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Insurance reimbursement for a primary care mindfulness program

Posted 04.15.2019 | by AMRA

Most patients with mild-to-moderate psychological problems are diagnosed and treated in primary care rather than mental health settings. Many of these patients also suffer from physical disorders, or from physical symptoms caused or made worse by psychological factors. Mindfulness-based programs that reduce anxiety and depression and promote self-care are useful supplements to primary care treatments; however, existing barriers hinder their successful implementation. These barriers include limitations on staff time and training, staff unfamiliarity with mindfulness, and problems with insurance reimbursement.

Gawande et al [Mindfulness] studied the feasibility, acceptability, and effectiveness of a mindfulness-based primary care program in reducing symptoms and improving self-care for patients with mild-to-moderate psychological problems.

The researchers randomly assigned 81 primary care patients (69% female; average age = 44; 78% Caucasian; 44% meditation naive) with anxiety, depressive, stress- or trauma-related disorders to either a Mindfulness Training for Primary Care (MTPC) program or a low-dose comparison group. If participants were already receiving psychological help in the primary care setting, they continued to receive it as usual.

MTPC is an 8-week group program based on Mindfulness-Based Cognitive Therapy that incorporates elements of self-compassion training, values clarification, and relapse prevention. MTPC and low dose comparison group participants were asked to develop a self-care plan together with their primary care providers during the sixth week of the program. MTPC group leaders were either appropriately trained mental health clinicians or primary care physicians, with the groups being tailored to meet the insurance requirements of each discipline.

The low dose comparison control consisted of a one-hour didactic/experiential introduction to mindfulness with information on how to access community and digital mindfulness resources. Low dose comparison participants were also placed on […]

April 15th, 2019|News|

Firefighter resilience increases after iPad mindfulness program

Posted 04.01.2019 | by AMRA

First responders such as firefighters, police, and EMTs are regularly exposed to stressful and traumatic experiences. These experiences put them at increased risk for depression, anxiety disorders, PTSD, and alcoholism. There is a considerable interest in developing workplace programs that can increase first responders’ resilience to and recovery from stressful experiences.

Joyce et al. [Journal of Medical internet Research] tested the efficacy of an online Resilience-at-Work (RAW) Mindfulness Program on firefighter resilience and wellbeing.

The researchers randomly selected 12 Australian fire stations as workplaces where firefighters could receive RAW training and 12 additional stations as attention-matched controls. A total of 143 firefighters (96% male, average age = 42) volunteered to participate, 79 of whom were available for post-treatment assessment, and 69 for a 6-month follow-up. Controls had a higher 6-week drop-out rate (54%) than RAW participants (32%).

RAW training consisted of six self-paced 20-25 minute iPad lessons that were to be completed over a period of up to 6 weeks. The lessons included aspects of Mindfulness-Based Cognitive Therapy and Acceptance and Commitment Therapy with additional training in self-compassion. The control condition completed six 20-minute Healthy Living lessons covering a range of topics such as skin health, maintaining a healthy home, and using cell phones wisely.

Self-reports were completed at baseline, post-intervention, and 6-month follow-up on measures of resilience (adaptation to stressful life events), bounce-back resilience, and other psychological measures.

RAW participants completed an average of 3.5 of the six trainings with only 37% completing the entire program. RAW participants increased their resilience scores more than controls. This difference approached significance at immediate post-testing and reached significance by the 6-month follow-up (a moderate-to-large effect). There were no group […]

April 1st, 2019|News|

Mindfulness plus acceptance training supports social connection

Posted 03.19.2019 | by AMRA

Loneliness and social isolation are major risk factors for poor health and increased mortality. Additionally, U.S. loneliness ratings have steadily risen in recent decades. Mindfulness could potentially mitigate this problem by enhancing emotional regulation, thereby improving social relationships.

Lindsay et al. [Proceedings of the National Academy of Science] conducted a randomized controlled study to see if training in mindful attention to sensory and mental experience, both with and without instructions to adopt an accepting attitude towards experience, helps to reduce feelings of loneliness and increase the frequency of social interactions.

The researchers randomly assigned 153 adults reporting higher than average stress levels (67% female; 52% Caucasian; average age = 32) to one of three groups. Participants in each group agreed to watch and listen to fourteen 20-minute lessons delivered via smartphone over the course of two weeks. The lessons all contained a combination of didactic instruction and guided exercises.

Participants in the Monitoring + Acceptance (M+A) group received training in present moment awareness plus training in accepting experience with openness, receptivity, and equanimity. Participants in the Monitoring Only (MO) group received training in present moment awareness without training in acceptance. Those in a third Coping control group received instruction on how to reflect on, analyze, and solve problems.

