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Primary care mindfulness program supports patient self care

Posted 01.24.2019 | by AMRA

Between 30-70% of physicians suffer from work-related burnout. Physician burnout is associated with higher medical error rates, poorer physician-patient communication, and increased physician substance abuse and suicide. Medical professionals are interested in developing ways to reduce burnout, including the implementation resilience curricula in medical schools.

Kemper et al. [Academic Medicine] surveyed pediatric residents to assess the rate of burnout during residency, and determine whether the traits of mindfulness and self-compassion served as protection against burnout..

A cohort of 872 pediatric residents serving at 31 different residency sites (72% female; 73% Caucasian; average age = 29 years) completed an online questionnaire in the spring of 2016 and again in the spring of 2017. The questionnaires measured burnout, perceived stress, confidence in their ability to provide compassionate care, mindfulness (the Cognitive and Affective Mindfulness Scale-Revised), and self-compassion. The burnout measure assessed emotional exhaustion (e.g., “I feel emotionally drained from my work”) and compassion fatigue (e.g., “I feel I treat some patients as if they were impersonal objects”).

The researchers looked at the stability of measures over time, the cross-sectional correlations between measures within each year, and the ability of 2016 mindfulness and self-compassion scores to predict 2017 burnout, stress, and confidence in being able to deliver compassionate care.

The results showed that 48% of the residents suffered from burnout in the spring of 2016 and again in the spring of 2017. In 2016, mindfulness significantly correlated positively with self-compassion (.61) and confidence in providing compassionate care (.37) and negatively with perceived stress (-.59) and burnout (-.44).

Self-Compassion significantly correlated positively with confidence in providing compassionate care (.29) and negatively with perceived stress (-.49) and burnout (-.38). Correlation magnitudes were […]

January 24th, 2019|News|

Primary care mindfulness program supports patient self care

Posted 01.18.2019 | by AMRA

While people with chronic illnesses can benefit from modifications in diet, exercise, and stress management, initiating and maintaining behavioral changes can be difficult. People with mental health problems can find it even harder to self-manage healthy lifestyle changes. Health care providers are interested in behavioral interventions that can be delivered directly in primary care settings to help patients better manage their illnesses.

Gawande et al. [Journal of General Internal Medicine] studied whether a primary care mindfulness-based intervention could promote improved patient self-management of behaviors that might favorably impact their health. They compared the effectiveness of an intensive in-house mindfulness training to a brief orientation to mindfulness coupled with referral to potential community and online mindfulness resources.

The researchers randomly assigned 136 primary care patients with depressive, anxiety, stress, adjustment, or traumatic stress diagnoses (65% female; 77% Caucasian; average age = 41 years) to either a Mindfulness Training for Primary Care (MTPC) group or a low dose comparator control. Participants who were already receiving mental health treatment were encouraged to continue it during the study.

MTPC was delivered in 8 weekly 2-hour group sessions along with a 7-hour retreat. The program was based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. It included instruction on self-compassion, illness self-management, values clarification, communication, and mindful action planning.

Prior to randomization, all participants attended a one-hour orientation to mindfulness that included didactic and practice elements. Following randomization, participants in the low dose comparator control were encouraged to practice mindfulness on their own, advised to seek out mindfulness resources, and placed on a 6-month MTPC waiting list. Both MTPC and control participants received biweekly phone calls encouraging continued home practice.

In the […]

January 18th, 2019|News|

Cost-savings of mindfulness program compared to routine care for mental health

Posted 12.28.2018 | by AMRA

Mental health problems are costly to society both in terms of treatment-related expenses and lost productivity. If research shows that two treatments are equally effective in reducing symptoms, it seems reasonable to ask which of the two is more cost effective.

A recent Swedish study showed that a group-based mindfulness intervention was equally as effective as standard care (mostly individual-based cognitive behavioral therapy) in reducing symptoms of anxiety and depression. Saha et al. [British Journal of Psychiatry] evaluated the previously published Swedish study to determine the cost-effectiveness of group-based mindfulness interventions as compared to the costs of standard care.

The original study randomly assigned 215 Swedish patients (average age = 42 years; 85% female) diagnosed with depression, anxiety, stress, or adjustment disorders who were being treated at 16 different primary care health centers to either a mindfulness-based intervention (MBI) or standard care.

