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 seventh week of the study, all participants were asked to develop a short-term action plan to self-manage chronic illness and promote wellness. In weeks 8 and 9, they self-rated the degree to which they had successfully initiated their action plans.

Participants also completed questionnaires at baseline, 8 weeks, and 24 weeks assessing anxiety, depression, stress, emotion regulation, self-compassion, mindfulness (Five Facet Mindfulness Questionnaire), awareness of body sensations, and measures of self-efficacy and perceived control in managing their illnesses.

MTPC attendance was fair to good, with 74% of participants attending 6 or more group sessions. MTPC participants engaged in an average of 191 minutes a week of home mindfulness practice compared to 53 minutes a week for controls.

MTPC participants showed significant improvements at 8 weeks on anxiety (d=0.80), depression (0.59), perceived stress (0.77), mindfulness (0.92), self-compassion (0.85), emotion regulation (0.71), awareness of body sensations (1.0), self-efficacy in managing illness (0.30), and perceived control in managing illness (0.41). Controls showed similar changes in anxiety, depression, perceived stress, and self-compassion, but experienced no improvement on the other measures. All of these improvements persisted at 24 weeks.

MTPC participants showed significantly larger improvements in mindfulness (d=0.57), self-compassion (0.41), emotion regulation (.58), and awareness of body sensations (0.75) than did controls. MTPC participants were also significantly more likely to report successfully initiating and implementing their illness self-management plans (58% vs. 32%). These plans typically involved changes in mindful self-care, physical activity level, and/or diet.

The study shows that intensive mindfulness training can be successfully integrated into a primary care setting, while improving mindfulness, self-compassion, body awareness, and emotional self-regulation better than a low dose comparator. MTPC also increases the likelihood of patients implementing short-term health care self-management plans.

Participants improved on a variety of mental health measures, although not more than those in the low dose comparator. The study is limited by its reliance on self-report to assess patient implementation of self-management plans, and by the absence of a treatment-as-usual control.

Reference:

Gawande, R., To, M. N., Pine, E., Griswold, T., Creedon, T. B., Brunel, A., . . . Schuman-Olivier, Z. (2018). Mindfulness training enhances self-regulation and facilitates health behavior change for primary care patients: A randomized controlled trial. Journal of General Internal Medicine.

[Link to abstract]