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Public health mindfulness program saves on mental health costs

Posted 12.27.2019 | by AMRA

National health care spending for mental disorders in the United States exceeds $200 billion a year. Public health promotion programs that aim to reduce the incidence of mental disorders have the potential to reduce the direct and indirect social and health care costs involved in mental health care.

A previous study showed that a mindfulness-based universal health promotion program called the Life Balance program prevented the emergence of new psychological symptoms in 1 of every 16 people treated at one year follow up. While these results were promising, this study did not address whether the program was cost-effective.

Müller et al. [BMC Public Health] used insurance fund cost data and a measure of anxiety and depressive symptoms to analyze the program’s cost-effectiveness over the course of a year.

The Life Balance program, a mindfulness-based health promotion program implemented in the German state of Baden-Wüerttemberg in 2014, trained 240 health coaches to deliver preventative mental health services at 80 different health care centers. The Life Balance program consisted of 6 weekly 90-minute group sessions drawing on strategies from Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, and Compassion-Focused Therapy.

A total of 583 Life Balance participants who were associated with a statutorily mandated health insurance fund (average age = 50 years; 85% female) agreed to participate in the study. They were compared to a group of 583 controls drawn from the same insurance fund pool and matched on Hospital Anxiety and Depression Scale (HADS) scores, age, sex, health status, activity level, and prior health care costs.

HADS scores were collected at baseline, post-intervention, and 6- and 12-month follow-up. Costs for medications, hospital stays, outpatient and rehabilitation visits, and lost […]

November 27th, 2019|News|

Opioid users reduce emotional cling to drug images after MBI

Posted 12.18.2019 | by AMRA

Over 15 million Americans report having an opioid use disorder, and opioid-related deaths currently exceed 45,000 per year. As people become addicted to opioids, they become more emotionally responsive to drug-related cues and less emotionally responsive to cues signaling the availability of naturally occurring rewards. Naturally occurring rewards include those that come from relationships, accomplishments, and aesthetic appreciation.

It is possible to measure this shift in cue responsiveness using an electroencephalogram (EEG). The Late Positive Potential (LPP) is an EEG wave that arises 400-800 milliseconds after a stimulus is presented. LPPs originate in the emotional processing centers of the brain and are down-regulated by the cognitive processing centers.

Opiate users show larger LPPs to drug-related cues than to natural reward cues. Moreover, larger LPPs in response to drug-related cues are associated with stronger drug-related cravings and an increased likelihood of opioid misuse. Interventions that reduce the salience of drug-related cues and restore the salience of natural reward cues can help in opioid abuse recovery.

Garland et al. [Science Advances] conducted four experiments to assess whether Mindfulness-Oriented Recovery Enhancement (MORE) could help opioid users reduce their emotional responsiveness to drug-related images (e.g., pills and pill bottles) and restore their responsiveness to images of naturally occurring rewards (e.g., social affiliation, natural beauty, sports victories). Emotional responsiveness was assessed using LPP magnitudes and participants’ subjective ratings of craving and positive affect.

The researchers randomly assigned three samples of middle-aged chronic prescription opioid users (total number of participants = 135; average opioid use duration = 10 years; 51% female; 84% Caucasian) to an 8-week Mindfulness-Oriented Recovery Enhancement (MORE) program or an 8-week support group control. The MORE program included training […]

November 18th, 2019|News|

Veterans Health Administration survey shows vets do mindfulness

Posted 10.21.2019 | by AMRA

The United States Veterans Health Administration (VHA) provides healthcare for 9 million military veterans across its 1,243 healthcare facilities. While half of all military veterans currently use or are interested in using complementary and integrative approaches to healthcare, little is known about their specific use of mindfulness meditation.

Goldberg et al. [Mindfulness] analyzed VHA survey data assessing veteran utilization of complementary and integrative healthcare techniques to help guide VHA decision-making about expanding mindfulness training opportunities within their healthcare system.

The VHA Survey asked 1,230 military veterans (85% male; 90% Caucasian; age range = 18-65+ years; modal age= 65+ years) who volunteered to complete the survey about their utilization of 22 different complementary and integrative health approaches. Veterans responded to questions about their use of the approaches, why they used them, their perceived effectiveness, and any barriers encountered in accessing them.

