapeutic mechanisms of mindfulness-based pain management in patients with chronic musculoskeletal pain. Patients were assessed using a series of tests (such as sustained attention tasks, EEG scans and questionnaires) before and after the Breathworks Mindfulness for Health programme. The lead author stated that: "The Breathworks programme improved the mental well-being of patients and their sense of being able to control their pain symptoms. These improvements were related to changes in patterns of activity in brain regions involved with cognitive control and emotional regulation."  Further detailed studies are in the planning stages.

2. Evaluation of the Breathworks mindfulness-based pain management programme: Effects of well-being and multiple measures of mindfulness

Cusens et al. (2010) Anaesthetics, Theatres and Pain Services Directorate, Derrieford Hospital, Plymouth, UK

Abstract here

This study used both subjective and objective measures to investigate two separate outcomes from our mindfulness-based pain reduction programme (MBPM); firstly whether the programme resulted in short-term wellbeing and secondly whether the course improved level of mindfulness itself. 53 individuals living with chronic pain (mostly back pain) took part in the study and were split into two groups; 33 subjects took part in our MBPM programme and 20 subjects formed the comparison group who simply continued with their original routine and treatment.

In the first study, all participants completed a self-report questionnaire both before and after the intervention. Results showed that despite pain intensity remaining the same for both groups, the MBPR group scored significantly higher on all wellbeing measures, including having higher levels of pain acceptance and lower levels of rumination and helplessness. In a second study, both subjective and objective measures were used to evaluate whether the MBPM programme also improved level of mindfulness, particularly with regards to attention and awareness. Self-reported measures collected through questionnaire data suggested that after taking the course, people perceived themselves as being more mindful compared to the control group and also became more aware of and attentive towards their positive moods. Further details are also available in the associated PhD thesis (Bryony Cusens, 2009, University of Bath).

3.  Two-Week Web-Based Mindfulness Training Reduces Stress, Anxiety, and Depressive Symptoms in Individuals with Self-reported Stress: A Randomized Control Trial'

Vesa et all. (2016) Department of Psychology, Umeå University, Sweden

Abstract & Article here or download the PDF - pdfPDF Download458.5 KB

This study examined the effects of a short-term web-based mindfulness program - the Breathworks/MFC Online Mindfulness Taster Course. 70 participants with severe stress were randomly assigned to a group taking the course and a control group. Pre and post questionnaire measures showed that mindfulness training increased mindfulness skills and reduced levels of perceived stress, anxiety, and depressive symptoms, with no such changes observed in the control group. Additionally, measured changes in mindfulness skills were associated with reductions in symptom scores, indicating treatment-specific effects.

4.  Effects of Eight-Week-Web-Based Mindfulness Training on Pain Intensity, Pain Acceptance, and Life Satisfaction in Individuals With Chronic Pain

Henriksson et al. (2016) Department of Psychology, Umeå University, Sweden.

Abstract & Article here or download the PDF - pdfAbstract and Article.pdf204.27 KB


This study examined the effects of the Breathworks eight-week-web-based mindfulness program designed for individuals with chronic pain. A sample of 107 participants with chronic pain were randomly assigned to a treatment group and a control group. The mindfulness program involved 20 minutes of training per day, six days a week, for eight weeks. During this period, the control group was invited to an online discussion forum involving pain-related topics. A total of 77 participants completed the post intervention assessment. The group assigned to mindfulness training showed significantly increased mindfulness skills, reduced pain intensity, reduced pain-related interference/suffering, heightened pain acceptance, reduced affective distress, and higher ratings of life satisfaction following the training in comparison to the control group. Despite the limitations of this study, including a less than ideal control group to isolate effects of mindfulness and lack of a long-term follow-up, the results appear promising and may motivate further investigations.

5.  Self-Selection all the Way: Improving Patients’ Pain Experience and Outcomes on a Pilot Breathworks Mindfulness for Health Programme

Alessio Agostinis, Michelle Barrow, Chad Taylor, Callum Gray, (2017), Pain Management Centre, Jersey UK Channel Islands.

