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Naskar S, Dixit S, Varadharasu S, Pattnaik JI, Singh R. Effect of mindfulness-based intervention on perceived stress among breast cancer patients undergoing chemotherapy. J Family Med Prim Care 2024; 13:2934-2940. [PMID: 39228637 PMCID: PMC11368353 DOI: 10.4103/jfmpc.jfmpc_1713_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Breast cancer is the second most prevalent disease among women in India and one of the most dangerous and lethal. Chemotherapy-treated breast cancer patients may have perceived stress, which is defined as emotions of mental or physical exhaustion that make them feel angry or anxious. Mindfulness-based intervention (MBI) gives some ideas in line with the conventional mindfulness technique. Purposes (i) To assess the effect of MBI on perceived stress among breast cancer patients undergoing chemotherapy. (ii) To determine the association between perceived stress with selected demographic variables among breast cancer patients undergoing chemotherapy. Methods The current quantitative pre- and postexperimental study was carried out in two oncology departments of selected cancer hospitals, Bhubaneswar. A total number of 40 breast cancer patients of perceived stress receiving chemotherapy and data were gathered by using a self-structured socio-demographic proforma and a structured Perceived Stress Scale 10. The experimental group received MBI, and a posttest was conducted on the 17th day on both the groups after 10 days of the termination of intervention. This MBI was provided to breast cancer patients for five sessions over five days continuously, each session for 45 min with mindfulness breathing exercises, progressive muscle relaxation techniques, practising meditation, and guided imagery technique. Results The study findings illustrated that reduction of perceived stress among female breast cancer patients undergoing chemotherapy with (t = 2.2463) (P = 0.0306) at the P < 0.05; furthermore, there is one socio-demographic variable which had association with perceived stress that is history of psychiatric illness (χ 2 = 14.1176) (P = 0.0009) and others had no association with perceived stress. Conclusion MBI was an effective therapy for reducing the perceived stress of breast cancer patients undergoing chemotherapy.
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Affiliation(s)
- Soumi Naskar
- Department of Mental Health Nursing, Kalinga Institute of Nursing Sciences, KIIT-DU, Bhubaneswar, Odisha, India
| | - Sanjukta Dixit
- Department of Mental Health Nursing, Kalinga Institute of Nursing Sciences, KIIT-DU, Bhubaneswar, Odisha, India
| | - Sivasankari Varadharasu
- Department of Mental Health Nursing, Kalinga Institute of Nursing Sciences, KIIT-DU, Bhubaneswar, Odisha, India
| | | | - Reena Singh
- Department of Mental Health Nursing, Kalinga Institute of Nursing Sciences, KIIT-DU, Bhubaneswar, Odisha, India
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Teixeira DS, Fortes S, Kestenberg C, Alves K, Campos MR, Neto AO, Ortega F, García-Campayo J, Demarzo M. Improving patient-centered mental health promotion in primary care in vulnerable communities through mindfulness training in Rio de Janeiro, Brazil. Front Med (Lausanne) 2024; 11:1356040. [PMID: 39040898 PMCID: PMC11261806 DOI: 10.3389/fmed.2024.1356040] [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: 12/14/2023] [Accepted: 06/07/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Brazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC. Objective To discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil. Methods The intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups. Results and discussion Sixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy. Conclusion Mindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.
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Affiliation(s)
- Débora Silva Teixeira
- Department of Integral Family and Community Medicine, Medical Sciences College, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sandra Fortes
- Medical Sciences College, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celia Kestenberg
- Nursing School, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kali Alves
- Pedro Ernesto University Hospital – State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Alfredo Oliveira Neto
- Primary Health Care Department, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Francisco Ortega
- Catalan Institution of Research and Advanced Study, Barcelona, Spain
- Medical Anthropology Research Center, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Marcelo Demarzo
- Mente Aberta – The Brazilian Center for Mindfulness and Health Promotion – Department of Preventive Medicine, Paulista Medical School – Federal University of São Paulo, São Paulo, Brazil
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To MN, Schuman-Olivier Z. Integrating choice points into mindfulness training for the dissociative subtype of PTSD: A case report. PSYCHIATRY RESEARCH CASE REPORTS 2024; 3:100218. [PMID: 39026577 PMCID: PMC11257171 DOI: 10.1016/j.psycr.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Approximately 15-30 % of individuals diagnosed with PTSD experience high levels of dissociation, a condition categorized in the DSM-V as a dissociative subtype of PTSD (PTSD-D). Despite the rising number of studies supporting mindfulness-based interventions (MBIs) for the treatment of PTSD, literature on mindfulness and dissociation remains scarce and discording. While best practices for offering mindfulness for dissociative patients remain unclear, integrating choice points into MBIs may be aligned with trauma-informed principles and effective in countering loss of self-agency associated with trauma. In this article, we present a case study from a larger randomized controlled trial of an individual with PTSD-D who successfully completed an 8-week MBI while displaying active dissociation symptoms throughout the group. Follow-up interviews with stakeholders in the patient's care as well as pre-and post-intervention assessments indicate that the patient had a positive experience with the mindfulness training and improved self-regulation. Analysis of the case study suggests that the mindfulness training may have been safe and effective for this patient due to the integration of choice points throughout the mindfulness training and promotion of structural safety. We expand on this by further discussing six influencing factors that contributed to the outcome of the case study and can serve as a reference for clinicians, researchers, and instructors who wish to offer MBIs safely to patients with PTSD-D.
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Affiliation(s)
- My Ngoc To
- Cambridge Health Alliance, Cambridge, MA, USA
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Poli S, Donisi V, Mazzi MA, Gobbin F, Giusto G, Orlandi R, Schena F, Del Piccolo L, das Nair R, Gajofatto A, Rimondini M. Fostering quality of life in young adults living with multiple sclerosis: a pilot study of a co-created integrated intervention. Front Psychol 2024; 15:1342166. [PMID: 38596329 PMCID: PMC11002131 DOI: 10.3389/fpsyg.2024.1342166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is generally diagnosed at an early age, making the acceptance of this chronic disease challenging. Research dedicated to young adults with MS (YawMS) is still limited. A biopsychosocial co-created intervention for YawMS integrating social, physical and psychological activities was developed (ESPRIMO intervention) in order to improve the quality of life (QoL) and well-being. This pre-post intervention assessment study examines the feasibility of the ESPRIMO intervention and its signal of efficacy. Methods Inclusion criteria were: age 18-45 years, MS diagnosis, Expanded Disability Status Scale score < 3.5. After giving informed consent, YawMS completed a battery of questionnaires, which was repeated after the intervention. The battery included a bespoke feasibility scale, the COOP/WONCA charts, and the Short Form-12 Health Survey (SF-12). Results Fifty-three YAwMS were enrolled and 43 (81.1%) completed the intervention. The majority of the sample positively rated the pleasantness, usefulness and feasibility of the intervention. A significant change in the COOP/WONCA "general QoL" chart (t = 3.65; p < 0.01) and SF-12 mental wellbeing component (t = -3.17; p < 0.01) was found. Discussion ESPRIMO is an innovative intervention that is feasible; preliminary results show an improvement in QoL and mental wellbeing. Further studies are needed to test its efficacy and evaluate future implementation in health services.Clinical trial registration: ClinicalTrials.gov, NCT04431323.
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Affiliation(s)
- Silvia Poli
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Maria Angela Mazzi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Francesca Gobbin
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Giorgia Giusto
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Riccardo Orlandi
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Federico Schena
- Section of Movement Science, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Roshan das Nair
- Department of Health Research, SINTEF Digital, Trondheim, Norway
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alberto Gajofatto
- Section of Neurology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | - Michela Rimondini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Verona, Italy
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van Loggerenberg F, Akena D, Alinaitwe R, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Kulenović AD, Selak N, Kiseljaković M, Musisi S, Nakasujja N, Sewankambo NK, Priebe S. Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda. BMC PRIMARY CARE 2023; 24:241. [PMID: 37968592 PMCID: PMC10652546 DOI: 10.1186/s12875-023-02197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).
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Affiliation(s)
- Francois van Loggerenberg
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Departments of Clinical Epidemiology and Biostatistics and Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Nejra Selak
- Primary Care Center Zenica, Zenica, Bosnia and Herzegovina
| | - Meliha Kiseljaković
- Emergency Medical Center of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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Bolibar Ribas B, Llobera-Cànaves J, García-Ortiz L, Bellón JÁ, Ramos R, García-Campayo J, Sánchez-Pérez Á, Claveria A, Martínez V, Vicens E, Minué C, Gil-Guillen V, Berenguera A, Moleras-Serra A. [The Research Network on Preventive Activities and Health Promotion (redIAPP): a reference network and promoter of primary care research]. Aten Primaria 2023; 55:102694. [PMID: 37481824 PMCID: PMC10391719 DOI: 10.1016/j.aprim.2023.102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 07/25/2023] Open
Abstract
The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.
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Affiliation(s)
- Bonaventura Bolibar Ribas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Joan Llobera-Cànaves
- Unitat de Recerca en Atenció Primaria de Mallorca, Servei de Salut de les Illes Balears (Ib-Salut), Palma, España; Institut de Investigació Sanitària de les Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma, España
| | - Luis García-Ortiz
- Unidad de Investigación en Atención Primaria de Salamanca (APISAL), Gerencia de Atención Primaria de Salamanca, Gerencia Regional de salud de Castilla y León (SACyL), Salamanca, España; Instituto de investigación Biomédica de Salamanca (IBSAL), Salamanca, España; Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, Salamanca, España
| | - Juan-Ángel Bellón
- Instituto de Investigación Biomédica de Málaga (IBIMA Plataforma BIONAND), Málaga, España; Centro de Salud El Palo, Servicio Andaluz de Salud (SAS), Málaga, España; Departmento de Salud Pública y Psiquiatría, Facultad de Medicina, Universidad de Málaga (UMA), Málaga, España
| | - Rafel Ramos
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Grup de Recerca en Salut Vascular, Institut d'Investigació Biomèdica de Girona (IdibGi), Parc Hospitalari Martí Julià, Girona, España; Department de Ciències Mèdiques, Facultat de Medicina, Campus Salut, Universitat de Girona, Girona, España; Atenció Primària, Institut Català de la Salut, Girona, Catalonia, España
| | - Javier García-Campayo
- Grupo de Aragón en Investigación en Atención Primaria (GAIAP), Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España; Servicio de Psiquiatría, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, España
| | - Álvaro Sánchez-Pérez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General Osakidetza, Bilbao, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biocruces Bizkaia, Barakaldo, España
| | - Ana Claveria
- Área Sanitaria de Vigo. Servicio Galego de Saúde (SERGAS), Grupo I-Saúde, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Galicia, España
| | - Vicente Martínez
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España; Facultad de Medicina, Universidad Autónoma de Chile, Talca, Chile
| | - Enric Vicens
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, España
| | - César Minué
- Grupo Clínico Asociado Madrid. Servicio Madrileño de Salud. CS Perales del Río, Madrid, España
| | - Vicente Gil-Guillen
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Unidad de Investigación. Hospital General Universitario de Elda, Alicante, España; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL. Hospital General Universitario de Alicante, Alicante, España
| | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Anna Moleras-Serra
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
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Ivanova MY, Hall A, Weinberger S, Buckingham SL, Copeland WE, Crockett P, Dainer-Best J, D'Alberto C, Dewey L, Foret D, Galano M, Goodrich L, Holly L, Lane N, Leahey M, Lerner M, Marsh J, McGinnis E, Paiva-Salisbury M, Shaw JS, Swift P, Tinker R, Hudziak JJ. The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life. Child Psychiatry Hum Dev 2023; 54:1297-1308. [PMID: 35246775 PMCID: PMC9793330 DOI: 10.1007/s10578-022-01329-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 01/30/2023]
Abstract
This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.
