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Frank HE, Albanese A, Sun S, Saadeh F, Johnson BT, Elwy AR, Loucks EB. Mindfulness-Based Stress Reduction Health Insurance Coverage: If, How, and When? An Integrated Knowledge Translation (iKT) Delphi Key Informant Analysis. Mindfulness (N Y) 2024; 15:1220-1233. [PMID: 38817538 PMCID: PMC11133142 DOI: 10.1007/s12671-024-02366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
Objectives Hundreds of trials have evaluated Mindfulness-Based Stress Reduction (MBSR), but in the United States, it is generally not covered by health insurance. Consequently, the aims were to identify the following: (1) key questions to make decisions about if, how, and when MBSR should be covered by health insurance; (2a) barriers and (2b) facilitators to understand and resolve for MBSR to be covered by health insurance; and (3) highest priority evidence needed to inform health insurance coverage decisions. Methods Key informants (n = 26) included health insurers, healthcare administrators, policymakers, clinicians, MBSR instructors, and MBSR students. An initial pool of items related to the study aims was generated through qualitative interviews. Through the Delphi process, participants rated, discussed, and re-rated each item's relevance. Items were required to reach a consensus of ≥ 80% agreement to be retained for final inclusion. Results Of the original 149 items, 42 (28.2%) met the ≥ 80% agreement criterion and were retained for final inclusion. The most highly rated items informing whether MBSR should be covered by health insurance included research demonstrating that MBSR works and that it is not harmful. The most highly rated barriers to coverage were that MBSR is not a medical treatment and patient barriers to attendance. Highly rated facilitators included the potential of MBSR to address common mental health and psychosomatic problems. Finally, understanding what conditions are effectively treated with MBSR and the impact of MBSR on stress were rated as the highest priority evidence needed to inform health insurance coverage decisions. Conclusions Findings highlight priorities for future research and policy efforts to advance health insurance coverage of MBSR in the United States. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-024-02366-x.
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Affiliation(s)
- Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Shufang Sun
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI USA
- Mindfulness Center, Brown University, Providence, RI USA
| | - Frances Saadeh
- Mindfulness Center, Brown University, Providence, RI USA
- School of Professional Studies, Brown University, Providence, RI USA
| | - Blair T. Johnson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA
| | - Eric B. Loucks
- Mindfulness Center, Brown University, Providence, RI USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02910 USA
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Price MM, Zanesco AP, Denkova E, Barry J, Rogers SL, Jha AP. Investigating the protective effects of mindfulness-based attention training on mind wandering in applied settings. Front Psychol 2023; 14:1232598. [PMID: 38213609 PMCID: PMC10781831 DOI: 10.3389/fpsyg.2023.1232598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Open
Abstract
Introduction Mind wandering, a phenomenon in which attention drifts away from the task-at-hand, is associated with deleterious effects on performance and well-being. As such, efforts to curb mind wandering are warranted. Recently, mindfulness training (MT) has been found to protect against mind wandering. Yet, many MT programs are at risk of falling off the implementation cliff due to challenges implementing these programs in applied settings. To mitigate against this, early-stage research in small convenience samples may be necessary to spur stakeholder engagement and collaboration. Herein, the effects of MT on mind wandering were examined via an internal meta-analysis of early-stage studies of a manualized, context-adaptable short-form MT program, referred to as Mindfulness-Based Attention Training (MBAT). Methods Five longitudinal studies (N = 304) were conducted in a variety of organizational cohorts. Self-reported mind wandering and meta-awareness, as well as accuracy (A') and response time variability (intra-individual coefficient of variation, ICV) during performance of the sustained attention to response task (SART) were assessed at baseline (T1) and 4 weeks later (T2) in MBAT and no-training participants. Results Standardized mean change (SMC) from T1 to T2 significantly differed between MBAT and no-training groups for mind wandering (ΔSMC = -0.387, p < 0.001), meta-awareness (ΔSMC = -0.374, p < 0.001), and ICV (ΔSMC = -0.376, p = 0.043), suggesting potential protective effects in self-reported and performance-based metrics of mind wandering. Discussion These results serve as preliminary proof-of-concept support for MBAT's protective effects on mind wandering. Further, they suggest that MBAT is amenable to implementation across a variety of applied and organizational settings and warrants additional research employing larger sample sizes in randomized controlled designs.
