Dataset Information

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial.

ABSTRACT:

Background

Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related and adjustment disorders compared with the increasingly standard practice of referring patients to outside mindfulness resources.

Objective

Mindfulness Training for Primary Care (MTPC) is an 8-week, referral-based, insurance-reimbursable program integrated into safety-net health system patient-centered medical homes. We hypothesized that MTPC would be more effective for catalyzing chronic disease self-management action plan initiation within 2 weeks, versus a low-dose comparator (LDC) consisting of a 60-min mindfulness introduction, referral to community and digital resources, and addition to a 6-month waitlist for MTPC.

Participants

Primary care providers (PCPs) and mental health clinicians referred 465 patients over 12 months. All participants had a DSM-V diagnosis.

Design and interventions

Participants (N?=?136) were randomized in a 2:1 allocation to MTPC (n?=?92) or LDC (n?=?44) in a randomized controlled comparative effectiveness trial. MTPC incorporates mindfulness, self-compassion, and mindfulness-oriented behavior change skills and is delivered as insurance-reimbursable visits within primary care. Participants took part in a chronic disease self-management action planning protocol at week 7.

Main measures

Level of self-reported action plan initiation on the action plan initiation survey by week 9.

Key results

Participants randomized to MTPC, relative to LDC, had significantly higher adjusted odds of self-management action plan initiation in an intention-to-treat analysis (OR?=?2.28; 95% CI?=?1.02 to 5.06, p?=?0.025).

Conclusions

An 8-week dose of mindfulness training is more effective than a low-dose mindfulness comparator in facilitating chronic disease self-management behavior change among primary care patients.

SUBMITTER: Gawande R

PROVIDER: S-EPMC6374253 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial.

Gawande Richa R To My Ngoc MN Pine Elizabeth E Griswold Todd T Creedon Timothy B TB Brunel Alexandra A Lozada Angela A Loucks Eric B EB Schuman-Olivier Zev Z

Journal of general internal medicine 20181203 2

<h4>Background</h4>Self-management of health is important for improving health outcomes among primary care patients with chronic disease. Anxiety and depressive disorders are common and interfere with self-regulation, which is required for disease self-management. An insurance-reimbursable mindfulness intervention integrated within primary care may be effective for enhancing chronic disease self-management behaviors among primary care patients with anxiety, depression, trauma, and stress-related ...[more]

PMID: 30511291

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Project description: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.

Project description:The onset of the COVID-19 pandemic has led to an increased demand for mental health interventions, with a special focus on digitally assisted ones. Self-regulation describes a set of meta-skills that enable one to take control over his/her mental health and it is recognized as a vital indicator of well-being. Mindfulness training is a promising training strategy for promoting self-regulation, behavioral change, and mental well-being. A growing body of research outlines that smart technologies are ready to revolutionize the way mental health training programs take place. Artificial intelligence (AI); extended reality (XR) including virtual reality (VR), augmented reality (AR), and mixed reality (MR); as well as the advancements in brain computer interfaces (BCIs) are ready to transform these mental health training programs. Mindfulness-based interventions assisted by smart technologies for mental, emotional, and behavioral regulation seem to be a crucial yet under-investigated issue. The current systematic review paper aims to explore whether and how smart technologies can assist mindfulness training for the development of self-regulation skills among people at risk of mental health issues as well as populations with various clinical characteristics. The PRISMA 2020 methodology was utilized to respond to the objectives and research questions using a total of sixty-six experimental studies that met the inclusion criteria. The results showed that digitally assisted mindfulness interventions supported by smart technologies, including AI-based applications, chatbots, virtual coaches, immersive technologies, and brain-sensing headbands, can effectively assist trainees in developing a wide range of cognitive, emotional, and behavioral self-regulation skills, leading to a greater satisfaction of their psychological needs, and thus mental wellness. These results may provide positive feedback for developing smarter and more inclusive training environments, with a special focus on people with special training needs or disabilities.

Project description:IntroductionExcess gestational weight gain (GWG) is a risk factor for several adverse outcomes for mothers and their offspring. In Nova Scotia, Canada, approximately 60% of women experience excess GWG. Outside the pregnancy arena, a patient-centered approach has been shown to promote increased patient adherence to clinician recommendations, and increased intentions for, and attempts at, behavior change. The 5As of Healthy Pregnancy Weight Gain is a tool that assists clinicians to have patient-centered discussions about GWG. This feasibility trial examined the association between training in the use of this tool and women's self-efficacy to manage GWG, readiness to adhere to GWG guidelines, perception of their clinicians' patient-centeredness when discussing GWG, and guideline concordance of total GWG.MethodParticipants were 11 family physicians who provide prenatal care and 24 of their patients who were pregnant. Physicians were randomly assigned to a single 60-minute training session in the use of the tool or usual care. Consenting patients completed measures of social support, stress, patient-perceived patient-centeredness, self-efficacy, and motivation. At the end of each woman's pregnancy, data pertaining to guideline concordance of GWG were collected.ResultsComparison of patient participants with prenatal care providers in the trained and untrained groups showed no significant difference in patient-perceived physician patient-centeredness when discussing GWG, self-efficacy to manage GWG, readiness to adhere to GWG guidelines, or GWG congruence with the guidelines.ConclusionThis feasibility study required very little time commitment and entailed minimal disruption to clinicians' practices. Nonetheless, it was very difficult to recruit clinicians for the study. Although recent theory-driven work showed that prenatal care providers have, overall, high perceived self-efficacy in discussing GWG with their patients, most studies have demonstrated that these providers do not often discuss GWG with their patients; so, there is clearly a mismatch in their perceived self-efficacy and what actually transpires.

Dataset Information

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial.

Background

Objective

Participants

Design and interventions

Main measures

Key results

Conclusions

Publications

Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial.

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