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Affiliation(s)
- Masha Y Ivanova
- Department of Psychiatry, University of Vermont, Burlington, VT, USA.
| | - Allison Hall
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Sara L Buckingham
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Phoenix Crockett
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | | | - Lauren Dewey
- Department of Psychological Sciences, University of Vermont, Burlington, VT, USA
| | - DeShan Foret
- University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Maria Galano
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
| | - Lisa Goodrich
- University of Vermont Medical Center, Burlington, VT, USA
| | - Lindsay Holly
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Nalini Lane
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Maureen Leahey
- University of Vermont Medical Center, Burlington, VT, USA
| | - Mathew Lerner
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jasmine Marsh
- University of Vermont Medical Center, Burlington, VT, USA
| | - Ellen McGinnis
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | | | - Judith S Shaw
- Department of Pediatrics, University of Vermont, Burlington, VT, USA
| | - Pamela Swift
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Rebekah Tinker
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - James J Hudziak
- Department of Psychiatry, University of Vermont, Burlington, VT, USA
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Tofighi B, Marini C, Lee JD, Garland EL. Patient Perceptions of Integrating Meditation-based Interventions in Office-based Opioid Treatment with Buprenorphine: A Mixed-methods Survey. J Addict Med 2023; 17:517-520. [PMID: 37788602 PMCID: PMC10533745 DOI: 10.1097/adm.0000000000001160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Recent findings support the provision of meditation-based interventions (MBIs) in primary care. However, the acceptability of MBI among patients prescribed medications for opioid use disorder (eg, buprenorphine) in primary care remains unclear. This study assessed experiences and preferences for adopting MBI among patients prescribed buprenorphine in office-based opioid treatment (OBOT). METHODS This 23-item, semistructured cross-sectional survey was administered by study staff to patients enrolled in OBOT (N = 72) and consisted of demographic and clinical characteristics, perceptions, experiences with MBI, and preferred strategies to access MBI to support their treatment on buprenorphine. RESULTS Most participants reported practicing at least 1 category of MBI (90.3%) on at least a daily (39.6%) or weekly (41.7%) basis including (1) spiritual meditation (eg, centering prayer; 67.7%); (2) nonmantra meditation (eg, comfortable posture; 61.3%); (3) mindfulness meditation (eg, mindfulness-based stress reduction; 54.8%); and (4) mantra meditation (eg, transcendental meditation; 29.0%). Interest in MBI was motivated by improving one's general health and well-being (73.4%), treatment outcomes with medications for OUD (eg, buprenorphine; 60.9%), and relationships with others (60.9%). Perceived clinical benefits of MBI included reduced anxiety or depression symptoms (70.3%), pain (62.5%), illicit substance or alcohol use (60.9%), cravings for illicit substances (57.8%), and opioid-related withdrawal symptoms (51.6%). CONCLUSIONS Findings from this study indicate high acceptability for adopting MBI among patients prescribed buprenorphine in OBOT. Further research is needed to assess the efficacy of MBI to improve clinical outcomes among patients initiating buprenorphine in OBOT.
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Affiliation(s)
- Babak Tofighi
- New York University School of Medicine, Department of Population Health
- Bellevue Hospital Center Division of General Internal Medicine
- Center for Drug Use and HIV Research
- Nathan Kline Institute for Psychiatric Research
| | - Christina Marini
- New York University School of Medicine, Department of Population Health
| | - Joshua D. Lee
- New York University School of Medicine, Department of Population Health
- Bellevue Hospital Center Division of General Internal Medicine
- Center for Drug Use and HIV Research
| | - Eric L. Garland
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work
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Tran T, Finlayson M, Nalder E, Trothen T, Donnelly C. Occupational Therapist-Led Mindfulness Training Program for Older Adults Living with Early Cognitive Decline in Primary Care: A Pilot Randomized Controlled Trial. J Alzheimers Dis Rep 2023; 7:775-790. [PMID: 37662611 PMCID: PMC10473152 DOI: 10.3233/adr-230006] [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: 01/20/2023] [Accepted: 05/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Community-dwelling older adults with early cognitive deficits experience less efficiency in performing everyday life tasks, resulting in decreased satisfaction and other adverse psychological outcomes. Mindfulness training has been linked to cognitive and psychological improvements and, most recently, has been identified as a potential intervention supporting performance of everyday life activities. Objective This study aimed to evaluate whether mindfulness practice can improve perceived performance and satisfaction with everyday life activity and secondary psychological outcomes. Methods This study is a pilot randomized controlled trial (RCT) in an interprofessional primary care team practice in Toronto, Ontario, Canada. The participants were 27 older adults aged 60 years of age or older living with early cognitive deficits. Participants were randomized into an 8-Week mindfulness training program (n = 14) group or a Wait-List Control (WLC; n = 13) group compared at baseline, post-intervention and 4-weeks follow-up. MANOVAs with post-hoc independent t-tests were used to compare between groups at different time points. Results There was a significant improvement in anxiety for the intervention group compared to the WLC group at post-intervention; Time-2 (mean difference = 3.90; CI = 0.04-7.75; p = 0.04) with large effect size (d = 0.80). Conclusion Mindfulness training significantly improved anxiety scores for patients with early cognitive deficits post-intervention. Further work is required to test the sustainability of reduced anxiety over time, but this study demonstrated that MBSR is a promising primary care intervention for those living with early cognitive deficits. This study warrants the pursuit of a future study in exploring how long the reduced anxiety effects would be sustained.
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Affiliation(s)
- Todd Tran
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
- Clinical Site: Women’s College Hospital, Toronto, ON, Canada
- University of Toronto, Temerty Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Toronto, ON, Canada
| | - Marcia Finlayson
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
| | - Emily Nalder
- University of Toronto, Temerty Faculty of Medicine, Department of Occupational Science & Occupational Therapy, Toronto, ON, Canada
| | - Tracy Trothen
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
- Queen’s University, jointly appointed to the School of Rehabilitation Therapy and School of Religion (Theological Hall), Kingston, ON, Canada
| | - Catherine Donnelly
- Queen’s University, Faculty of Health Sciences, School of Rehabilitation Therapy, Aging & Health, Kingston, ON, Canada
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Tran T, Donnelly C, Nalder E, Trothen T, Finlayson M. Mindfulness-based stress reduction for community-dwelling older adults with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in primary care: a mixed-methods feasibility randomized control trial. BMC PRIMARY CARE 2023; 24:44. [PMID: 36759766 PMCID: PMC9912594 DOI: 10.1186/s12875-023-02002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Primary care is often the first point of contact when community-dwelling older adults experience subjective cognitive decline (SCD) or mild cognitive impairment (MCI). Living with SCD or MCI can be life-altering, resulting in low mood and increased anxiety, further exacerbating cognitive decline. However, there is scant literature on interventions that interprofessional primary care providers can provide to support those living with SCD or MCI. Practicing mindfulness-based stress reduction (MBSR) in an interprofessional primary care setting may support emotional health and well-being for those with cognitive decline, but it has not been studied in an interprofessional primary care context. OBJECTIVES This study's primary aim was to determine the feasibility of, and perceived benefits to and satisfaction with, a 9-Week MBSR program delivered in a team-based primary care setting. The secondary aim was to examine the acceptability of using technology (computer tablet and App Insight Timer®) for program delivery and home practice. METHODS A convergent mixed-methods, single-blind pilot randomized controlled trial (RCT) study design was used. A quantitative strand was used to evaluate the feasibility of the MBSR program. The qualitative strand used a focus group with older adult participants with SCD or MCI. Individual semi-structured interviews with occupational therapists who are qualified-MBSR teachers were conducted to explore the acceptability of using computer tablets for program delivery and home practice. RESULTS 27 participants were randomized (14 MBSR; 13 Control) with retention rates of 64.3% (9/14 completed ≥6 sessions), true adherence rates of 50% (7/14 met ≥19.5 hrs of home practice), 21.4% attrition rates, and 100% post-intervention follow-up. No participants who used computer tablets at the beginning of the intervention switched to low technology. Older adult participants found the use of computer tablets in the MBSR course acceptable and appreciated the portability of the tablets. CONCLUSIONS Based on the lower-than-expected rates of recruitment, retention, and adherence, our study, as designed, did not meet the feasibility benchmarks that were set. However, with minor modifications to the design, including changing how participants who drop-out are analyzed, extending recruitment, and adding multiple sites, this intervention would be well suited to further study using a full-scale RCT. However, we found that embedding MBSR in an interprofessional primary care setting was feasible in practice and qualitative data highlighted the satisfaction and perceived benefits based on the intervention. The use of technology was acceptable and portable, as participants utilized their computer tablets consistently until the study's end. Our study showed that older adults living with SCD or MCI were highly receptive to learning how to use technology, and future group intervention programs in interprofessional primary care settings may also incorporate tablet use. TRIAL REGISTRATION This study was reviewed and approved by the Research Ethics Board in Toronto, Ontario, Canada (REB# 2017-0056-E); Queen's University (REB# 6026418) in Kingston, Ontario, Canada, and Clinicaltrials.gov (08/03/2019; NCT03867474).
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Affiliation(s)
- Todd Tran
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, Ontario, K7L 3N6, Canada. .,Clinical Site: Women's College Hospital, 76 Grenville St., Toronto, Ontario, M5S 1B2, Canada.
| | - Catherine Donnelly
- grid.410356.50000 0004 1936 8331School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Emily Nalder
- grid.17063.330000 0001 2157 2938Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7 Canada
| | - Tracy Trothen
- grid.410356.50000 0004 1936 8331Jointly appointed to the School of Rehabilitation Therapy and School of Religion (Theological Hall), Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
| | - Marcia Finlayson
- grid.410356.50000 0004 1936 8331School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, Ontario K7L 3N6 Canada
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Liu H, Cai K, Wang J, Zhang H. The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis. Front Public Health 2023; 10:1045642. [PMID: 36699873 PMCID: PMC9869042 DOI: 10.3389/fpubh.2022.1045642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women. Methods A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers. Results A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women. Conclusion MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation. Systematic review registration https://www.crd.york.ac.uk/prospero/#recordDetails.
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Berta-Otero T, Barceló-Soler A, Montero-Marin J, Maloney S, Pérez-Aranda A, López-Montoyo A, Salvo V, Sussumu M, García-Campayo J, Demarzo M. Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian "Acceptance and Action Questionnaire" (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:225. [PMID: 36612546 PMCID: PMC9819638 DOI: 10.3390/ijerph20010225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms. METHODS A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety. RESULTS The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms. CONCLUSIONS The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.