This study investigated the changes in pain experience and quality of life resulting from an 8-week Breathworks accredited Mindfulness for Health programme, for patients experiencing chronic pain. Data was analysed between three direct selection (DS) and three self-selection (SS) groups. Outcomes for the overall sampled showed an improvement in standardised measures. Improvements in quality of life and mindfulness were also reported, as well as positive written and verbal feedback. Groups with a preliminary taster and engagement session, showed greater improvement, within a wider number of measures and better treatment retention.

This following research poster was first presented at the British Pain Society Annual Conference in Birmingham 2017 - pdfResearch Poster - British Pain Society 2017.pdf470.64 KB

6.  Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial

Hearn & Finlay (2018), University of Buckingham Medical School and Department of Psychology, Buckingham, UK

Read the full Article here


This study investigated the efficacy and feasibility of an internet-delivered version of our Breathworks Mindfulness of Health course, in individuals with spinal-cord injury (SCI).
A sample of 67 participants were split into two randomly assigned groups; one receiving the internet-delivered 8-week mindfulness intervention and the other, 8-weeks of internet-delivered psychoeducation. The Breathworks intervention encourages individuals to cultivate the ability to be in the present moment non-judgementally through meditations such as breathing awareness and mindful movements. Psychoeducation, an intervention commonly assigned to people with chronic pain consisted of accessible educational information about SCI sent weekly; including the role of stress and unhelpful thoughts, and options for pain and psychological management.
Immediately after the interventions, it was found that the group assigned to the internet-delivered Breathworks intervention, had significantly decreased depression symptoms, compared to the psychoeducation group, as well as significantly reduced anxiety, pain catastrophizing (negative and exaggerated thinking surrounding pain), and pain unpleasantness. Self-report measures of total mindfulness were also found to be significantly increased. At 3-months post intervention a significant reduction in depression, pain catastrophizing and anxiety was sustained for the mindfulness participants.
Overall, the study was indicative of our Breathworks internet-delivered mindfulness course being a practical and effective intervention for individuals with reduced sensory and motor function, compared to standardly provided psychoeducation. Suggestions for further research include examining the effectiveness of combined mindfulness and psychoeducation, and evaluating the mechanisms of change that underlie facets of mindfulness and psychoeducation, in individuals with spinal-cord injury.


7.  A Literature Review of Breathworks and Mindfulness Intervention

Mehan & Morris (2018), North East London Foundation Trust, London, UK

"The aim of this paper was to achieve a critical review of the literature to date concerning mindfulness interventions. Me and Julia (the paper’s other author) wanted to provide a holistic picture of review in this field and were surprised by the general failure to utilise the internal evaluations and external studies using the Breathworks mindfulness programmes. We sought to fill this gap in the literature and the result was this paper, which highlights the importance of high-quality methodology in research studies within mindfulness and that the full programme must be employed for maximal effectiveness from the intervention. Studies that extracted a single practice, such as the body scan or self-compassion practices, found positive changes but to a smaller effect.

If you wish to ask any questions regarding the paper or just want to discuss it further, please do not hesitate and feel free to email me on"

View Paper Here

 8.  Evaluation of Breathworks' Mindfulness for Stress 8-week course: Effects on depressive symptoms, psychiatric symptoms, affects, self-compassion, and mindfulness facets in Brazilian health professionals

Pizutti et al. (2019) Federal University of Rio Grande do Sul, Brazil

This study, conducted on health professionals in the city of Porto Alegre, Brazil, evaluated the effect of the Mindfulness for Stress program on depressive symptoms, psychiatric symptoms, and positive and negative affects. The health professionals were divided into three groups: mindfulness, relaxation practices, and waiting list, with a significant difference in the results between groups. Other studies have shown that health care professionals have a high frequency of emotional distress, and finding interventions that are helpful in reducing such suffering can lead to improved emotional health and potentially more compassionate patient care. This study described a significant reduction in depressive and psychiatric symptoms, and in negative affects, and also showed an increase in non-judgemental and non-reactivity characteristics, and self-compassion in health professionals, which are attitudes cultivated through the Breathworks programme.