The results showed that 18% of the veteran sample had used mindfulness meditation in the past year. Utilization was highest for female and Hispanic veterans, divorced, widowed, or separated veterans, and for those 35-49 years of age. Mindfulness meditation use was lowest for veterans 65 years of age or older or married.

Mindfulness meditation was the third most frequently used of the 22 approaches, exceeded only by massage and chiropractic care. It was used significantly more often than 19 other approaches, including acupuncture, relaxation, movement therapy, reflexology, imagery, biofeedback, hypnosis, tai chi, and qi gong.

Of those who used mindfulness meditation, 28% reported using it every day, 18% a few times a week, 20% a few times a month, 11% once a month, and 22% a few times a year. Most veterans reported using it for purposes […]

October 21st, 2019|News|

MBCT reduces migraine-related disability among chronic sufferers

Posted 10.15.2019 | by AMRA

Episodic and chronic migraines affect approximately one billion people worldwide. Symptoms including migraine aura, headache, nausea, and light sensitivity can significantly impair functioning at work, home, and in social situations. Existing behavioral treatments including biofeedback, relaxation and cognitive therapy, and pharmacological treatments have limited efficacy, but no treatment works for everyone.

Seng et al. [Headache] evaluated the efficacy of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) compared to a control in reducing migraine-related disability.

The authors randomly assigned 60 migraine patients (average age=40 years; 82% Caucasian; 92% female; average headache days per month=16) to MBCT-M or a treatment-as-usual waitlist control. Thirty-six percent of MBCT-M participants and 62% of control participants came to the study on prescribed prophylactic migraine medication that was continued throughout the study. The groups did not differ on headache frequency, intensity, or disability at baseline.

All participants kept a 30-day headache diary both before and after intervention. In addition, participants were assessed on two measures of headache disability: the Headache Disability Inventory (HDI) and Migraine Disability Assessment (MIDAS) at baseline, and 1, 2, and 4 months.

MBCT-M consisted of once weekly 75-minute individual training sessions for 8 weeks. Sessions included didactic training, cognitive exercises, mindfulness meditation practice and homework review. Most sessions were conducted in person; however, participants were allowed up to 3 telephone-delivered sessions when headaches prevented in-person attendance.

The trainers were clinical psychology graduate students with 12 hours of MBCT training. The trainers received continuous supervision from licensed psychologists with expertise in headaches, and sessions were monitored to assure treatment fidelity. The control group continued whatever treatment they were getting prior to the onset of the study and were placed on an MBCT-M […]

October 15th, 2019|News|

Brain changes in children after school-based mindfulness program

Posted 09.24.2019 | by AMRA

The stress response is associated with brain activity in the amygdala and the prefrontal cortex. The amygdala initiates the fight, flight, or freeze response to fear-inducing stimuli, while the prefrontal cortex helps modulate this response. A higher degree of connectivity between these brain regions is thought to enhance emotional regulation. These conclusions are based on research with adults. Little is known about the neural basis for children’s responses to stress, however, and whether it can be beneficially modified by mindfulness-based interventions.

Bauer et al. [Behavioral Neuroscience] tested whether mindfulness training reduces stress levels in middle school children, and if so, whether it is done by inducing changes in the amygdala and its connectivity to a region of the prefrontal cortex. This is the first study investigating the effects of a mindfulness-based intervention on children’s brain activity.

All 6th graders in a Boston charter school were randomly assigned to an 8-week mindfulness training program or an 8-week computer coding training program. The researchers requested the 6th graders’ families to permit their children to participate in the functional magnetic imaging (fMRI) portion of the study. Forty children received permission (average age = 12 years; 70% female; 53% Caucasian; Average WASI IQ = 98), and 33 of their fMRI protocols were usable.

Mindfulness and computer coding groups met four times a week for 45 minutes during the last class of the school day. Each mindfulness session included 15 minutes of mindfulness exercises involving focused attention on the present moment and related didactic instruction and group discussion. Exercises included focused breath meditations, attention to the senses, open monitoring, and practice in noticing thoughts.

Control group sessions involved teaching the SCRATCH […]

September 24th, 2019|News|

MBSR helps soothe pain after joint replacement surgery

Posted 09.20.2019 | by AMRA

Total hip and knee replacements are among the highest volume elective surgical procedures performed today. The vast majority of joint replacement patients report significant post-operative reductions in pain and disability. Nonetheless, about 15% of patients report poor surgical outcomes marked by continuing pain, disability, and dissatisfaction.