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Affiliation(s)
- Tatiana Berta-Otero
- Centro Mente Aberta (Brazilian Center for Mindfulness and Health Promotion), Department of Preventive Medicine, UNIFESP, São Paulo 04753-060, Brazil
| | - Alberto Barceló-Soler
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiology and Public Health—CIBERESP), 28029 Madrid, Spain
| | - Shannon Maloney
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | | | - Alba López-Montoyo
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón de la Plana, Spain
| | - Vera Salvo
- Centro Mente Aberta (Brazilian Center for Mindfulness and Health Promotion), Department of Preventive Medicine, UNIFESP, São Paulo 04753-060, Brazil
| | - Marcio Sussumu
- Centro Mente Aberta (Brazilian Center for Mindfulness and Health Promotion), Department of Preventive Medicine, UNIFESP, São Paulo 04753-060, Brazil
| | - Javier García-Campayo
- Institute of Health Research of Aragon (IIS), 50009 Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 28029 Madrid, Spain
- Psychiatric Service, Hospital Miguel Servet, 50009 Zaragoza, Spain
- Department of Psychiatry, University of Zaragoza, 50009 Zaragoza, Spain
| | - Marcelo Demarzo
- Centro Mente Aberta (Brazilian Center for Mindfulness and Health Promotion), Department of Preventive Medicine, UNIFESP, São Paulo 04753-060, Brazil
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Dhungana RR, Pedisic Z, de Courten M. Implementation of non-pharmacological interventions for the treatment of hypertension in primary care: a narrative review of effectiveness, cost-effectiveness, barriers, and facilitators. BMC PRIMARY CARE 2022; 23:298. [PMID: 36418958 PMCID: PMC9686020 DOI: 10.1186/s12875-022-01884-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The current guidelines for the prevention, detection, evaluation, and management of hypertension recommend six types of non-pharmacological interventions: alcohol reduction, salt intake reduction, increased potassium intake, physical activity, weight loss, and heart-healthy diets. However, the non-pharmacological interventions are still not widely used in primary care. In this paper, we, therefore, reviewed and summarised the evidence on the effectiveness, cost-effectiveness, barriers, and facilitators of non-pharmacological interventions for the treatment of hypertension in primary care. METHODS A thorough literature search was conducted in Embase, Google Scholar, and PubMed databases, to identify the most recent reviews or, in their absence, primary studies on alcohol reduction, salt intake reduction, potassium supplementation, physical activity, weight reduction, heart-healthy diets, and other non-pharmacological interventions for the treatment of hypertension in primary care. RESULTS Alcohol reduction is a non-pharmacological intervention for the treatment of hypertension in primary care with proven effectiveness, feasibility, and acceptability. Interventions for sodium intake reduction, physical activity, and weight reduction are effective but there is insufficient evidence regarding their feasibility and acceptability in primary care settings. Evidence on the effectiveness of potassium intake and heart-healthy diets is limited and inconsistent. There is a lack of evidence on the cost-effectiveness of non-pharmacological interventions in the treatment of hypertension. The most common barriers to deliver such interventions related to healthcare providers include a lack of time, knowledge, self-confidence, resources, clear guidelines, and financial incentives. The most common barriers related to patients include a lack of motivation and educational resources. Less evidence is available on facilitators of implementing non-pharmacological interventions in primary care. Besides, facilitators differed by different types of interventions. CONCLUSIONS Available evidence suggests that more pragmatic, clinically feasible, and logistically simple interventions are required for sodium intake reduction, physical activity, and weight reduction in primary care settings. Future studies should provide further evidence on the effectiveness of weight control, potassium intake, and heart-healthy diets. More research is also needed on cost-effectiveness and facilitators of all types of effective non-pharmacological interventions for the treatment of hypertension in primary care.
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Affiliation(s)
- Raja Ram Dhungana
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Jalón C, Montero-Marin J, Modrego-Alarcón M, Gascón S, Navarro-Gil M, Barceló-Soler A, Delgado-Suárez I, García-Campayo J. Implementing a training program to promote mindful, empathic, and pro-environmental attitudes in the classroom: a controlled exploratory study with elementary school students. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00962-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Jedel S, Beck T, Swanson G, Hood MM, Voigt RM, Gorenz A, Jakate S, Raeisi S, Hobfoll S, Keshavarzian A. Mindfulness Intervention Decreases Frequency and Severity of Flares in Inactive Ulcerative Colitis Patients: Results of a Phase II, Randomized, Placebo-Controlled Trial. Inflamm Bowel Dis 2022; 28:1872-1892. [PMID: 35661212 PMCID: PMC9713500 DOI: 10.1093/ibd/izac036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ulcerative Colitis (UC) is a chronic, inflammatory disease, characterized by symptomatic periods (flare) interspersed with asymptomatic periods (remission). Evidence suggests that psychological stress can trigger flare. Studies have shown that mindfulness interventions (MI) reduce stress, foster more adaptive coping, and improve quality of life, but have been minimally used for UC patients. The objective of this study was to determine whether participation in an MI results in improvements in UC disease course and inflammatory cascades, mindfulness, perceived stress, and other psychological outcomes in inactive UC patients with limited or no exposure to past MI. METHODS Participants were randomized to an 8-week MI or control group. Biological and psychological assessments were performed at baseline, post 8-week course, and at 6- and 12-months. RESULTS Forty-three participants enrolled. The MI increased the state of mindfulness and mindfulness skills, decreased perceived stress and stress response in patients with inactive UC. The MI intervention significantly decreased the incidence of flare over 12 months (P < .05). None of the UC patients in the MI flared during 12 months, while 5 of 23 (22%) control group participants flared during the same period. CONCLUSIONS MIs could be considered as adjuvant treatment for a subset of UC patients with high perceived stress and low state of mindfulness.The trial was registered at clinicaltrials.gov as NCT01491997.
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Affiliation(s)
- Sharon Jedel
- Address correspondence to: Sharon Jedel, PsyD, 1725 W. Harrison Street, Suite 207, Chicago, IL 60612 ()
| | - Todd Beck
- Bioinformatics and Biostatics Core, Rush University Medical Center, Chicago, IL, USA
| | - Garth Swanson
- Bioinformatics and Biostatics Core, Rush University Medical Center, Chicago, IL, USA
| | - Megan M Hood
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Robin M Voigt
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Annika Gorenz
- Rush University Medical Center, College of Nursing, Chicago, IL, USA
| | - Shriram Jakate
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Shohreh Raeisi
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Stevan Hobfoll
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ali Keshavarzian
- Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
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Fosnot L, Jones CD, Keniston A, Burden M, Indovina KA, Patel H. Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study. PATIENT EDUCATION AND COUNSELING 2022; 105:1209-1215. [PMID: 34511284 DOI: 10.1016/j.pec.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts. METHODS We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters. RESULTS Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources. CONCLUSIONS Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms. PRACTICE IMPLICATIONS Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being.
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Affiliation(s)
- Lisa Fosnot
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado, Denver Health, Denver, CO, USA.
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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Spirituality in Primary Care Settings: Addressing the Whole Person through Christian Mindfulness. RELIGIONS 2022. [DOI: 10.3390/rel13040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spirituality is integral to the provision of high-quality health and mental healthcare. Despite this, there is limited research on how to assess and address spiritual determinants of health within primary care settings. Many individuals initiate care within primary care settings, and several will only receive care from their primary care provider. The high prevalence of individuals receiving care within primary care settings coupled with the positive impact spirituality has on health and mental health reveal the need to care for spiritual needs within primary care settings. Integrated care is a model of treatment that addresses the fragmentation of healthcare by assessing and addressing the psychosocial determinants of health within primary care settings. The structure of integrated care models is designed to treat the biological and psychosocial determinants of health and, as a result, provide suitable context for assessing and addressing spirituality in primary care settings. The purpose of this paper is to (1) summarize the efforts to integrate spirituality within primary care (whole person care models), (2) summarize the integrated care efforts to promote psychosocial integration, (3) highlight Christian mindfulness as a potential form of intervention to address spirituality within integrated care models, and (4) operationalize the delivery of Christian mindfulness within a fully integrated care model. The conclusions from the conceptual review include both practice innovation for the assessment and intervention of spirituality in integrated care as well as potential direction for future research to study Christian mindfulness within integrated care settings.
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Collado-Navarro C, Navarro-Gil M, Pérez-Aranda A, López-Del-Hoyo Y, Garcia-Campayo J, Montero-Marin J. Effectiveness of mindfulness-based stress reduction and attachment-based compassion therapy for the treatment of depressive, anxious, and adjustment disorders in mental health settings: A randomized controlled trial. Depress Anxiety 2021; 38:1138-1151. [PMID: 34288280 DOI: 10.1002/da.23198] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To study the effectiveness of attachment-based compassion therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety, or adjustment disorders, and to explore its mechanisms of action. METHODS This randomized controlled trial involved the assessment time points of pretreatment, posttreatment and 6-month follow-up. A total of 90 patients from three mental health units in Castellón, Spain, were recruited and randomly assigned to "ABCT + treatment as usual (TAU)," "Mindfulness-based stress reduction (MBSR) + TAU" or "TAU" alone. Affective distress, as measured by the "Depression, Anxiety and Stress Scales" (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were used to estimate the effectiveness of the program, and path analyses were conducted to study the potential mechanistic role of mindfulness and self-compassion. RESULTS ABCT was not superior to MBSR in any outcome or at any assessment point. ABCT was superior to TAU alone both posttreatment (B = -13.20; 95% confidence interval [CI]: -19.57, -6.84) and at 6-month follow-up (B = -7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU alone both posttreatment (B = -11.51; 95% CI: -17.97, -5.05) and at 6-month follow-up (B = -8.59; 95% CI: -15.09, -2.10), with large effects (d ≥ 0.90). Changes produced by ABCT in DASS-21 were mediated by self-compassion, whereas changes produced by MBSR were mediated by both mindfulness and self-compassion. CONCLUSION ABCT is effective for reducing affective distress in patients with anxiety, depressive and adjustment disorders, although its effect is not superior to that offered by MBSR. Self-compassion seems to be a significant mediator of the effects of ABCT.
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Affiliation(s)
- Carlos Collado-Navarro
- Department of Psychology, University and Polytechnic La Fe Hospital, Valencia, Spain.,Department of Psychology and Sociology, Department of Psychiatry, University of Zaragoza, Zaragoza, Spain
| | - Mayte Navarro-Gil
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Adrián Pérez-Aranda
- Research Group on Mental Health in Primary Care, Institute of Health Research of Aragon (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain.,Research, Innovation and Teaching Unit, AGORA Research Group, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | - Yolanda López-Del-Hoyo
- Department of Psychology and Sociology, Department of Psychiatry, University of Zaragoza, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain.,Research Group on Mental Health in Primary Care, Institute of Health Research of Aragon (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Garcia-Campayo
- Department of Psychology and Sociology, Department of Psychiatry, University of Zaragoza, Zaragoza, Spain.,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain.,Research Group on Mental Health in Primary Care, Institute of Health Research of Aragon (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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Smith JL, Allen JW, Haack CI, Wehrmeyer KL, Alden KG, Lund MB, Mascaro JS. Impact of App-Delivered Mindfulness Meditation on Functional Connectivity, Mental Health, and Sleep Disturbances Among Physician Assistant Students: Randomized, Wait-list Controlled Pilot Study. JMIR Form Res 2021; 5:e24208. [PMID: 34665153 PMCID: PMC8564666 DOI: 10.2196/24208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/23/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Health care provider and trainee burnout results in substantial national and institutional costs and profound social effects. Identifying effective solutions and interventions to cultivate resilience among health care trainees is critical. Although less is known about the mental health needs of physician assistants (PAs) or PA students, accumulating research indicates that they experience similarly alarming rates of burnout, depression, and emotional exhaustion. Mobile app-delivered mindfulness meditation may be an effective part of salubrious programming to bolster long-term resilience and health among PA students. OBJECTIVE This study aims to examine the impact of app-delivered mindfulness meditation on self-reported mental health symptoms among PA students. A secondary aim is to investigate changes in brain connectivity to identify neurobiological changes related to changes in mental health symptoms. METHODS We recruited PA students enrolled in their third semester of PA school and used a longitudinal, randomized, wait-list-controlled design. Participants randomized to the mindfulness group were provided 1-year subscriptions to the 10% Happier app, a consumer-based meditation app, and asked to practice every day for 8 weeks. Before randomization and again after completion of the 8-week program, all participants completed resting-state functional magnetic resonance imaging as well as self-report assessments of burnout, depression, anxiety, and sleep impairment. App use was acquired as a measure of mindfulness practice time. RESULTS PA students randomized to the mindfulness group reported improvements in sleep impairment compared with those randomized to the wait-list control group (ηp2=0.42; P=.01). Sleep impairment decreased significantly in the mindfulness group (19% reduction; P=.006) but not in the control group (1% reduction; P=.71). There were no other significant changes in mental health for those randomized to app-delivered mindfulness. Across all students, changes in sleep impairment were associated with increased resting-state functional connectivity between the medial prefrontal cortex (a component of the default mode network) and the superior temporal gyrus, as well as between areas important for working memory. Changes in connectivity predicted categorical conversion from impaired to nonimpaired sleep in the mindfulness group. CONCLUSIONS This pilot study is the first to examine app-based mindfulness for PA students' mental health and investigate the impact of mindfulness on PA students' brain function. These findings suggest that app-delivered mindfulness may be an effective tool to improve sleep dysfunction and that it may be an important part of the programming necessary to reduce the epidemic of suffering among health profession trainees.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
- Department of Neurology, Emory University, Atlanta, GA, United States
| | - Carla I Haack
- Department of Surgery, Emory University, Atlanta, GA, United States
| | - Kathryn L Wehrmeyer
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Kayley G Alden
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Maha B Lund
- Physician Assistant Program, Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
| | - Jennifer S Mascaro
- Department of Family and Preventative Medicine, Emory University, Atlanta, GA, United States
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Schuman-Olivier Z, Trombka M, Lovas DA, Brewer JA, Vago DR, Gawande R, Dunne JP, Lazar SW, Loucks EB, Fulwiler C. Mindfulness and Behavior Change. Harv Rev Psychiatry 2021; 28:371-394. [PMID: 33156156 PMCID: PMC7647439 DOI: 10.1097/hrp.0000000000000277] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/22/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.