Participants rated how lonely they felt and recorded their daily social contacts and how many different people they interacted with in diaries completed three days before and three days after the intervention. Participants also reported their immediate feelings of loneliness and real-time social interactions multiple times a day via cellphone (a procedure called “ecological momentary assessment”). Finally, participants completed standardized retrospective self-report measures of loneliness, social isolation, and […]

March 19th, 2019|News|

Journal articles on mindfulness continue to grow in 2018

Posted 03.13.2019 | by AMRA

A new search of the term “mindfulness” shows that the concept continues to gain popularity. The number of academic journal articles published with the term “mindfulness” in the title reached 842 in 2018. This is up from under 800 articles published in 2017. A full-size image is free for reuse and reprint for research and teaching purposes here. Data obtained from an ISI Web of Science search of the term “mindfulness” in academic journal article titles including reviews, editorial letters, and proceedings papers.

March 13th, 2019|News|

MBCT associated with less grief after death of loved one

Posted 02.27.2019 | by AMRA

The death of a loved one is a powerful stressor. Bereavement is not only painful and distressing, but can also trigger the onset of a variety of mental and medical disorders. Bereaved individuals may experience difficulty regulating their emotions and intrusive unpleasant thoughts and feelings that can disrupt cognitive functioning.

Huang et al. [Frontiers in Human Neuroscience] tested whether Mindfulness-Based Cognitive Therapy (MBCT) can improve emotional regulation and executive cognitive functioning in bereaved individuals.

The researchers recruited 23 participants reporting unresolved grief (91% female; average age = 48) who had lost at least one significant relative in the previous four years. All the participants attended an 8-week MBCT program. Self-report measures of grief, anxiety, depression, emotional regulation difficulty, and mindfulness (using the Five Facet Mindfulness Questionnaire) were obtained pre- and post-intervention.

Neurocognitive functioning was assessed before and after the intervention by having participants perform a Stroop task while monitoring their brain activity with functional magnetic resonance imaging. The Stroop task required participants to judge which of two visually presented digits was numerically larger. In each presentation, the relative physical sizes of the digits were either congruent or incongruent with their relative numerical size.

People usually take longer to correctly respond on incongruous Stroop trials. Their reaction time on those trials was used as a measure of executive cognitive function—the ability to make judgments in the presence of conflicting information.

After MBCT, participants reported significantly reduced grief (Cohen’s d = -0.89), anxiety (d = -0.65), depression (d = -1.17), and emotional regulation difficulty (d = -0.76), as well as increased mindfulness (d = 0.80). Post-MBCT mindfulness scores were significantly associated with lower post-MBCT grief (r = -.52), anxiety […]

February 27th, 2019|News|

CBT plus mindfulness meditation to prevent teen alcohol use

Posted 02.21.2019 | by AMRA

Nearly half of all 15-19 year olds drink alcohol, at least on occasion, despite laws prohibiting its use by minors. Increased alcohol consumption by teenagers is linked to problems with attention, memory, and cognition. Impulsive teenagers are at higher risk for alcohol use, and interventions that reduce impulsivity may also reduce their likelihood of drinking. Public schools can serve as important venues for health programs aimed at lessening alcohol-related harm.

Patton et al. [Journal of Consulting and Clinical Psychology] tested whether including mindfulness meditation in a school-based cognitive behavioral therapy intervention adds to its effectiveness in decreasing teenage alcohol use.

The researchers randomly assigned 404 Australian 9th and 10th graders (62% female; average age = 15 years) to either a cognitive behavioral therapy intervention combined with mindful breathing (CBT+MM), a cognitive behavioral therapy intervention combined with progressive muscle relaxation (CBT+PMR), or an assessment-only control. The interventions were delivered in three group-based sessions lasting an average of 58 minutes each, and were taught by graduate-level psychology students.

Mindfulness training consisted of one session that included an introduction to mindfulness, a mindful eating exercise, and a mindfulness of the body and breath exercise, and a second session that included an exercise involving mindfulness of thoughts. Cognitive behavioral training consisted of one session that included an introduction to the cognitive model and identifying cognitive distortions, and a second session in which the cognitive model was applied to thoughts about alcohol.

All students were assessed before the intervention, at post-intervention, and at 3- and 6-month follow-up on self-report measures of alcohol use, impulsivity, mindfulness (using the Mindful Attention Awareness Scale), positive and negative beliefs about the effects of alcohol, and […]

February 21st, 2019|News|

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|