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 self-management. Participants scheduled 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 self-management 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.
Clinical Trials Registration Number: NCT02972203
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Allen, L. A., Gara, M. A., Escobar, J. I., Waitzkin, H., & Silver, R. C. (2001). Somatization: a debilitating syndrome in primary care. Psychosomatics, 42(1), 63–67.
Altschuler, A., Rosenbaum, E., Gordon, P., Canales, S., & Avins, A. L. (2012). Audio recordings of mindfulness-based stress reduction training to improve cancer patients' mood and quality of life--a pilot feasibility study. Support Care Cancer, 20(6), 1291–1297. https://doi.org/10.1007/s00520-011-1216-7.
Amaro, H., Spear, S., Vallejo, Z., Conron, K., & Black, D. S. (2014). Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment. Substance Use & Misuse, 49(5), 547–559. https://doi.org/10.3109/10826084.2013.852587.
American College of Medical Quality. (2010). Definition and Application of Medical Necessity. Retrieved from http://www.acmq.org/policies/policy8.pdf.
Antonucci, J. (2008). A new approach group visits: helping high-need patients make behavioral change. Family Practice Management, 15(4), A6–A8.
Armitage, C. C. M. (1999). Distinguishing perceptions of control from self-efficacy: predicting consumption of a low-fat diet using the theory of planned behavior. Journal of Applied Social Psychology, 29, 72–90.
Arozullah, A. M., Yarnold, P. R., Bennett, C. L., Soltysik, R. C., Wolf, M. S., Ferreira, R. M., et al. (2007). Development and validation of a short-form, rapid estimate of adult literacy in medicine. Medical Care, 45(11), 1026–1033. https://doi.org/10.1097/MLR.0b013e3180616c1b.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. https://doi.org/10.1177/1073191107313003.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B, 57, 289–300.
Benzo, R. P. (2013). Mindfulness and motivational interviewing: two candidate methods for promoting self-management. Chronic Respiratory Disease, 10(3), 175–182. https://doi.org/10.1177/1479972313497372.
Bigi, S. (2014). Key components of effective collaborative goal setting in the chronic care encounter. Communication & Medicine, 11(2), 103–115.
Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002a). Patient self-management of chronic disease in primary care. JAMA, 288(19), 2469–2475.
Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002b). Improving primary care for patients with chronic illness. JAMA, 288(14), 1775–1779.
Bor, D. (2017). Cambridge Health Alliance: 2017 Academic Overview Retrieved from https://static1.squarespace.com/static/59271313e3df289d83dde161/t/59ef5987cd39c3bc41164c8c/1508858257512/2017+Academic+Overview.+Final+10.18.17+%281%29.pdf. Accessed December 2018.
Breitenstein, S. M., Gross, D., Garvey, C. A., Hill, C., Fogg, L., & Resnick, B. (2010). Implementation fidelity in community-based interventions. Research in Nursing & Health, 33(2), 164–173. https://doi.org/10.1002/nur.20373.
Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., et al. (2011). Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug and Alcohol Dependence, 119(1–2), 72–80. https://doi.org/10.1016/j.drugalcdep.2011.05.027.
Burnett-Zeigler, I. E., Satyshur, M. D., Hong, S., Yang, A., J, T. M., & Wisner, K. L. (2016). Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban federally qualified health center. Complementary Therapies in Clinical Practice, 25, 59–67. https://doi.org/10.1016/j.ctcp.2016.08.007.
Cao, J., & Zhang, S. (2014). Multiple comparison procedures. JAMA, 312(5), 543–544. https://doi.org/10.1001/jama.2014.9440.
Carmody, J., & Baer, R. A. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. https://doi.org/10.1002/jclp.20555.
Chapman, D. P., Perry, G. S., & Strine, T. W. (2005). The vital link between chronic disease and depressive disorders. Preventing Chronic Disease, 2(1), A14.
Chawla, N., Collin, S., Bowen, S., Hsu, S., Grow, J., Douglass, A., & Marlatt, G. A. (2010). The mindfulness-based relapse prevention adherence and competence scale: development, interrater reliability, and validity. Psychotherapy Research, 20(4), 388–397. https://doi.org/10.1080/10503300903544257.