Pre-surgical levels of distress related to depression and anxiety are the best predictors of which patients are likely to fare poorly after surgery.

Medical professionals are interested in psychological interventions that could improve post-surgical outcomes. Dowsey et al. [Complementary Therapies in Medicine] tested whether pre-surgical Mindfulness-Based Stress Reduction (MBSR) could improve physical and psychological wellbeing outcomes after joint replacement surgery.

The researchers randomly assigned 127 Australian arthritis patients (average age = 65 years; female = 72%) with moderate-to-severe psychological distress (based on a psychological assessment cut-off score) who were surgically approved for knee or hip replacement to either surgery and post-operative care as usual, or a standard 8-week MBSR program followed by surgery and post-operative care as usual. Out of this sample, 45 MBSR assignees and 56 treatment-as-usual assignees eventually underwent surgery. Surgical patients were seen by their treating surgeons during 12-month surgical follow-up appointments.

Patients completed a self-report osteoarthritis measure that included subscales assessing pain, stiffness, and functional disability, as well as a total overall score that can serve as a single measure of global symptom severity. They also completed measures of general physical and psychological wellbeing, pain-management self-efficacy, and mindfulness (using the Five Facet Mindfulness Questionnaire). Assessments were completed at baseline, 3 months, and 12 months.

MBSR participants reported significantly less pain at 12 months than controls. They also reported significantly greater improvement on the global measure of overall […]

September 20th, 2019|News|

MBSR shows cost benefit for fibromyalgia, fewer sick days

Posted 08.30.2019 | by AMRA

Fibromyalgia is a chronic disorder affecting approximately 10,000,000 Americans. The disorder presents with symptoms of widespread musculoskeletal pain, fatigue, and mood, sleep, and cognitive difficulties. The cause of fibromyalgia is unknown, and its treatment is largely palliative, consisting of medication to reduce pain and inflammation, graded physical exercise and/or cognitive-behavioral therapy. The disorder incurs a wide variety of costs including high rates of unemployment, sick leave, disability claims, and direct medical care utilization.

Perez-Aranda et al. [Journal of Clinical Medicine] compared the cost-effectiveness and clinical utility of adjunctive Mindfulness-Based Stress Reduction (MBSR) to a previously validated comparator intervention and treatment-as-usual in the treatment of fibromyalgia.

The researchers randomly assigned 225 fibromyalgia patients recruited from a Spanish hospital to one of three treatment interventions: 1) MBSR + treatment-as-usual, 2) FibroQoL + treatment-as-usual, and 3) treatment-as-usual alone. MBSR was delivered using the standard 8-week group protocol with minimal adaptations. FibroQoL is a fibromyalgia intervention with previously demonstrated superiority to treatment-as-usual. It consists of 8 weekly 2-hour group sessions that include fibromyalgia psycho-education, relaxation, and self-hypnosis to help patients control pain and visualize a future pain-free life. Treatment-as-usual involved prescription medications for pain, inflammation, depression, and anxiety, along with recommendations for daily exercise.

Cost-utility data was only available for a final sample of 204 participants (98% female; average age = 53 years). Analyses were performed separately for the full intention-to-treat sample and for 107 patients who attended at least 6 of the 8 intervention sessions and their 12-month follow-up appointments.

Self-ratings of quality-of-life were obtained at baseline and 12 months using the EuroQol EQ-5D to assess disease impingement on mobility, self-care, and activities of daily living, as well as […]

August 30th, 2019|News|

Mindfulness program prevents dropout from addictions treatment

Posted 08.19.2019 | by AMRA

Many women attending residential substance use disorder treatment fail to successfully complete their program. These women often have complex social histories, multiple psychiatric and medical diagnoses, and histories of incarceration. They may also have trouble adjusting to the programs due to conflicts with staff and peers, substance withdrawal and cravings, and difficulty abiding by program rules and structure. Mindfulness may help women negotiate these difficulties by reducing their automatic reactivity to cravings, interpersonal conflicts, and other emotional triggers.

Black et al. [Behaviour Research and Therapy] studied whether a mindfulness-based intervention specifically designed for women in residential substance use disorder treatment settings could reduce the likelihood of prematurely leaving the program in unimproved condition.