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21
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Effectiveness of a Mindfulness and Self-Compassion Standard Training Program versus an Abbreviated Training Program on Stress in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910230. [PMID: 34639532 PMCID: PMC8507764 DOI: 10.3390/ijerph181910230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 12/18/2022]
Abstract
Stress is one of the most common problems among healthcare professionals, as they are exposed to potentially stressful and emotionally challenging situations in the workplace. Mindfulness-based stress reduction (MBSR) training programs have been shown to decrease stress. The objective of this study was to compare the effectiveness of an abbreviated 4-weeks MBSR training program in relation to a standard 8-weeks one on the stress levels. A controlled and randomized clinical trial was designed, in which 112 tutors and resident intern specialists in Family and Community Medicine and Nursing of six Spanish National Health System teaching units (TUs) participated. Participants included in the experimental groups (EGs) received a MBRS training program (standard or abbreviated), while control group (CG) participants did not receive any intervention. The stress levels were assessed by the Perceived Stress Questionnaire (PSQ) in three different moments during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant reduction in stress (F(2,91) = 5.165; p = 0.008; η2 = 0.102) in the post-test visit, attributable to the implementation of the standard training program, but without the maintenance of its effects over time. No significant impact of the abbreviated training program on stress levels was observed in the intergroup comparison. A standard 8-weeks MBSR training program aimed at tutors and resident intern specialists in Family and Community Medicine and Nursing produces significant improvements in stress levels compared with the abbreviated intervention and no intervention. New studies about abbreviated training programs are needed to provide effective treatments which improve well-being of these professionals.
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22
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Trombka M, Creedon TB, Demarzo M, Cuoco LT, Smith L, Oxnard AC, Rozembaque AT, Hirayama MS, Moreno NB, Comeau A, Gawande R, Griswold T, Cook BL, Rocha NS, Schuman-Olivier Z. Mindfulness Training for Primary Care for Portuguese-Speaking Immigrants: A Pilot Study. Front Psychiatry 2021; 12:664381. [PMID: 34566708 PMCID: PMC8458702 DOI: 10.3389/fpsyt.2021.664381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Portuguese-speaking immigrants are a growing underserved population in the Unites States who experience high levels of psychological distress and increased vulnerability to mental health disorders such as depression and anxiety. Current evidence shows that mindfulness-based interventions (MBIs) are effective to promote physical and mental health among educated English speakers; nonetheless, the lack of diversity in the mindfulness literature is a considerable limitation. To our knowledge, the feasibility and acceptability of MBIs among Portuguese-speaking immigrants have not yet been investigated. Methods: This single-arm pilot study (N = 30) explored the feasibility, acceptability, and cultural aspects of Mindfulness Training for Primary Care (MTPC)-Portuguese among Portuguese-speaking immigrants in the Boston area. MTPC is an 8-week, primary care-adapted, referral-based, insurance-reimbursable, trauma-informed MBI that is fully integrated into a healthcare system. The study also examined intervention preliminary effectiveness on mental health outcomes (depression and anxiety symptoms) and self-regulation (emotional regulation, mindfulness, self-compassion, interoceptive awareness), and initiation of health behavior was explored. Results: Primary care providers referred 129 patients from 2018 to 2020. Main DSM-5 primary diagnoses were depression (76.3%) and anxiety disorders (6.7%). Participants (N = 30) attended a mean of 6.1 (SD 1.92) sessions and reported a mean of 213.7 (SD = 124.3) min of practice per week. All survey finishers would recommend the program to a friend, found the program helpful, and rated the overall program as "very good" or "excellent," and 93% would participate again, with satisfaction mean scores between 4.6 and 5 (Likert scale 0-5). Participants and group leaders provided feedback to refine MTPC-Portuguese culturally responsiveness regarding materials language, settings, time, food, and community building. Patients exhibited reductions in depression (d = 0.67; p < 0.001) and anxiety (d = 0.48; p = 0.011) symptoms, as well as enhanced emotional regulation (d = 0.45; p = 0.009), and among survey finishers, 50% initiated health behavior change through action plan initiation. Conclusion: This pilot study suggests that MTPC-Portuguese is feasible, acceptable, and culturally appropriate among Portuguese-speaking patients in the Boston area. Furthermore, the intervention might potentially decrease depression and anxiety symptoms, facilitate health behavior change, and improve emotional regulation. MTPC-Portuguese investigation with larger samples in controlled studies is warranted to support its dissemination and implementation in the healthcare system. Clinical Trial Registration: Identifier: NCT04268355.
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Affiliation(s)
- Marcelo Trombka
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry–Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center–Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Timothy B. Creedon
- Cambridge Health Alliance, Health Equity Research Lab, Cambridge, MA, United States
| | - Marcelo Demarzo
- Department of Preventive Medicine, Mente Aberta–Brazilian Center for Mindfulness and Health Promotion, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Letícia T. Cuoco
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Lydia Smith
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Alexandra C. Oxnard
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Alana T. Rozembaque
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Marcio S. Hirayama
- Mente Aberta—Brazilian Center for Mindfulness and Health Promotion, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Natalia B. Moreno
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Alexandra Comeau
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Richa Gawande
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Todd Griswold
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Benjamin L. Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Health Equity Research Lab, Cambridge, MA, United States
| | - Neusa S. Rocha
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry–Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center–Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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23
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Modrego-Alarcón M, López-Del-Hoyo Y, García-Campayo J, Pérez-Aranda A, Navarro-Gil M, Beltrán-Ruiz M, Morillo H, Delgado-Suarez I, Oliván-Arévalo R, Montero-Marin J. Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behav Res Ther 2021; 142:103866. [PMID: 33957506 DOI: 10.1016/j.brat.2021.103866] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention. METHODS This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to 'MBP', 'MBP + VR', or 'Relaxation' (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme. RESULTS Both 'MBP' (B = -2.77, d = -0.72, p = .006) and 'MBP + VR' (B = -2.44, d = -0.59, p = .014) were superior to 'Relaxation' in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the 'MBP + VR' group, with higher retention rates and session attendance (p < .001). CONCLUSIONS This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT03771300.
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Affiliation(s)
- Marta Modrego-Alarcón
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Yolanda López-Del-Hoyo
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Javier García-Campayo
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Miguel Servet University Hospital, Zaragoza, Spain
| | - Adrián Pérez-Aranda
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; AGORA Research Group; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Basic Psychology, Autonomous University of Barcelona, Cerdanyola Del Vallès, Spain.
| | - Mayte Navarro-Gil
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Beltrán-Ruiz
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Héctor Morillo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Irene Delgado-Suarez
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Rebeca Oliván-Arévalo
- AGORA Research Group; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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24
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Pérula-de Torres LÁ, Verdes-Montenegro-Atalaya JC, Melús-Palazón E, García-de Vinuesa L, Valverde FJ, Rodríguez LA, Lietor-Villajos N, Bartolomé-Moreno C, Moreno-Martos H, García-Campayo J, González-Santos J, Rodríguez-Fernández P, León-del-Barco B, Soto-Cámara R, González-Bernal JJ. Comparison of the Effectiveness of an Abbreviated Program versus a Standard Program in Mindfulness, Self-Compassion and Self-Perceived Empathy in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4340. [PMID: 33923868 PMCID: PMC8073262 DOI: 10.3390/ijerph18084340] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271; p = 0.042; η2 = 0.067) and self-compassion (F(2,91) = 6.046; p = 0.003; η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880; p = 0.025; η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.
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Affiliation(s)
- Luis Ángel Pérula-de Torres
- Multi-Professional Teaching Unit for Family and Community Care of Córdoba, Healthcare District of Córdoba and Guadalquivir, Institute Maimónides of Research Córdoba (Imibic), Reina Sofía University Hospital, University of Córdoba, 14001 Cordoba, Spain;
| | | | - Elena Melús-Palazón
- Family and Community Medicine Teaching Department of Zaragoza Sector 1, 5018 Zaragoza, Spain; (E.M.-P.); (C.B.-M.)
| | - Leonor García-de Vinuesa
- Multi-Professional Teaching Unit for Family and Community Care of Córdoba, Healthcare District of Córdoba and Guadalquivir, 14001 Córdoba, Spain;
| | | | - Luis Alberto Rodríguez
- Family and Community Medicine Teaching Department of Ponferrada, Ponferrada, 24400 León, Spain;
| | - Norberto Lietor-Villajos
- Family and Community Medicine Teaching Department of Jaen, 23007 Jaen, Spain; (F.J.V.); (N.L.-V.)
| | - Cruz Bartolomé-Moreno
- Family and Community Medicine Teaching Department of Zaragoza Sector 1, 5018 Zaragoza, Spain; (E.M.-P.); (C.B.-M.)
| | - Herminia Moreno-Martos
- Multi-Professional Teaching Unit for Family and Community Care of Almería, 04009 Almería, Spain;
| | | | - Josefa González-Santos
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (P.R.-F.); (J.J.G.-B.)
| | | | - Benito León-del-Barco
- Department of Psychology, Faculty of Teacher Training College, University of Extremadura, 10071 Caceres, Spain;
| | - Raúl Soto-Cámara
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (P.R.-F.); (J.J.G.-B.)
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25
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Trombka M, Demarzo M, Campos D, Antonio SB, Cicuto K, Walcher AL, García-Campayo J, Schuman-Olivier Z, Rocha NS. Mindfulness Training Improves Quality of Life and Reduces Depression and Anxiety Symptoms Among Police Officers: Results From the POLICE Study-A Multicenter Randomized Controlled Trial. Front Psychiatry 2021; 12:624876. [PMID: 33716824 PMCID: PMC7952984 DOI: 10.3389/fpsyt.2021.624876] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations. Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated. Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined. Clinical Trial Registration: www.ClinicalTrials.gov. identifier: NCT03114605.