Chong, J., Reinschmidt, K. M., & Moreno, F. A. (2010). Symptoms of depression in a Hispanic primary care population with and without chronic medical illnesses. Primary Care Companion to The Journal of Clinical Psychiatry, 12(3). https://doi.org/10.4088/PCC.09m00846blu.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.
Cohen, S., Janicki-Deverts, D., & Miller, G. E. (2007). Psychological stress and disease. JAMA, 298(14), 1685–1687. https://doi.org/10.1001/jama.298.14.1685.
Cole, S. R. (1999). Assessment of differential item functioning in the Perceived Stress Scale-10. Journal of Epidemiology and Community Health, 53(5), 319–320.
Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J. M., & Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47(6), 990–999. https://doi.org/10.1017/S0033291716003317.
Croghan, T.W., Brown, J.D. (2010). Integrating Mental Health Treatment Into the Patient Centered Medical Home (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2). Retrieved from https://pcmh.ahrq.gov/page/integrating-mental-health-treatment-patient-centered-medical-home. AHRQ Publication No. 10-0084-EF, Rockville, MD: Agency for Healthcare Research and Quality. Accessed March 2015.
Culpepper, L., Clayton, A. H., Lieberman, J. A., III., & Susman, J. L. (2008). Treating depression and anxiety in primary care. The Primary Care Companion to the Journal of Clinical Psychiatry, 10(2), 145–152.
deGruy, F., III. (1996). In K. D. Y. Molla, S. Donaldson, K. N. Lohr, & N. A. Vanselow (Eds.), Primary Care: America’s Health in a New Era (Chapter: Mental Health Care in the Primary Care Setting). Washington D.C.: National Academies Press.
Demarzo, M. M., Cebolla, A., & Garcia-Campayo, J. (2015a). The implementation of mindfulness in healthcare systems: a theoretical analysis. General Hospital Psychiatry, 37(2), 166–171. https://doi.org/10.1016/j.genhosppsych.2014.11.013.
Demarzo, M. M., Montero-Marin, J., Cuijpers, P., Zabaleta-del-Olmo, E., Mahtani, K. R., Vellinga, A., et al. (2015b). The efficacy of mindfulness-based interventions in primary care: a meta-analytic review. Annals of Family Medicine, 13(6), 573–582. https://doi.org/10.1370/afm.1863.
Demarzo, M., Montero-Marin, J., Puebla-Guedea, M., Navarro-Gil, M., Herrera-Mercadal, P., Moreno-Gonzalez, S., et al. (2017). Efficacy of 8- and 4-session mindfulness-based interventions in a non-clinical population: A controlled study. Frontiers in Psychology, 8, 1343. https://doi.org/10.3389/fpsyg.2017.01343.
Disease Control and Prevention, C. f (2018). About chronic diseases. Retrieved from https://www.cdc.gov/chronicdisease/about/index.htm. Accessed November 2018.
Eisenberg, L. (1992). Treating depression and anxiety in primary care. Closing the gap between knowledge and practice. The New England Journal of Medicine, 326(16), 1080–1084. https://doi.org/10.1056/NEJM199204163261610.
Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., et al. (2012). Shared decision making: a model for clinical practice. Journal of General Internal Medicine, 27(10), 1361–1367. https://doi.org/10.1007/s11606-012-2077-6.
Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. 6(9), 579–585. doi:https://doi.org/10.1177/1755738012471029.
Fiore, L. D., & Lavori, P. W. (2016). Integrating randomized comparative effectiveness research with patient care. The New England Journal of Medicine, 374(22), 2152–2158. https://doi.org/10.1056/NEJMra1510057.
Friis, A. M., Johnson, M. H., Cutfield, R. G., & Consedine, N. S. (2016). Kindness matters: a randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA1c among patients with diabetes. Diabetes Care, 39(11), 1963–1971. https://doi.org/10.2337/dc16-0416.