The MBI was offered in two-hour weekly group sessions over eight weeks and based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. The majority of standard care patents (76%) received individual cognitive-behavioral therapy for an average of 6.3 sessions.

Intervention and control participants were equally likely to be taking antidepressant and/or anti-anxiety medications, so that group differences cannot be attributed to medication effects. The researchers compared the two groups in terms of 1) total health care costs over the course of 8 weeks (the costs of therapy, medication, and medical visits), 2) self-reported quality of life improvement in terms of mobility, self-care, activities of daily living, pain, suffering, anxiety, and depression, and 3) productivity in terms of patient reported sick leave and hours worked.

The results showed that the group-based mindfulness intervention cost about $130 […]

December 28th, 2018|News|

Medication and mindfulness meditation to treat hypertension

Posted 12.21.2018 | by AMRA

High blood pressure is a major cardiovascular risk factor impacting 35% of U.S. adults. Stress, anxiety, and depression can contribute to its onset and intensification. The condition is usually treated with antihypertensive medications, but a significant proportion of patients fail to achieve adequate control with medication alone.

Researchers are interested in whether stress-reduction interventions together with conventional medical care can improve outcomes compared to medication alone. In a randomized controlled trial, Marquez et al. [Journal of Human Hypertension] compared relative effectiveness of mindfulness meditation and health education programs in reducing blood pressure as well as levels of stress, anxiety, and depression.

The researchers randomly assigned 42 meditation-naïve participants (average age = 57 years; 43% male; 69% on antihypertensive medication) with high-normal blood pressure or stage 1 hypertension to a Mindfulness Meditation or Health Education intervention. Both interventions were offered in two-hour group sessions that met weekly over the course of 8 weeks.

Mindfulness Meditation content was similar to that offered in Mindfulness-Based Stress Reduction (MBSR). The Health Education intervention offered didactic information on hypertension risk factors, along with methods of prevention through medication, diet, and exercise. Participants were assessed at baseline, 4, 8, and 20 weeks on measures of mindfulness (evaluated using the Five Facet Mindfulness Questionnaire), mood, perceived stress, anxiety, depression, and clinically assessed blood pressure (BP).

Additionally, each participant’s ambulatory BP was assessed over a 24-hour period at baseline and at week 8 using a body-worn automated device that measured BP at 15-30 minute intervals throughout the day and night. Ambulatory BP is a sound measure because it eliminates the error associated with the “white coat” effect—the spurious elevation in BP that occurs when […]

December 21st, 2018|News|

MBSR added to residential mental health treatment for adolescents

Posted 12.04.2018 | by AMRA

While there is a fairly extensive research literature evaluating the benefits of Mindfulness Based Stress Reduction (MBSR) for adults with depression and anxiety, research into the benefits of MBSR for adolescents with mental health problems is sparse.

Vohra et al. [Child and Adolescent Mental Health] conducted a controlled trial of MBSR as an adjunctive treatment for adolescents attending an intensive residential mental health treatment program.

The researchers studied 85 non-psychotic adolescent patients (average age = 14 years; 59% male; 73% Caucasian) residing in an intensive residential mental health treatment program. Half of the residents received standard residential care and half received standard residential care plus adjunctive MBSR. Assignment to condition was based on the time of year that patients resided in the treatment program, rather than on individual randomization.

Standard residential care consisted of a structured program including daily group therapy, medication, education, recreation, and weekly family therapy. Adjunctive MBSR was offered in eight two-hour weekly sessions with a three-hour retreat in week eight. The standard MBSR protocol was modified for the age group and homework was less demanding.

Outcome measures assessed at baseline, 10 weeks, and 3 months included parent, teacher, and self-ratings using the Behavioral Assessment System for Children System (BASC) as well as self-ratings on perceived stress, mindfulness (using the Child Acceptance and Mindfulness Measure), and emotional regulation. During the course of the study, 4 participants were discharged early and one participant declined further participation. Average MBSR session attendance was 88%.

BASC teacher ratings showed significant improvements for the adjunctive MBSR group on measures of internalizing problems (depression, anxiety, somatization) and adaptive skills (social skills, study skills, leadership) compared to standard care alone. Average […]

December 4th, 2018|News|

Mindfulness coach supports women undergoing breast biopsy

Posted 11.26.2018 | by AMRA

About one in eight U.S. women will be diagnosed with breast cancer at some point in their lives. Cancer is often diagnosed by a stereotactic breast biopsy that uses a mammography-guided needle to extract suspicious tissue. The procedure requires women to remain immobile for 15-30 minutes while undergoing breast compression, which can be an uncomfortable, anxiety provoking experience.