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Affiliation(s)
- Marcelo Trombka
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Marcelo Demarzo
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Grupo de Investigación en Salud Mental en Atención Primaria, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sonia B. Antonio
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Karen Cicuto
- Mente Aberta, Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ana L. Walcher
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Javier García-Campayo
- Grupo de Investigación en Salud Mental en Atención Primaria, Miguel Servet University Hospital, Zaragoza, Spain
| | - Zev Schuman-Olivier
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Cambridge Health Alliance, Center for Mindfulness and Compassion, Cambridge, MA, United States
| | - Neusa S. Rocha
- Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Innovations and Interventions for Quality of Life Research Group, Porto Alegre, Brazil
- Clinical Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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26
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Magallón-Botaya R, Pérula-de Torres LA, Verdes-Montenegro Atalaya JC, Pérula-Jiménez C, Lietor-Villajos N, Bartolomé-Moreno C, Garcia-Campayo J, Moreno-Martos H. Mindfulness in primary care healthcare and teaching professionals and its relationship with stress at work: a multicentric cross-sectional study. BMC FAMILY PRACTICE 2021; 22:29. [PMID: 33530929 PMCID: PMC7856795 DOI: 10.1186/s12875-021-01375-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 01/17/2021] [Indexed: 12/30/2022]
Abstract
Background Work stress is a common problem among the health personnel of the Spanish National Health System. The objective of this paper is to assess the state of mindfulness among Spanish primary care providers and to evaluate its potential relationship with work stress and basic labor and sociodemographic characteristics. Methods Cross-sectional, multi-centric study. Primary care nurses, teachers, teaching collaborators and residents assigned to six Spanish Family Medicine/Family and Community Care Departments were invited to participate (n = 475). A template was designed in Google Forms, including sociodemographic and work-related variables. The state of mindfulness was measured with the Five Facet Mindfulness Questionnaire (FFMQ), while work-related stress was measured using an ordinal scale ranging from 0 to 10 points. Descriptive and inferential statistical analyses were carried out, as well as bivariate and multivariate statistics. Results The mean age of participants was 40,14 ± 13.12 (range:23–65 years); 66.9% were women, 42.5% internal medicine residents, 29.3% family physicians, and 20.2% nurses. More than half (54.5%) knew about mindfulness, with 24.0% have received training on it, and 22.5% were usual practitioners. The average level of mindfulness was 127.18 ± 15.45 (range: 89–177). The average score of stress at work was 6.00 ± 2.44; 49.9% (range: 0–10). 49.9% of participants scored 7 or more on the stress at work scale. There was an inverse correlation between the levels of mindfulness (FFMQ total score) and work-related stress (Spearman’s r = − 0.155, p = 0.003). Significant relationships between the mindfulness practice and the level of mindfulness (F = 29.80, p < 0.001), as well as between the mindfulness practice and the level of work-related stress (F = 9.68, p = 0.042), were also found. Conclusions Levels of mindfulness in primary care health providers were in line with those levels observed in other groups of health professionals. Half of all of the primary care providers suffered from a high degree of stress. Although weak, inverse relationships were observed between levels of mindfulness and stress at work, with lower values of stress at work among those who practiced mindfulness. Trial registration NCT03629457. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01375-2.
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Affiliation(s)
- Rosa Magallón-Botaya
- Family and Community Medicine Teaching Department of Zaragoza Sector 1, Institute of Health Carlos III (redIAPP 06/18), IIS-Aragon, Group B21-R17, University of Zaragoza, Zaragoza, Spain
| | - Luis Angel Pérula-de Torres
- Multi-professional Teaching Unit for Family and Community Care of Córdoba, Healthcare District of Córdoba and Guadalquivir, Institute Maimónides of Research Córdoba (IMIBIC)/Hospital Reina Sofía/University of Córdoba, Isla de Lanzarote, 3, 14011, Córdoba, Spain. .,Instittute of Health Carlos III (redIAPP 06/18), IIS-Aragon, Group B. University of Zaragoza, Zaragoza, Spain.
| | | | - Celia Pérula-Jiménez
- Multi-professional Teaching Unit for Family and Community Care of Córdoba, Healthcare District of Córdoba and Guadalquivir, Institute Maimónides of Research Córdoba (IMIBIC)/Hospital Reina Sofía/University of Córdoba, Isla de Lanzarote, 3, 14011, Córdoba, Spain
| | | | - Cruz Bartolomé-Moreno
- Family and Community Medicine Teaching Department of Zaragoza Sector 1, Institute of Health Carlos III (redIAPP 06/18), IIS-Aragon, Group B21-R17, University of Zaragoza, Zaragoza, Spain
| | | | - Herminia Moreno-Martos
- Multi-professional Teaching Unit for Family and Community Care of Almeria, Almeria, Spain
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Goldstein E, Topitzes J, Benton SF, Sarino KP. Evaluation of a Motivation-Based Intervention to Reduce Health Risk Behaviors among Black Primary Care Patients with Adverse Childhood Experiences. Perm J 2021; 24:1-9. [PMID: 33482960 DOI: 10.7812/tpp/19.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Considerable evidence suggests that greater attention should be paid to the impact of trauma among low-income, racial/ethnic minority patients living in urban communities. The goal of this article is to evaluate a 2-session, motivational intervention designed to motivate a change in health risk behaviors among low-income, self-identified Black/African American patients with adverse childhood experiences (ACEs). METHODS Qualitative self-reported data described helpful aspects of the intervention and those that could be improved. Eligible participants with 1 or more ACEs being seen in a community-based clinic were interviewed by a mental health clinician researcher for 2 in-person sessions scheduled 1 month apart. Content analysis was performed using a general inductive approach to identify core themes. RESULTS In total, 36 of 40 participants completed both sessions, with the majority reporting a high rate of satisfaction. Participants emphasized the importance of talking with a trained professional who could listen without judgment, understand patient challenges, clarify patient goals, and facilitate behavior change plans. Suggestions for improvement included modifying structure and content, enhancing clinic environment, improving linkages to behavioral health, and increasing communication and collaboration with clinicians. CONCLUSION Participant evaluation data gathered for this study suggest that through the practice of asking, listening, and accepting, clinicians can help patients who have been exposed to childhood adversity better understand themselves and promote healthy coping behaviors. This study provides preliminary data on the needs of underserved patients that can be utilized to develop and deliver health promotion interventions using a trauma-informed approach in community-based clinics.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI
| | - James Topitzes
- Institute for Child and Family Well-Being, University of Wisconsin-Milwaukee Helen Bader School of Social Welfare, Milwaukee, WI
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Brief Mindfulness Therapy and Mental Health in People Exposed to a Recent Stressful Event: A Study of Multiple Cases with Follow-Up. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2021. [DOI: 10.1007/s10879-020-09483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Torres C, Brophy-Herb HE, McCaffery H, Struza J, Williams JM, Choi HH, Horodynski MA, Contreras D, Kerver J, Kaciroti N, Lumeng JC. Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score. Acad Pediatr 2021; 21:70-75. [PMID: 32590057 PMCID: PMC7755689 DOI: 10.1016/j.acap.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Parental mindfulness may be a novel intervention target for child obesity prevention. OBJECTIVE To examine associations between maternal mindfulness and child body mass index z-score (BMIz). METHODS In a secondary data analysis of preintervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n = 105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. RESULTS Children were M = 53.7 (standard deviation [SD] 7.5) months old, and mothers were M = 31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β = -.02 (SE 0.01), P = .027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (P = .016) and BMI at the trend level (P = .0595) at the trend level. CONCLUSIONS Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.
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Affiliation(s)
- Chioma Torres
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich.
| | - Holly E Brophy-Herb
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich
| | - Julie Struza
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich
| | - Jessica M Williams
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Hailey Hyunjin Choi
- Department of Human Development and Family Studies, Michigan State University (HE Brophy-Herb, JM Williams, and HH Choi), East Lansing, Mich
| | - Mildred A Horodynski
- College of Nursing, Michigan State University (MA Horodynski), East Lansing, Mich
| | - Dawn Contreras
- Michigan State University Extension, Michigan State University (D Contreras), East Lansing, Mich
| | - Jean Kerver
- Department of Epidemiology and Biostatistics, Michigan State University (J Kerver), East Lansing, Mich
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School (C Torres, J Struza, and JC Lumeng), Ann Arbor, Mich; Center for Human Growth and Development, University of Michigan (H McCaffery, N Kaciroti, and JC Lumeng), Ann Arbor, Mich; Department of Nutritional Sciences, University of Michigan School of Public Health (JC Lumeng), Ann Arbor, Mich
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Baer R, Crane C, Montero-Marin J, Phillips A, Taylor L, Tickell A, Kuyken W. Frequency of Self-reported Unpleasant Events and Harm in a Mindfulness-Based Program in Two General Population Samples. Mindfulness (N Y) 2020; 12:763-774. [PMID: 33747251 PMCID: PMC7920887 DOI: 10.1007/s12671-020-01547-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Evidence-based mindfulness programs have well-established benefits, but the potential for harmful effects is understudied. We explored the frequency and severity of unpleasant experiences and harm in two nonclinical samples participating in an adaptation of mindfulness-based cognitive therapy (MBCT) for the general population. METHODS Study 1 included 84 schoolteachers; study 2 included 74 university students. Both studies were uncontrolled. Participants completed self-report questionnaires about psychological symptoms before and after the 8-week mindfulness course. After the course, they responded to a survey designed for this study that included Likert ratings and free-text questions about unpleasant experiences and harm. All data were collected online. RESULTS In both samples, about two-thirds of participants reported unpleasant experiences associated with mindfulness practice during the course. Most participants (85-92%) rated these experiences as not at all or somewhat upsetting; some indicated that difficult experiences led to important learning or were beneficial in some way. The proportion of participants reporting harm from the mindfulness course ranged from 3 to 7%. The proportion showing reliable deterioration on symptom questionnaires ranged from 2 to 7%. Those reporting harm and those showing reliable deterioration on questionnaires were largely separate subgroups; only one participant fell in both. CONCLUSIONS Findings highlight the need for mindfulness teachers to manage expectations about benefits and difficulties that may occur in mindfulness-based programs and to work skilfully with participants experiencing difficulties. Experiences of harm may not be captured by symptom questionnaires and should be explicitly assessed in other ways. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12671-020-01547-8.
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Affiliation(s)
- Ruth Baer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Jesus Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Alice Phillips
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Alice Tickell
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
| | - The MYRIAD team
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, OX3 7JX UK
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Examining the Associations between Psychological Flexibility, Mindfulness, Psychosomatic Functioning, and Anxiety during the COVID-19 Pandemic: A Path Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238764. [PMID: 33255758 PMCID: PMC7728363 DOI: 10.3390/ijerph17238764] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
Social distancing plays a leading role in controlling the spread of coronavirus. However, prolonged lockdown can lead to negative consequences in terms of mental health. The goal of the research is to examine the relationship between anxiety and general psychosomatic functioning during the COVID-19 pandemic; the impact of psychological flexibility and mindfulness is also considered. Variables were measured with self-report questionnaires and symptom checklists. The sample included 170 people (M = 27.79, SD = 8.16). Pearson’s correlation, stepwise regression, and path analysis were conducted. The results showed a significant positive relationship between state anxiety and somatic and psychological responses to the pandemic. Path analysis revealed that mindfulness had a direct negative impact on and decreased the level of state anxiety (b = −0.22, p = 0.002), whereas psychological flexibility influenced the variable indirectly (b = 0.23, p = 0.002) by enhancing psychosomatic functioning (b = −0.64, p < 0.001). Psychological flexibility and mindfulness may mediate the development of mental disorders and facilitate achieving overall wellbeing. The study points to the usefulness of mindfulness practice as a form of self-help with anxiety symptoms; this is crucial during the pandemic because contact with clients is restricted.