Qualitative Published Studies

1.  Starting where I am: a grounded theory exploration of mindfulness as a facilitator of transition in living with a long-term condition

Long et al. (2016), School of Nursing and Midwifery, De Montfort University, Leicester

The full text of this paper, which is the results of Dr Jaqui Long's PhD research at the University of Leeds, is available here pdfLong_et_al-2016-Journal_of_Advanced_Nursing.pdf433.76 KB, or you can download this four page PDF Summary by ther author here (127.9 KB).

This study is particularly exciting as it studied the long-term effects of mindfulness meditation training on individuals living with a chronic health condition, focusing on the experiences of participants who had learnt mindfulness up to 8 or 9 years ago, to see what changes it had made in how they lived with and managed long term illness. Forty-one people, including 37 Mindfulness for Health course participants living with a range of long-term illnesses (e.g. chronic fatigue syndrome, cancer and depression) and 7 Breathworks trainers, took part in a series of interviews and focus groups, and reported highly positive life changes and benefits that continued to be sustained in the years following the course, even for the longest period under study (8-9 years).

Findings were grouped into themes, from which Jaqui developed a 'model' of peoples' experiences which she named 'the Starting Where I Am' model, in reference to the way that participants were able to be more aware of and accepting of their illness and themselves, and as a result to respond to their needs more appropriately and compassionately. The main themes were 'Getting a New Perspective' (being more aware of their condition but also able to see the bigger picture around it), 'Feeling Equipped to Cope' (having skills and insights to understand and manage their condition and choose how they reacted to it), 'Doing Life Differently' (responding more accurately and compassionately to their condition in how they lived their lives, both in immediate situations and over the longer term). Two other themes 'Seeing a Change' (improvements in condition, mental wellbeing and relationships due to mindfulness) and 'Finding it Difficult' (some found aspects of mindfulness practice difficult including finding time to meditate, feeling guilty at dedicating time to themselves, and increased distress when becoming more aware of their condition) described how their experience could be positively or negatively affected. Overall however, it was found that mindfulness practice had a huge benefit on the wellbeing of most of the participants, with the effects lasting for several years after attending the course. 

2. Experiencing Wellness Within Illness: Exploring a Mindfulness-Based Approach to Chronic Back Pain

Doran (2014) - Faculty of Medical and Human Sciences, School of Medicine, Division of Primary Care. University of Manchester

Abstract here

This study was conducted on 16 volunteers attending the Breathworks "Mindfulness-based Living Well with Pain and Illness" programme to gather information on their personal experience of living with persistent back pain. Data was collected through observations and semi-structured interviews which were conducted at 6 months after completion of the course. Interviews were also repeated for 5 participants at 1 year after completion of the course. Several recurring themes emerged from the analysis including; 'Unpacking the Experience' (being able to respond to early warning signs of flare ups), 'Changing Relationship to Pain' (learning to live in harmony with the pain rather than tighten around it), 'Letting Go of the Label' (eliminating the need to find an explanation for the pain), 'Self-compassion and Acceptance' (accepting their pain and to stop blaming themselves for flare ups), and 'Wellness Within Illness' (having a better quality of life despite the pain).

For more information on this project please consult the links below:


3. Mindfulness, Pain, and the Occupational Self: A Narrative Exploration

Mr Eli Dunsford’s (2016) Dissertation – Sheffield Hallam University, MSc in Occupational Therapy.

This Dissertation was awarded a distinction, and is currently being written up into a paper for publication.

This study explored the narratives of three participants from various backgrounds that experience different chronic pain conditions. One experiences lower back pain due to a work based injury, one broke his back and ankle in a car accident which also left him with PTSD, and one had chronic fatigue syndrome with a significant pain element. Each had previously undergone an eight week mindfulness course for chronic pain. Mindfulness was a major element for each of them in the recovery, maintenance and elevation of themselves as occupational beings.

Click here to see a pdfsummary of the Dissertation from Eli.

Other Studies

1. Department of Health – staff well-being pilot

At the beginning of 2013, Breathworks successfully bid to run an innovative wellbeing pilot for staff of the Department of Health at their main offices in London and Leeds, UK.  The programme was designed as a health and wellbeing support initiative for staff, and as a “proof of concept” study assessing benefits and challenges to wider implementation.