Patients can take prescription drugs to reduce anxiety, but this requires them to be driven to and from the procedure and can delay their return to work. As a result, there is interest in non-drug interventions to reduce biopsy discomfort and anxiety.

Ratcliff et al. [Journal of the American College of Radiology] compared the effect of mindfulness meditation or focused breathing to a control group on breast biopsy pain and anxiety.

The researchers randomly assigned 76 women (average age = 55 years; 74% Caucasian and 20% Hispanic/Latina) preparing to undergo stereotactic breast biopsy to: 1) a 10-minute guided mindfulness meditation, 2) a 10-minute guided period of focused diaphragmatic breathing, or 3) a 10-minute period of listening to a neutral audio clip.

Mindfulness meditation emphasized nonjudgmental observation of the breath, sensations, thoughts, and feelings with reminders to refocus whenever the mind wandered. The meditation was guided in-person by a mind-body medicine specialist. The specialist also accompanied the patient to the biopsy, coaching them in meditation during the procedure. Focused breathing was taught and coached similarly. Audio clip patients were not accompanied or coached during the biopsy.

Measures of anxiety and pain were taken after the training interventions, every four minutes during the biopsy, and immediately following the biopsy. Additionally, an electroencephalogram (EEG) measured patient brain wave activity in regions of […]

November 26th, 2018|News|

Mindful parenting program affects parenting style and child weight gain

Posted 10.30.2018 | by AMRA

Children from low-income, high-stress families are at increased risk for obesity. Further, highly stressed parents tend towards parenting styles that are less warm, less involved, and more punitive. An intervention that improves parental nonjudgmental attention to moment-to-moment parent-child interactions might also prove helpful in preventing childhood obesity.

Jastreboff et al. [Journal of Pediatrics] explored whether a novel mindful parenting program could improve parenting style and reduce the risk for obesity in the parents’ preschool-aged children.

The researchers randomly assigned 42 highly stressed low-income parents of preschool aged children (average age = 31 years; 98% female; 62% multiracial; average BMI=36) to either an 8-week Parenting Mindfully for Health (PMH) program or an educational control group. High parental stress was defined by high scores on a perceived stress scale.

The PMH and control participants both attended 8 weekly 2-hour group sessions that included 20 minutes of nutrition and physical activity education and counseling. The remainder of the time in the PMH group was modeled after MBSR, which included a focus on mindful parenting, eating, and physical activity. The remainder of the control group’s time was devoted to viewing and discussing nature videos.

Parents were assessed pre- and post-intervention for mindfulness (using the Mindful Attention Awareness Scale), perceived stress, nutritional intake, pedometer-measured physical activity, and BMI. Their preschool children wore an activity sensor to measure levels of physical activity and also had their BMI calculated from their height and weight.

Parent-child dyads were videotaped during a “Toy Wait Test” in which the children had to wait five minutes until their parents completed some paperwork before they could play with a toy. Toy Wait Test videotapes were rated for the quality […]

October 30th, 2018|News|

Mindfulness intervention supports eye health in glaucoma patients

Posted 10.23.2018 | by AMRA

Glaucoma is a leading cause of blindness that affects 65 million people worldwide. It is caused by increased fluid buildup inside of the eye (intraocular pressure) that results in progressive damage to the optic nerve. Psychological stress is known to increase several glaucoma risk factors (oxidative stress, inflammation, glutamate toxicity, and vascular dysregulation) while simultaneously reducing several protective factors (neurotrophins and glial activity). This finding has led some to wonder whether stress reduction interventions might benefit glaucoma patients.

Dada et al. [Journal of Glaucoma] conducted a randomized, controlled study to test if a mindfulness-based intervention (MBI) could reduce intraocular pressure and affect psychological stress-related biomarkers as well as alter gene expression in glaucoma patients.

The researchers randomly assigned 90 patients (average age = 57 years; 55% male) with moderate-to-severe glaucoma to either a MBI or a wait-list control group. MBI participants engaged in daily hour-long teacher-led group sessions for 21 consecutive days. The sessions included 15 minutes of slow-breathing exercises followed by 45 minutes of mindfulness meditation. Attrition rate was 18% in the MBI group and 7% in the wait-list control group.