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Coster S, Gould RL, Coulson M, Norman IJ. An online mindfulness intervention to enhance compassion in nursing practice: A feasibility and acceptability study with nursing students. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2020; 2:100004. [PMID: 38745902 PMCID: PMC11080300 DOI: 10.1016/j.ijnsa.2020.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background Compassion is an important component of nursing care, but public enquiries into care failures have noted that it is not always evident. Mindfulness interventions have the potential to support compassion. However, the feasibility of delivering a mindfulness intervention at scale to nursing students has not been established. Objectives To develop and test the feasibility and acceptability of a tailored mindfulness based online intervention to foster compassion in nursing students within clinical practice. Design A randomised feasibility study with a waiting list control. Setting A UK nursing faculty within a large university. Participants Post-graduate, post-registration and pre-registration nursing students (N = 77). Methods An online five module mindfulness based intervention (Mindful Nursing Online) was developed and tailored to support compassion in clinical nursing. The feasibility study comprised 77 participants randomised in a 2:1 ratio into an immediate access group (intervention, n = 50) or a delayed access group (waiting list control, n = 27). Data on feasibility through completion, attrition and practice rates, were collected through follow-up questionnaires at post-intervention, and 14 and 20 weeks after baseline. Acceptability data was collected through semi-structured interviews with 12 participants. Results Non-completion rates were high with all five modules completed by only 28% (n = 14) of participants, and three modules completed by only 46% (n = 23). The most commonly cited reason for non-completion was lack of time. However, the interview data suggested those who completed the intervention were using mindfulness techniques in practice. They described feeling less stressed on the ward, having an increased focus on patients and a greater appreciation of the importance of self-care. Evaluative feedback therefore showed that the intervention was perceived to be effective at promoting mindfulness skills and was relevant to nursing work. Conclusion Minimising attrition and enhancing engagement with the intervention should be the key objectives of a future study. Feedback from participants who completed the intervention indicates that a brief mindfulness intervention delivered online may support the delivery of compassionate nursing care.
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Affiliation(s)
- Samantha Coster
- Research Fellow, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London
| | - Rebecca L. Gould
- Lecturer, Division of Psychiatry, Faculty of Brain Sciences, University College London, London
| | - Mark Coulson
- Associate Professor of Psychology, School of Psychology, Faculty of Social Sciences, University of East Anglia, London
| | - Ian James Norman
- Executive Dean, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London
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Zhang Z, Xu Q, Joshi RM. A meta-analysis on the effectiveness of intervention in children with primary speech and language delays/disorders: Focusing on China and the United States. Clin Psychol Psychother 2020; 28:585-605. [PMID: 33068068 DOI: 10.1002/cpp.2522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/31/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
The purpose of this meta-analysis was to investigate the immediate and long-term effects of intervention for children with primary speech and language delays/disorders and to explore whether some characteristics of interventions, specifics of the study and research participants moderate the magnitude of the effectiveness of interventions. Using the random effect model, we pooled the effect size and conducted a publication bias evaluation, a moderating effect analysis in CMA 2.0. Results of a random effects model analysis demonstrated a moderate immediate effect (g = 0.70), whereas the long-term efficacy was small (g = 0.23). Additionally, type of measure, language of intervention, parental involvement, intervention content and study quality, as well as the duration of intervention, significantly moderated the effect size of intervention effectiveness.
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Affiliation(s)
- Zhigang Zhang
- Jiangsu Provincial Key Constructive Laboratory of Special Children's Impairment and Intervention, Nanjing Normal University of Special Education, Nanjing, China
| | - Qinfang Xu
- Jiangsu Provincial Key Constructive Laboratory of Special Children's Impairment and Intervention, Nanjing Normal University of Special Education, Nanjing, China.,School of Languages, Nanjing Normal University of Special Education, Nanjing, China
| | - R Malatesha Joshi
- College of Education and Human Development, Texas A&M University, College Station, TX, USA
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Smith JL, Allen JW, Haack C, Wehrmeyer K, Alden K, Lund MB, Mascaro JS. The Impact of App-Delivered Mindfulness Meditation on Functional Connectivity and Self-Reported Mindfulness Among Health Profession Trainees. Mindfulness (N Y) 2020; 12:92-106. [PMID: 33052251 PMCID: PMC7543678 DOI: 10.1007/s12671-020-01502-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 12/30/2022]
Abstract
Objectives Previous research indicates that mindfulness meditation reduces anxiety and depression and enhances well-being. We examined the impact of app-delivered mindfulness meditation on resting state functional MRI (fMRI) connectivity among physician assistant (PA) students and surgery residents. Methods PA students and residents were randomized to receive a popular meditation app or to wait-list control group. Before and after the 8-week meditation period, we acquired fMRI scans of participants’ resting state, and participants completed a self-report measure of mindfulness. We used a 2 × 2, within- and between-group factorial design and leveraged a whole-brain connectome approach to examine changes in within- and between-network connectivity across the entire brain, and to examine whether changes in connectivity were associated with app use or to changes in self-reported mindfulness. Results Meditation practitioners exhibited significantly stronger connectivity between the frontoparietal network and the left and right nucleus accumbens and between the default mode (DMN) and salience networks, among other regions. Mindfulness practice time was correlated with increased connectivity between the lateral parietal cortex and the supramarginal gyrus, which were also positively correlated with increased scores on the “Describing” subscale of the Five Facet Mindfulness Questionnaire between baseline and post-meditation. These findings are consistent with previous research indicating that mindfulness-based interventions alter functional connectivity within the DMN and between the DMN and other networks both during meditation and at rest, as well as increased connectivity in systems important for emotion and reward. Conclusions Recent commentaries call for healthcare provider and trainee wellness programs that are sustainable and preventive in nature rather than reactive; these data indicate that even brief sessions of app-delivered mindfulness practice are associated with functional connectivity changes in a dose-dependent manner. Electronic supplementary material The online version of this article (10.1007/s12671-020-01502-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA USA.,Department of Neurology, Emory University, Atlanta, GA USA
| | - Carla Haack
- Department of Surgery, Emory University, Atlanta, GA USA
| | - Kathryn Wehrmeyer
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
| | - Kayley Alden
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
| | - Maha B Lund
- Department of Family and Preventive Medicine, Physician Assistant Program, Emory University, Atlanta, GA USA
| | - Jennifer S Mascaro
- Department of Family and Preventive Medicine, Emory University, 1841 Clifton Road NE, Suite 507, Atlanta, GA 30329 USA
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Gaitzsch H, Benard J, Hugon-Rodin J, Benzakour L, Streuli I. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 2020; 23:479-491. [PMID: 31897607 DOI: 10.1007/s00737-019-01009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.
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Affiliation(s)
- Hélène Gaitzsch
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Julie Benard
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | | | - Lamyae Benzakour
- Division for Liaison Psychiatry and Crisis Intervention, Department of Mental Health, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Isabelle Streuli
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
- Hélène Gaitzsch Medical Resident Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
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[Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:353-374. [PMID: 32615894 DOI: 10.13109/prkk.2020.69.4.353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".
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37
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Montero-Marin J, Kuyken W, Gasión V, Barceló-Soler A, Rojas L, Manrique A, Esteban R, García Campayo J. Feasibility and Effectiveness of a Workplace-Adapted Mindfulness-Based Programme to Reduce Stress in Workers at a Private Sector Logistics Company: An Exploratory Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1643. [PMID: 32138362 PMCID: PMC7084587 DOI: 10.3390/ijerph17051643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
There is a high prevalence of stress in the logistics sector owing to very demanding, fast-paced and unpredictable tasks. Mindfulness-based programmes may reduce stress but require considerable practice. Our aim was to evaluate the feasibility and effectiveness of a shortened, workplace-adapted mindfulness-based programme for the logistics sector (WA-MBP-LS) for the purpose of reducing stress. A nonblinded, nonrandomised, two-arm controlled trial was conducted. The WA-MBP-LS (n = 32) consisted of six weekly 90-min mindfulness sessions. The control group (n = 36) attended a psycho-educational seminar. The Perceived Stress Scale (PSS) and Five Facets of Mindfulness Questionnaire (FFMQ) were measured at pretest, posttest and 6-month follow-up. Differences between groups were evaluated using mixed-effects models. Qualitative methods were used to analyse implementation issues. A 64.2% reduction was observed between initial volunteers and actual participants. Attrition at six-month follow-up was 45.6%. Participants attended a median of five sessions. Decreases in PSS favoured the WA-MBP-LS group at posttest and follow-up. FFMQ played a mediating role in PSS reductions. Barriers were disinterest, lack of programming, work overload and absences from work. Facilitators were curiosity, timing, company facilities and audio recordings. The WA-MBP-LS was feasible and effective in reducing stress, but more efforts to improve the practicalities of implementation are desirable.
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Affiliation(s)
- Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; (J.M.-M.); (W.K.)
| | - Willem Kuyken
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; (J.M.-M.); (W.K.)
| | - Virginia Gasión
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
| | - Alberto Barceló-Soler
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
- Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Lynda Rojas
- Mindfulness Consultant, Parenthesis Consultants, 050031 Medellin, Colombia;
| | - Ana Manrique
- Human Resources Department, Sese Group, 50014 Zaragoza, Spain; (A.M.); (R.E.)
| | - Rosa Esteban
- Human Resources Department, Sese Group, 50014 Zaragoza, Spain; (A.M.); (R.E.)
| | - Javier García Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), 50009 Zaragoza, Spain;
- Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
- Miguel Servet University Hospital, University of Zaragoza, 50009 Zaragoza, Spain
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Hanley AW, Dambrun M, Garland EL. Effects of Mindfulness Meditation on Self-Transcendent States: Perceived Body Boundaries and Spatial Frames of Reference. Mindfulness (N Y) 2020; 11:1194-1203. [PMID: 33747250 DOI: 10.1007/s12671-020-01330-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: 1) perceived body boundary dissolution, and 2) more allocentric spatial frames of reference. Methods A sample of healthy, young adults (n=45) were randomized to five sessions of mindfulness training or an active listening control condition. Results Results indicated mindfulness training decreased perceived body boundaries (F 4,172=6.010, p<.001, η 2=.12) and encouraged more allocentric frames of reference (F 4,168=2.586, p=.039, η 2=.06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference ((β=-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries (β=.24, se=.17, CI: 0.11 to 0.78). Conclusions Taken together, study results suggest that mindfulness training alters practitioners' experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences.