The researchers randomly assigned 200 women in residential substance use disorder treatment (average age = 33 years; 58% Hispanic; 62% with incarceration history; 76% with amphetamine/methamphetamine abuse) to either the Moment-by-Moment Women’s Recovery (MMWR) program or a time-matched psycho-educational control.

Both were add-on interventions with participants continuing to receive all of the services ordinarily provided by the residential treatment program. In both of the interventions, the participants met twice weekly for 80-minute group sessions over the course of six weeks.

The MMWR program was based on Mindfulness-Based Stress Reduction, but specifically designed for ethnoracially diverse women in residential substance use treatment. The program addressed the role of mindfulness in dealing with cravings and relapse, trauma, parenting, conflicts with staff and peers, and other issues likely to arise in treatment.

The psycho-educational control consisted of didactic material regarding brain structure, function, and biochemical changes pertaining to substance abuse. Attendance in both groups averaged 9 out of 12 classes, and participants rated both groups highly in […]

August 19th, 2019|News|

MBSR supports less stress and fear extinction via hippocampus

Posted 07.23.2019 | by AMRA

Overcoming irrational fears involves recognizing when stimuli previously associated with danger have ceased their association with that danger. This means “extinguishing” a learned connection between a stimulus and its previously feared negative consequences.

Mindfulness can help with fear extinction by enabling individuals to approach previously feared stimuli with an attitude of non-reactive acceptance. Sevinc et al. [Biological Psychiatry] studied whether a mindfulness-based intervention affects the brain activity underlying the fear extinction process.

The researchers assigned 94 meditation-naive adults (average age = 32 years; 64% female) to either an 8-week mindfulness-based stress reduction (MBSR) program or an 8-week exercise-based stress management education program. Stress education consisted of 8 weekly 2 hour group sessions that included 40 minutes of light aerobic exercise and didactic presentations on coping with stress through exercise, nutrition, humor, and sleep hygiene.

Two weeks before and after intervention, participants underwent a two-day classical fear conditioning and fear extinction paradigm while being monitored by brain imaging (fMRI).

In the fear conditioning paradigm, participants were presented with images of rooms with either red, blue, or yellow lights. An annoying electric shock immediately followed the images of the rooms with the red or blue lights, but not the yellow lights. Fear was considered “conditioned” to the red or blue lights when exposure to those images led to an increase in skin conductance.

After the conditioned skin conductance response (SCR) was acquired, participants were then repeatedly exposed to the image with the red light without a consequent shock in order to extinguish the skin conductance response to that image while maintaining the conditioned skin conductance response to the blue light.

The next day, participant SCRs to the images were reassessed […]

July 23rd, 2019|News|

Online mindfulness training for emergency medical dispatchers

Posted 07.16.2019 | by AMRA

Emergency medical dispatchers (EMDs) face stressful job demands. In addition to dispatching emergency medical personnel, EMDs provide emergency advice over the phone and may be the last person to speak to an injured party alive. They are also subject to rotating shifts and mandatory overtime.

While EMDs might benefit from stress reduction interventions, the nature of their workplaces makes it difficult to implement time-intensive group-based trainings. Lily et al. [Occupational and Environmental Medicine] conducted a randomized controlled study to discover whether an on-line mindfulness-based intervention could successfully reduce stress among EMDs.

The researchers randomly assigned 323 North American EMDs (82% female; 90% Caucasian; modal age = 25-55 years) to either a mindfulness-based intervention or a wait list control. The mindfulness program (Destress 9-1-1) was delivered once per week for seven weeks in 20-30 minute online modules.

Each module included a brief video introduction to the theme of the week, an audio-guided mindfulness exercise, and suggestions for mindfulness activities to engage in during the week. The program was modeled after mindfulness-based stress reduction (MBSR), but required less time in terms of coursework, meditation length, and suggested weekly practice.

Participants were assessed on measures of stress and mindfulness (using the Mindful Attention Awareness Scale, or MAAS) at baseline, post-intervention, and 3-month follow-up.

Attrition was fairly high with 32% of mindfulness assignees and 18% of controls failing to complete the post-intervention assessment, and 47% of mindfulness assignees and 38% of controls failing to complete the 3-month follow-up.

Of those assigned to the mindfulness intervention, 25% completed 0 modules, 20% completed 1-5 modules, and 55% completed 6-7 modules over the seven weeks. Mindfulness assignees engaged in practice an average of twice per […]

July 16th, 2019|News|