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Affiliation(s)
- Malena M. Price
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Anthony P. Zanesco
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Ekaterina Denkova
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Jordan Barry
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Scott L. Rogers
- School of Law, University of Miami, Coral Gables, FL, United States
| | - Amishi P. Jha
- Department of Psychology, University of Miami, Coral Gables, FL, United States
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Folger A, Nekkanti A, Williamson G, Guidinger C, Kelly NR. Rural sixth-grade teachers' and students' perceptions of a mindfulness-based mental health curriculum. Front Psychol 2023; 14:1277614. [PMID: 38106395 PMCID: PMC10722802 DOI: 10.3389/fpsyg.2023.1277614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/27/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Mindfulness-based interventions (MBIs) have the potential to improve students' mood, behavior and cognitive functioning; yet, little is known about the feasibility and acceptability of adapting such programs for rural middle schools. Methods An exploratory qualitative evaluation was conducted to examine the feasibility and acceptability of an initial trial delivery of AttuneEd®, a trauma-informed, mindfulness-based mental health curriculum. In this single-group design study, 10 weekly lessons were taught in a middle school located in a rural town in the pacific northwest during 6th grade students' P.E. classes. Three P.E. teachers, 26 6th grade teachers, and one school counselor attended trainings before and mid-curriculum implementation, where they provided qualitative feedback. A total of 160 students completed acceptability surveys before and after curriculum delivery. Results Three themes were identified from qualitative data: cultural considerations, teacher self-efficacy, and barriers and facilitators to student acceptability. Student acceptability ratings were high. Students reported, on average, that the classes helped them better understand themselves and others. Conclusion Some identified needs for future MBIs include (1) the need for culturally sensitive, trauma-informed delivery strategies; (2) teachers' desire for more support in content delivery; and (3) students' desire to have their own teachers deliver the curriculum. Findings elucidate the nuances associated with implementing an MBI in a rural middle school and have notable implications for development, scalability, and sustainability.
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Affiliation(s)
- Austin Folger
- Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Akhila Nekkanti
- Choice Filled Lives Network, Inc., Berkeley, CA, United States
| | - Gina Williamson
- Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
| | - Nichole R. Kelly
- Counseling Psychology and Human Services, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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Zhang ZJ, Lo HHM, Ng SM, Mak WWS, Wong SYS, Hung KSY, Lo CSL, Wong JOY, Lui SSY, Lin E, Siu CMW, Yan EWC, Chan SHW, Yip A, Poon MF, Wong GOC, Mak JWH, Tam HSW, Tse IHH, Leung BFH. The Effects of a Mindfulness-Based Family Psychoeducation Intervention for the Caregivers of Young Adults with First-Episode Psychosis: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1018. [PMID: 36673773 PMCID: PMC9858753 DOI: 10.3390/ijerph20021018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program. METHOD We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes. RESULTS Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers' outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement. CONCLUSIONS A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size.
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Affiliation(s)
- Zoe Jiwen Zhang
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Herman Hay Ming Lo
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong
| | | | | | | | | | | | | | | | - Edmund Lin
- Castle Peak Hospital, Hospital Authority, Hong Kong
| | | | | | | | - Annie Yip
- School of Nursing, Hong Kong Polytechnic University, Hong Kong
| | | | | | | | - Hillman Shiu Wah Tam
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong
- Heartfelt Listening Counselling Space, Hong Kong
| | | | - Bobby Fook Hin Leung
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong
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Myall K, Montero-Marin J, Gorczynski P, Kajee N, Syed Sheriff R, Bernard R, Harriss E, Kuyken W. Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis. Br J Sports Med 2023; 57:99-108. [PMID: 36223914 DOI: 10.1136/bjsports-2022-105596] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight online databases (Embase, PsycINFO, SPORTDiscus, MEDLINE, Scopus, Cochrane CENTRAL, ProQuest Dissertations & Theses and Google Scholar), plus forward and backward searching from included studies and previous systematic reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they were randomised controlled trials (RCTs) that compared an MBP against a control, in current or former elite athletes. RESULTS Of 2386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBPs and 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g=-0.87, number of studies (n)=6, p=0.017, I 2=90) and stress (g=-0.91, n=5, p=0.012, I 2=74) and increasing psychological well-being (g=0.96, n=5, p=0.039., I 2=89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity. CONCLUSION MBPs improved several mental health outcomes. Given the moderate degree of evidence, high-quality, adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence and scalability within elite sport. PROSPERO REGISTRATION NUMBER CRD42020176654.