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Affiliation(s)
- Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah.,College of Social Work, University of Utah
| | - Michael Dambrun
- Laboratory of Social and Cognitive Psychology, Université Clermont Auvergne
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah.,College of Social Work, University of Utah
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Bloom-Foster J, Mehl-Madrona L. An Ultra-Brief Mindfulness-Based Intervention for Patients in Treatment for Opioid Addiction with Buprenorphine: A Primary Care Feasibility Pilot Study. J Altern Complement Med 2020; 26:34-43. [DOI: 10.1089/acm.2019.0242] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Bloom-Foster
- Family Medicine Residency, Northern Light Eastern Maine Medical Center, Bangor, ME
| | - Lewis Mehl-Madrona
- Family Medicine Residency, Northern Light Eastern Maine Medical Center, Bangor, ME
- Coyote Institute, Orono, ME
- Wabanaki Health and Wellness, Bangor, ME
- Graduate School, University of Maine, Orono, ME
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Akase M, Terao T, Kawano N, Sakai A, Hatano K, Shirahama M, Hirakawa H, Kohno K, Ishii N. More Purpose in Life and Less Novelty Seeking Predict Improvements in Self-Compassion During a Mindfulness-Based Intervention: The EXMIND Study. Front Psychiatry 2020; 11:252. [PMID: 32317992 PMCID: PMC7146234 DOI: 10.3389/fpsyt.2020.00252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/16/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Recently, a 4-week mindfulness-based intervention followed by a 4-week existential approach was found to be as effective for increasing self-compassion as an 8-week mindfulness-based intervention. The purpose of the present study was to identify the factors that predicted change in self-compassion during the 8-week mindfulness-based intervention. METHODS Fifty-seven of the 61 completers of the 8-week mindfulness-based intervention provided baseline, 4-week, and 8-week self-compassion scale scores. The mean age of the 47 females and 10 males was 49.6 years. Pearson's correlation coefficients were generated on the associations between the change of total self-compassion scale scores from baseline to 8 weeks with age; gender; and the baseline scores on the Temperament Evaluation of Memphis, Pisa and San Diego Auto-questionnaire, Temperament and Character Inventory (TCI), Mini-Mental State Examination, Japanese Adult Reading Test, Young Mania Rating Scale, Hamilton Rating Scale for Depression, Parental Bonding Instrument, and purpose in life (PIL). Multiple regression analysis was performed to identify the predictors of the change in total self-compassion scale scores. RESULTS Novelty seeking (TCI) was significantly and negatively associated with the change in total self-compassion scale scores, whereas the PIL scores were significantly and positively associated with the change in total self-compassion scale scores. Novelty seeking was not significantly associated with baseline, 4-week, or 8-week total self-compassion scale scores, whereas the PIL scores were significantly and positively associated with baseline, 4-week, and 8-week total self-compassion scale scores. The limitation of the present study was a relatively small number of subjects which deterred a more sophisticated analysis of the pathways involved. CONCLUSIONS The present findings suggest that more PIL and less novelty seeking predict improvements in self-compassion during mindfulness-based interventions, although novelty seeking might substantially predict the improvement but self-compassion scale and PIL might somewhat conceptually overlap.
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Affiliation(s)
- Mari Akase
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Takeshi Terao
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuko Kawano
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan.,Department of Psychology, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Akari Sakai
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Koji Hatano
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Masanao Shirahama
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hirofumi Hirakawa
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kentaro Kohno
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuyoshi Ishii
- Department of Neuropsychiatry, Faculty of Medicine, Oita University, Yufu, Japan
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Lopez-Montoyo A, Quero S, Montero-Marin J, Barcelo-Soler A, Beltran M, Campos D, Garcia-Campayo J. Effectiveness of a brief psychological mindfulness-based intervention for the treatment of depression in primary care: study protocol for a randomized controlled clinical trial. BMC Psychiatry 2019; 19:301. [PMID: 31619196 PMCID: PMC6796394 DOI: 10.1186/s12888-019-2298-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/20/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Depressive symptoms are quite prevalent in Primary Care (PC) settings. The treatment as usual (TAU) in PC is pharmacotherapy, despite the high relapse rates it produces. Many patients would prefer psychotherapy, but specialized services are overloaded. Studies that apply Mindfulness-Based Interventions (MBIs) for the treatment of depression have obtained significant improvements. Brief low-intensity approaches delivered from PC could be a promising approach. This study aims to compare a low-intensity mindfulness intervention for the treatment of depression in PC using different intervention formats - a face-to-face MBI delivered in a group and the same MBI individually applied on the Internet - to a control group that will receive PC medical treatment as usual. METHODS A randomized controlled clinical trial will be conducted in PC, with about 120 depressed patients allocated (1:1:1) to three groups: "face-to-face MBI + TAU", "Internet-delivered MBI + TAU", and "TAU alone". The MBI programs will be composed of four modules. The primary outcome will be depressive symptoms, measured through the Beck Depression Inventory, assessed at pre- and post-treatment and 6- and 12-month follow-ups. Other outcomes will be mindfulness, happiness, affectivity, quality of life, and the use of healthcare services. Intention-to-treat analysis using linear mixed models adjusted for baseline scores and routine sociodemographic analysis that could show baseline differences will be conducted. Per-protocol secondary outcome analyses will also be performed. DISCUSSION This is the first Spanish RCT to apply a low-intensity face-to-face MBI (plus TAU) to treat depression in PC settings compared to TAU (alone). Moreover, this study will also make it possible to evaluate the same MBI program (plus TAU), but Internet-delivered, considering their cost-effectiveness. Positive results from this RCT might have an important impact on mental health settings, helping to decrease the overload of the system and offering treatment alternatives beyond antidepressant medication through high-quality, flexible PC interventions. TRIAL REGISTRATION Clinical Trials.gov NCT03034343 . Trial Registration date 24 January 2017, retrospectively registered.
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Affiliation(s)
- Alba Lopez-Montoyo
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain
| | - Soledad Quero
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
| | - Jesus Montero-Marin
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Alberto Barcelo-Soler
- University of Zaragoza, Zaragoza, Spain
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | | | - Daniel Campos
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain
- Aragón Health Research Institute (IIS Aragón), Zaragoza, Spain
| | - Javier Garcia-Campayo
- Department of Psychiatry, University of Zaragoza, Zaragoza, Spain
- Psychiatry Service, Miguel Servet Hospital, Zaragoza, Spain
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Nonoperative Management Prior to Hip Arthroscopy for Femoroacetabular Impingement Syndrome: An Investigation Into the Utilization and Content of Physical Therapy. J Orthop Sports Phys Ther 2019; 49:593-600. [PMID: 31092124 DOI: 10.2519/jospt.2019.8581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been a significant increase in surgeries for femoroacetabular impingement syndrome in recent years, but little is known about the use of physical therapy prior to surgery. OBJECTIVES To investigate the use of physical therapy prior to hip arthroscopy for femoroacetabular impingement syndrome, by assessing the number of visits and use of exercise. A secondary objective was to evaluate whether comorbidities prior to surgery were associated with the use of physical therapy. METHODS In this retrospective observational cohort study, eligible participants between the ages of 18 and 50 years undergoing hip arthroscopy between 2004 and 2013 in the Military Health System were included. Patients were categorized based on whether they saw a physical therapist for their hip in the year prior to surgery. For physical therapy patients, dosing variables were identified, including total number of visits and visits that included an exercise therapy procedure code. RESULTS Of 1870 participants, 1106 (59.1%) did not see a physical therapist for their hip prior to surgery. For those who did, the median number of visits was 2. Only 220 (11.8%) had 6 or more unique visits with an exercise therapy procedure code. Exercise was coded in 43.4% to 63.0% of the total visits in each individual course of care (mean, 52.3%). There was an association between substance abuse and exercise utilization. No other comorbidities were associated with physical therapy or exercise therapy utilization. CONCLUSION Physical therapy was not commonly used before undergoing arthroscopic hip surgery by patients seeking care in the Military Health System. Further research is needed to understand the reasons for poor utilization and better define failed nonoperative management. LEVEL OF EVIDENCE Therapy, level 2b. J Orthop Sports Phys Ther 2019;49(8):593-600. Epub 15 May 2019. doi:10.2519/jospt.2019.8581.
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Abstract
PURPOSE OF REVIEW Mindfulness, the practice of paying attention to the present moment, purposefully and nonjudgmentally, has been gaining popularity as adjunct treatment for adolescents with a range of physical and mental health problems. Research conducted in adults and emerging research conducted in adolescents has shown that mindfulness-based interventions can improve outcomes in several areas. The purpose of this review is to discuss recent research on the effects of mindfulness and suggest exercises that primary care clinicians can offer to their adolescent patients. RECENT FINDINGS Research has shown positive effects of mindfulness across several health conditions commonly encountered during adolescence. Mindfulness-based Interventions can reduce symptoms of anxiety and depression. The application of mindfulness can help with the prevention and treatment of binge eating, over-eating, and restrictive eating disorders. In the treatment of substance use disorders, mindfulness can improve emotion regulation and reduce symptoms of withdrawal and craving. Mindfulness can also lead to improvement in overall quality of life for patients suffering from chronic pain. Lastly, mindfulness can be useful for adolescents with ADHD, sleep problems, chronic illness, and stress related to performance sports. SUMMARY Although research in adolescents remains limited, mindfulness holds promise in the treatment of a range of health conditions in adolescents.
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Duarte R, Lloyd A, Kotas E, Andronis L, White R. Are acceptance and mindfulness-based interventions 'value for money'? Evidence from a systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:187-210. [PMID: 30499217 PMCID: PMC6588093 DOI: 10.1111/bjc.12208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/26/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Acceptance and mindfulness-based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions. METHODS Eight electronic bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines. RESULTS Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost-effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost-effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made. CONCLUSION This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost-effectiveness of A/MBIs for mental health conditions. PRACTITIONER POINTS The findings of the review provide information that may be relevant to mental health service commissioners and decision-makers as all economic evidence available on acceptance and mindfulness-based interventions for mental health conditions is summarized. Evidence relating to the cost-effectiveness and cost-saving potential of acceptance and mindfulness-based interventions is focused mainly on depression and emotional unstable personality disorder to date. Heterogeneity in the specific forms of acceptance and mindfulness-based interventions may limit generalizability of the findings. The number of health economic evaluations relating to acceptance and mindfulness-based interventions remains relatively small. Further research in this area is required.
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Affiliation(s)
- Rui Duarte
- Liverpool Reviews and Implementation GroupUniversity of LiverpoolUK
| | | | - Eleanor Kotas
- Liverpool Reviews and Implementation GroupUniversity of LiverpoolUK
| | - Lazaros Andronis
- Populations, Evidence and Technologies GroupDivision of Health SciencesUniversity of WarwickCoventryUK
- Division of Clinical TrialsUniversity of WarwickCoventryUK
| | - Ross White
- School of PsychologyUniversity of LiverpoolUK
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Santiago PHR, Valle Serra E Meira LR, Colussi CF. Feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system. Complement Ther Clin Pract 2019; 35:8-17. [PMID: 31003691 DOI: 10.1016/j.ctcp.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE In the last decades, an increasing body of scientific studies has shown mindfulness-based interventions as efficacious for reducing stress, including among primary care professionals. Despite the strength of the evidence, mindfulness-based interventions still are not widely adopted as a clinical practice in national health systems. The aim of the present study was to conduct a feasibility evaluation of a mindfulness-based stress reduction program for primary care professionals in Brazilian national health system. MATERIALS AND METHODS A pilot mindfulness program was conducted through the course of four weekly encounters in the municipality of Biguaçu with the participation of 26 primary care professionals. Data was collected through direct observations and four self-report questionnaires. The information was used to complete an evaluation matrix and reach a value judgment about the feasibility level of the components of the mindfulness-based program. RESULTS The subdimensions Integration, Demand, and Acceptability were judged as "Highly Feasible", the subdimension Practicality was judged as "Feasible" and the subdimension Adaptation was judged as "Lowly Feasible". The results indicated that there is a high demand for stress-reduction interventions within the context of primary care and the acceptability by the stakeholders (participants and management) was excellent. However, the two main barriers found were the need for a brief version of the program to accommodate the restrictive timetable of the primary care professionals and the low retention rates. CONCLUSION The implementation of a mindfulness-based program for primary care professionals in Brazilian national health system was judged as "Feasible". Further studies need to conduct the feasibility evaluation in other municipalities and with larger sample sizes to ensure the generalizability of these results.