Intraocular pressure was assessed pre- and post-intervention, as were biomarkers of psychological stress (cortisol and β-endorphins), inflammation (IL-6 and TNF-α), oxidative stress (the imbalance between free radicals and antioxidants as measured by ROS and TAC), and a protein that protects nerve cells (BDNF). Whole blood RNA was assessed for post-intervention differences in gene expression, and participants completed the World Health Organization Quality of Life Questionnaire.

MBI participants showed a significant 6 mmHg reduction in intraocular pressure, while controls only decreased by about 1 mmHg. Seventy-five percent of the participants who completed the MBI reduced […]

October 23rd, 2018|News|

Daily brief meditation takes more than four weeks to boost mood

Posted 09.27.2018 | by AMRA

Meditation practice reliably demonstrates beneficial effects for memory, attention, mood, and emotional regulation. It is unclear, however, whether there is a minimum dosage necessary to attain these benefits.

Basso et al. [Behavioural Brain Research] measured the benefits of meditation in a group of meditation-naïve participants by assigning them to either daily brief guided meditations or to a control group, and measuring their changes in mood and cognition over time.

The researchers randomly assigned 72 meditation-naïve participants to either a meditation audio or a podcast audio. The meditation group listened to 13-minute guided meditations daily for 8 weeks. The meditations included breath-focused exercises and a body scan practice. The podcast group listened to 13-minute excerpts from NPR’s Radiolab podcast daily for 8 weeks.

Participants underwent neuropsychological and psychological evaluations and salivary cortisol (a stress hormone) assessments at baseline, 4 weeks, and 8 weeks. Computer-administered neuropsychological tests included measures of attention, working and recognition memory, and response inhibition. The psychological tests measured mindfulness (Mindful Attention Awareness Scale or MAAS), mood, stress, depression, anxiety, rumination, sleep quality, fatigue, quality of life, self-esteem, and life satisfaction.

Following the final assessments, participants were subjected to a stress-inducing task. They were told to prepare for a job interview and deliver a five-minute presentation on why they should be hired in front of two stone-faced judges. They were then told to perform a difficult serial subtraction problem. Whenever they made an arithmetic mistake, they were instructed to start the problem over from the beginning.

Subjective measures of anxiety were taken at baseline, immediately after, and at 10, 20, and 30-minute intervals after the stress-inducing tasks. Salivary cortisol levels were also assessed at each of […]

September 27th, 2018|News|

MBCT helps patients with treatment-resistant depression

Posted 09.20.2018 | by AMRA

About one-in-five major depressive episodes are not responsive to either medication or psychotherapy and go on to become chronic illnesses. Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be useful as an adjunctive treatment in acute depressions and the prevention of depressive relapse in patents with a history of multiple depressive episodes. Its effectiveness in chronic treatment-resistant depressions has not yet been established.

Cladder-Micus et al. [Depression and Anxiety] compared the effectiveness of MBCT as an adjunctive treatment to treatment-as-usual in patients with treatment-resistant chronic depression.

The researchers randomly assigned 106 patients with treatment-resistant chronic depression (female = 62%; mean age = 47 years; mean length of depressive episode = 70 months; mean number of previous episodes = 2.7) to either treatment-as-usual (TAU) or TAU combined with adjunctive MBCT. MBCT was offered in the standard 8-week group format. TAU consisted of medication, psychological treatment, psychiatric nursing support, and day hospitalization as needed. There was no difference between conditions as to the type and amount of TAU received.

Participants were assessed at baseline and post-treatment on symptom severity, remission of illness (no symptoms for two weeks), quality of life, rumination, self-compassion, and mindfulness (using the Five Facet Mindfulness Questionnaire).

The MBCT attrition rate was 24.5%, with participants dropping out due to physical complaints, trouble awakening in the morning, and practical considerations (e.g., moving away from the area). Completers did not differ from non-completers in terms of baseline depressive symptoms.

The main analyses were performed using an intention-to-treat (ITT) protocol using data from all participants available for post-testing, whether or not they successfully completed the MBCT program. Secondary analyses were conducted using only those MBCT participants who completed 4 […]

September 20th, 2018|News|