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Affiliation(s)
- Kearnan Myall
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Oxford University, Oxford, UK .,Teaching, Reseach and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Paul Gorczynski
- School of Human Science, University of Greenwich, London, UK
| | - Nabeela Kajee
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Rebecca Syed Sheriff
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, NHS, Oxford, UK
| | - Robert Bernard
- Department of Education, Concordia University, Montreal, Quebec, Canada
| | - Eli Harriss
- Bodleian Health Care Libraries, Oxford University, Oxford, UK
| | - Willem Kuyken
- Department of Psychiatry, Oxford University, Oxford, UK
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Greco CM, Dore GA, Weinberg JM, Roth I, Thomas HN, Lawrence S, Rodriguez R, McGillis M, Morone NE. A Brief Measure of Fidelity for Mindfulness Programs: Development and Evaluation of the Concise Fidelity for Mindfulness-Based Interventions Tool. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231174234. [PMID: 37426338 PMCID: PMC10327996 DOI: 10.1177/27536130231174234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Mindfulness research and clinical programs are widespread, and it is important that mindfulness-based interventions are delivered with fidelity, or as intended, across settings. The MBI:TAC is a comprehensive system for assessing teacher competence, yet it can be complex to implement. A standardized, simple fidelity/engagement tool to address treatment delivery is needed. Objective We describe the development, evaluation, and outcomes of a brief, practical tool for assessing fidelity and engagement in online mindfulness-based programs. The tool contains questions about session elements such as meditation guidance and group discussion, and questions about participant engagement and technology-based barriers to engagement. Methods The fidelity rating tool was developed and tested in OPTIMUM, Optimizing Pain Treatment in Medical settings Using Mindfulness. The OPTIMUM study is a 3-site pragmatic randomized trial of group medical visits and adapted mindfulness-based stress reduction for primary care patients with chronic low back pain, delivered online. Two trained study personnel independently rated 26 recorded OPTIMUM sessions to determine inter-rater reliability of the Concise Fidelity for Mindfulness-Based Interventions (CoFi-MBI) tool. Trained raters also completed the CoFi-MBI for 105 sessions. Raters provided qualitative data via optional open text fields within the tool. Results Inter-rater agreement was 77-100% for presence of key session components, and 69-88% for Likert ratings of participant engagement and challenges related to technology, with discrepancies only occurring within 2 categories: 'very much' and 'quite a bit'. Key session components occurred as intended in 94-100% of the 105 sessions, and participant engagement was rated as 'very much' or 'quite a bit' in 95% of the sessions. Qualitative analysis of rater comments revealed themes related to engagement challenges and technology failures. Conclusion The CoFi-MBI provides a practical way to assess basic adherence to online delivery of mindfulness session elements, participant engagement, and extent of technology obstacles. Optional text can guide strategies to improve engagement and reduce technology barriers.
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Affiliation(s)
- Carol M. Greco
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
- Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pennsylvania
| | - Graham A. Dore
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | - Janice M. Weinberg
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
| | - Isabel Roth
- Program on Integrative Medicine, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, NC, USA
| | - Holly N. Thomas
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pennsylvania
| | - Suzanne Lawrence
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania
| | | | | | - Natalia E. Morone
- Boston Medical Center, Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
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Serpa JG, Shamblen SR, Atwood K, Sangpukdee A, Whitehead A, Wolf C. Mindfulness-Based Teaching Competency Assessment: Comparing Self-Assessment With Expert Evaluation in the Veterans Administration - Compassionate Awareness Learning Module Program. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231197654. [PMID: 37693682 PMCID: PMC10492467 DOI: 10.1177/27536130231197654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/25/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
Background Meditation, including Mindfulness-Based Interventions (MBI), is a required Complementary and Integrative Health intervention at the US Department of Veterans Affairs (VA). Training VA clinicians to provide MBI at scale must address fidelity concerns and the assessment of clinician competency. Objective The psychometric properties of the Mindfulness-Based Intervention: Teaching Assessment Criteria (MBI:TAC), a widely used tool for assessing facilitator competence, continue to be explored. To support the dissemination of MBI, the utility of using the MBI:TAC for self-assessment for clinicians in a national training program was evaluated. Methods In a training cohort of VA clinicians (n = 39), participant self evaluations on 2 domains of the MBI:TAC are compared to the competency scores of 2 expert evaluators as based on the observations of a 10-minute exercise. Additionally, the inter-rater reliability between the 2 experts was explored. Results Intraclass Correlation for the 2 expert evaluators for Guiding Practice was significant (ρ = .83, P = .003), but was not significant for Embodiment of Mindfulness (ρ = .34, P = .186). Self-evaluation scores were not significantly correlated to expert rater scores such that participants rate their level of competence higher than expert scores. Conclusion The MBI:TAC, while an essential tool in teacher training, may not produce accurate scores when used for self-assessment. Instruction from a senior teacher is needed for accurate scoring. Interrater reliability may be improved with enhanced domain operationalization and training. Implications for MBI training are explored.
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Affiliation(s)
- J Greg Serpa
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Kathy Atwood
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Aree Sangpukdee
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Alison Whitehead
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
| | - Christiane Wolf
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
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