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Affiliation(s)
- Pedro Henrique Ribeiro Santiago
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina (UFSC), Endereço: Campus Reitor João David Ferreira Lima, Rua Delfino Conti, s/n, Bloco H, Brasil.
| | - Leonardo Rodrigues Valle Serra E Meira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina (UFSC), Endereço: Campus Reitor João David Ferreira Lima, Rua Delfino Conti, s/n, Bloco H, Brasil.
| | - Cláudia Flemming Colussi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina (UFSC), Endereço: Campus Reitor João David Ferreira Lima, Rua Delfino Conti, s/n, Bloco H, Brasil.
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Campos D, Modrego-Alarcón M, López-del-Hoyo Y, González-Panzano M, Van Gordon W, Shonin E, Navarro-Gil M, García-Campayo J. Exploring the Role of Meditation and Dispositional Mindfulness on Social Cognition Domains: A Controlled Study. Front Psychol 2019; 10:809. [PMID: 31031678 PMCID: PMC6470267 DOI: 10.3389/fpsyg.2019.00809] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/26/2019] [Indexed: 01/27/2023] Open
Abstract
Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.
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Affiliation(s)
- Daniel Campos
- Laboratorio de Psicología y Tecnología, Department of Basic Psychology, Universitat Jaume I, Castelló de La Plana, Spain
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
| | - Marta Modrego-Alarcón
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, Madrid, Spain
| | - Yolanda López-del-Hoyo
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, Madrid, Spain
| | | | - William Van Gordon
- Human Sciences Research Centre, University of Derby, Derby, United Kingdom
| | - Edo Shonin
- Awake to Wisdom Centre for Meditation and Mindfulness Research, Ragusa, Italy
| | - Mayte Navarro-Gil
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Javier García-Campayo
- Instituto de Investigación Sanitaria de Aragón, IIS Aragón, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Primary Care Prevention and Health Promotion Research Network, Madrid, Spain
- University Hospital Miguel Servet, Zaragoza, Spain
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Montero-Marin J, Perez-Yus MC, Cebolla A, Soler J, Demarzo M, Garcia-Campayo J. Religiosity and Meditation Practice: Exploring Their Explanatory Power on Psychological Adjustment. Front Psychol 2019; 10:630. [PMID: 30971982 PMCID: PMC6445895 DOI: 10.3389/fpsyg.2019.00630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/06/2019] [Indexed: 01/11/2023] Open
Abstract
There has been increased interest in the relationships between religiosity, meditation practice and well-being, but there is lack of understanding as to how specific religious components and distinct meditation practices could influence different positive and negative psychological adjustment outcomes. The aim of this study was to assess the explanatory power of religious beliefs and the practice of prayer, focused attention (FA), open monitoring (OM), and compassion meditation (CM) on psychological adjustment, taking into consideration a number of practice-related variables such as session length, frequency of practice and lifetime practice. Psychological adjustment was assessed by means of happiness, positive affect, depression, negative affect, and emotional overproduction. A cross-sectional design was used, with a final sample comprising 210 Spanish participants who completed an online assessment protocol. Hierarchical regressions were performed, including age, sex and psychotropic medication use in the first step as possible confounders, with the addition of religious beliefs and the practice of prayer, FA, OM, and CM in the second step. FA session length was related to all psychological adjustment outcomes: happiness (ΔR 2 = 0.09, p = 0.002; β = 0.25, p = 0.001), positive affect (ΔR 2 = 0.09, p = 0.002; β = 0.18, p = 0.014), depression (ΔR2 = 0.07, p = 0.004; β = -0.27, p < 0.001), negative affect (ΔR 2 = 0.08, p = 0.007; β = -0.27, p < 0.001) and emotional overproduction (ΔR 2 = 0.07, p = 0.013; β = -0.23, p = 0.001). CM session length was related to positive affect (β = 0.18, p = 0.011). CM practice frequency was associated with happiness (ΔR 2 = 0.06, p = 0.038; β = 0.16, p = 0.041). Lifetime practice of FA was related to happiness (ΔR 2 = 0.08, p = 0.007; β = 0.21, p = 0.030) and OM to emotional overproduction (ΔR 2 = 0.08, p = 0.037; β = -0.19, p = 0.047). Religious beliefs and prayer seemed to be less relevant than meditation practices such as FA, OM, and CM in explaining psychological adjustment. The distinct meditation practices might be differentially related to distinct psychological adjustment outcomes through different practice-related variables. However, research into other forms of institutional religiosity integrating social aspects of religion is required.
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Affiliation(s)
- Jesus Montero-Marin
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Maria C. Perez-Yus
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Ausias Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain
- CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Joaquim Soler
- Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau–IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain
| | - Marcelo Demarzo
- Mente Aberta – Brazilian Center for Mindfulness and Health Promotion, Department of Preventive Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Javier Garcia-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
- Miguel Servet Hospital and University of Zaragoza, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
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Gawande R, Pine E, Griswold T, Creedon T, Vallejo Z, Rosenbaum E, Lozada A, Schuman-Olivier Z. Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial. Mindfulness (N Y) 2019; 10:1744-1759. [PMID: 32042349 DOI: 10.1007/s12671-019-01116-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives Mindfulness is effective for reducing anxiety and depression and increasing chronic disease self-management. An accessible, insurance-reimbursable model for implementation in patient-centered medical homes within US healthcare systems has promise for patients with multi-morbid conditions. Clarifying both the dose needed to impact anxiety, depression and self-management, and the design requirements for accessible primary care implementation, is essential. Methods We tested feasibility, acceptability, and effectiveness of Mindfulness Training for Primary Care (MTPC), an 8-week, referral-based, insurance-reimbursable mindfulness program integrated within primary care, compared with a Low-Dose Comparator (LDC), consisting of a 60-minute mindfulness introduction plus referral to community and digital resources. Outcome measures were assessed at baseline and 8 weeks. MTPC is trauma-informed, incorporates mindfulness-oriented behavior change skills, and is designed to target anxiety, depression, stress, and chronic illness selfmanagement. Participants schedule a PCP visit to co-create a self-management action plan during week 6. Results Primary care providers (PCP) referred 344 patients over 14 months. Eighty-one participants with DSM-V anxiety disorders, depressive disorders, trauma- and stress-related disorders participated in this pilot randomized-controlled comparative effectiveness trial [MTPC (n=54); LDC (n=27)]. These data suggest that MTPC was more effective than LDC for reducing anxiety (p=0.01), enhancing mindfulness (p=0.02) and self-compassion (p=0.001), and for catalyzing selfmanagement behavior change through action plan initiation (OR=4.34, p=0.03). Conclusions MTPC was successfully integrated into a health system, was billed to insurance, and was acceptable to a diverse primary care population. Replication with a larger study and further accessibility adaptations are needed to confirm and expand these pilot results.
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Affiliation(s)
- Richa Gawande
- Harvard Medical School, Department of Psychiatry.,Cambridge Health Alliance
| | | | - Todd Griswold
- Harvard Medical School, Department of Psychiatry.,Cambridge Health Alliance
| | - Timothy Creedon
- The Heller School for Social Policy and Management, Brandeis University.,IBM Watson Health
| | - Zayda Vallejo
- Cambridge Health Alliance.,The Heller School for Social Policy and Management, Brandeis University
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Pérula-de Torres LA, Atalaya JCVM, García-Campayo J, Roldán-Villalobos A, Magallón-Botaya R, Bartolomé-Moreno C, Moreno-Martos H, Melús-Palazón E, Liétor-Villajos N, Valverde-Bolívar FJ, Hachem-Salas N, Rodríguez LA, Navarro-Gil M, Epstein R, Cabezón-Crespo A, Moreno CMV. Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. BMC FAMILY PRACTICE 2019; 20:24. [PMID: 30727962 PMCID: PMC6364464 DOI: 10.1186/s12875-019-0913-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. METHODS The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). DISCUSSION If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well. TRIAL REGISTRATION The study has been registered at ClinicalTrials.gov ( NCT03629457 ; date of registration: 13.08.2018).
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Affiliation(s)
- Luis-Angel Pérula-de Torres
- Clinical and Epidemiological Research Group in Primary Care (GICEAP), IMIBIC/Reina Sofía University Hospital/University of Córdoba, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Family and Community Medicine Teaching Unit of Córdoba, Córdoba, Spain
| | | | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Centre for Biomedical Research Network on Mental Health, Zaragoza, Spain
- Miguel Servet Hospital, University of Zaragoza, Zaragoza, Spain
| | - Ana Roldán-Villalobos
- Clinical and Epidemiological Research Group in Primary Care (GICEAP), IMIBIC/Reina Sofía University Hospital/University of Córdoba. Family and Community Medicine Teaching Unit of Córdoba, Córdoba, Spain
| | - Rosa Magallón-Botaya
- Arrabal Health Centre. Primary Care Prevention and Health Promotion Research Network (RedIAPP), University of Zaragoza, Health Research Institute of Aragón, Zaragoza, Spain
| | | | - Herminia Moreno-Martos
- UGC Almería Periphery. Retamar Health Center, Research Network on Communication and Health (RICyS) of the Program Communication and Health (semFYC), Almería, Spain
| | - Elena Melús-Palazón
- Family and Community Care Teaching Unit of Zaragoza Sector I, Zaragoza, Spain
| | | | | | | | - Luis-Alberto Rodríguez
- Familiar and Community Attention Multiprofessional Teaching Unit of León II, Ponferrada, León, Spain
| | - Mayte Navarro-Gil
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | | | | | - the collaborative group of the MINDUUDD study
- Clinical and Epidemiological Research Group in Primary Care (GICEAP), IMIBIC/Reina Sofía University Hospital/University of Córdoba, Primary Care Prevention and Health Promotion Research Network (RedIAPP), Family and Community Medicine Teaching Unit of Córdoba, Córdoba, Spain
- Comuneros Health Center, Research Network on Communication and Health (RICyS) of the Communication and Health program (semFYC), Burgos, Spain
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Centre for Biomedical Research Network on Mental Health, Zaragoza, Spain
- Miguel Servet Hospital, University of Zaragoza, Zaragoza, Spain
- Clinical and Epidemiological Research Group in Primary Care (GICEAP), IMIBIC/Reina Sofía University Hospital/University of Córdoba. Family and Community Medicine Teaching Unit of Córdoba, Córdoba, Spain
- Arrabal Health Centre. Primary Care Prevention and Health Promotion Research Network (RedIAPP), University of Zaragoza, Health Research Institute of Aragón, Zaragoza, Spain
- Family and Community Care Teaching Unit of Zaragoza Sector I, Zaragoza, Spain
- UGC Almería Periphery. Retamar Health Center, Research Network on Communication and Health (RICyS) of the Program Communication and Health (semFYC), Almería, Spain
- Belén Health Centre, Jaén, Spain
- Family and Community Medicine Teaching Unit of Jaén, Jaén, Spain
- Mediterranean Health Centre, Torrecárdenas, Almería, Spain
- Familiar and Community Attention Multiprofessional Teaching Unit of León II, Ponferrada, León, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- University of Rochester Medical Center, New York, USA
- Family and Community Medicine Teaching Unit of Burgos, Burgos, Spain
- Family and Community Medicine Teaching Unit of Córdoba. Lucena II Health Centre, Córdoba, Spain
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