Statistically significant changes for the group as a whole included:

  • Reduced Perceived Stress.
  • Improvement in Satisfaction with Life.
  • Improved Wellbeing.
  • Reduced sense of isolation.
  • Less likely to be overwhelmed by painful thoughts and feelings.

2. Randomised Control Trial into Online Mindfulness Training for Chronic Pain

The study was a randomised controlled trial with a partly active control group. 21 participants from the intervention group and 40 participants from the control group completed post measurement. The intervention group, who took part in the Mindfulness for Health online course, demonstrated:

  • increased levels of mindfulness,
  • reduced pain related distress
  • heightened pain acceptance
  • increased quality of life
  • a strong tendency towards a perceived reduction of pain intensity

The research is available as PDF download.

3. Mindfulness and work preparedness pilot programme

Breathworks has been involved in an inspiring and successful programme in which 30 people recovering from addiction completed a mindfulness for stress course in order to improve wellbeing and readiness to return to work. This inspiring and successful programme was in collaboration with the Department of Health North West and National Health Service North West. The pilot programme was delivered in early 2011, with the (initially very promising!) results currently being evaluated by a team at Manchester Metropolitan University.

Individuals recovering from addiction were joined by key community workers in attending 4 fortnightly day sessions in mindfulness meditation. This was followed by a 'Next Steps to Employment' session and the intervention concluded with a 'Celebration Day' in which participants shared their initial outcomes.

One individual reported, "I'm a lot calmer now and can deal with things a lot better, accepting and releasing, I'm sleeping a lot better, I definitely think it helps with my continued recovery."

For more details see here

4. Effectiveness of a Mindfulness-Based Intervention in the Management of Musculoskeletal Pain in Nursing Workers

Chronic Pain is a serious and widespread problem for nursing workers. This study tested the efficacy of a Mindfulness-Based Intervention for nurses in a Brazilian University Hospital. Musculoskeletal symptoms, anxiety, depression, and pain catastrophising were significantly (p < .001) reduced, as self-compassion, and the perception of quality of life increased (≤ .04), with medium to large effect sizes.


Lopes, S. A., Vannucchi, B. P., Demarzo, M., Cunha, Â. G. J., & Nunes, M. D. P. T. (2018). Effectiveness of a Mindfulness-Based Intervention in the Management of Musculoskeletal Pain in Nursing Workers. Pain Management Nursing

5. Studies on Self-Compassion and the Body Scan

Within the scope of our Breathworks course, there are a number of key practices and activities which are designed to foster both mindfulness and kindness. Two of the main practices within this course are self-compassion and the body scan. Self-compassion is the ability to extend kindness towards oneself in challenging circumstances, and the body scan entails focusing ones attention to bodily sensations and the breath, whilst accepting any thoughts and feelings that arise without judgement. Both of these components have been evidenced individually to have a positive effect on individuals with chronic pain.

Wren et al. found that in obese individuals with chronic pain, higher levels of self-compassion predicted: higher positive affect (emotional experience), lower negative affect, less pain catastrophizing (negative anticipation of pain) and less pain disability. These results indicate self-compassion may be important in explaining variability to pain adjustment, particularly in obese individuals with persistent pain.


 Wren, A. A., Somers, T. J., Wright, M. A., Goetz, M. C., Leary, M. R., Fras, A. M., ... & Keefe, F. J. (2012). Self-compassion in patients with persistent musculoskeletal pain: relationship of self-compassion to adjustment to persistent pain. Journal of Pain and Symptom Management43(4), 759-770.

Ussher et al. also found that in a clinical setting individuals who took part in an audio-guided body scan, compared to listening to a reading on natural history, had a significant reduction in ratings for pain related distress and pain interfering with social relations. This suggests that in a clinical setting, the body scan has immediate benefits for individuals with chronic pain.


 Ussher, M., Spatz, A., Copland, C., Nicolaou, A., Cargill, A., Amini-Tabrizi, N., & McCracken, L. M. (2014). Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. Journal of behavioral medicine37(1), 127-134.