Garland, E. L., Schwarz, N. M., Kelly, A., Whitt, A., & Howard, M. O. (2012). Mindfulness-oriented recovery enhancement for alcohol dependence: Therapeutic mechanisms and intervention acceptability. Journal of Social Work Practice in the Addictions, 12(3), 242–263. https://doi.org/10.1080/1533256X.2012.702638.
Gerra, G., Leonardi, C., D’Amore, A., Strepparola, G., Fagetti, R., Assi, C., et al. (2006). Buprenorphine treatment outcome in dually diagnosed heroin dependent patients: a retrospective study. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 30(2), 265–272. https://doi.org/10.1016/j.pnpbp.2005.10.007.
Glickman, M. E., Rao, S. R., & Schultz, M. R. (2014). False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies. Journal of Clinical Epidemiology, 67(8), 850–857. https://doi.org/10.1016/j.jclinepi.2014.03.012.
Goyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018.
Grady, P. A., & Gough, L. L. (2014). Self-management: a comprehensive approach to management of chronic conditions. American Journal of Public Health, 104(8), e25–e31. https://doi.org/10.2105/AJPH.2014.302041.
Guck, T. P. (2008). Attributions regarding unmet treatment goals after interdisciplinary chronic pain rehabilitation. The Clinical Journal of Pain, 24(5), 415–420.
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010.
Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880. https://doi.org/10.1007/s11136-009-9496-9.
Jerant, A., Moore, M., Lorig, K., & Franks, P. (2008). Perceived control moderated the self-efficacy-enhancing effects of a chronic illness self-management intervention. Chronic Illness, 4(3), 173–182. https://doi.org/10.1177/1742395308089057.
Joormann, J., & Stanton, C. H. (2016). Examining emotion regulation in depression: A review and future directions. Behaviour Research and Therapy, 86, 35–49. https://doi.org/10.1016/j.brat.2016.07.007.
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L. G., Fletcher, K. E., Pbert, L., et al. (1992). Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. The American Journal of Psychiatry, 149(7), 936–943. https://doi.org/10.1176/ajp.149.7.936.
Kanaan, S. (2008). Promoting effective self-management approaches to improve chronic disease care: lessons learned. Retrieved from http://www.chcf.org/publications/2008/04/promoting-effective-selfmanagement-approaches-to-improve-chronic-disease-care-lessons-learned. Accessed July 2017.
Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., et al. (2010). Collaborative care for patients with depression and chronic illnesses. The New England Journal of Medicine, 363(27), 2611–2620. https://doi.org/10.1056/NEJMoa1003955.
Kessler, R. C., DuPont, R. L., Berglund, P., & Wittchen, H. U. (1999). Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. The American Journal of Psychiatry, 156(12), 1915–1923. https://doi.org/10.1176/ajp.156.12.1915.
Kinser, P. A., & Robins, J. L. (2013). Control group design: Enhancing rigor in research of mind-body therapies for depression. Evidence-based Complementary and Alternative Medicine, 2013, 140467. https://doi.org/10.1155/2013/140467.
Klein, D. B., Laugesen, M.J., Liu, N. (2013). The patient-centered medical home: a future standard for American healthcare? Public Administration Review, 73(s1), S82-S92. https://doi.org/10.1111/puar.12082
Kurdyak, P., Newman, A., & Segal, Z. (2014). Impact of mindfulness-based cognitive therapy on health care utilization: a population-based controlled comparison. Journal of Psychosomatic Research, 77(2), 85–89. https://doi.org/10.1016/j.jpsychores.2014.06.009.
Lazarus, A. (2004). Reality check: is your behavior aligned with organizational goals? The Physician Executive, 30(5), 50–52.
Lenzen, S. A., J, v. D., Daniëls, R., van Bokhoven, M. A., van der Weijden, T., & Beurskens, A. (2015). Setting goals in chronic care: shared decision making as self-management support by the family physician. The European Journal of General Practice, 21(2), 138–144.
Lesser, I., Rosales, A., Zisook, S., Gonzalez, C., Flores, D., Trivedi, M., et al. (2008). Depression outcomes of Spanish- and English-speaking Hispanic outpatients in STAR*D. Psychiatric Services, 59(11), 1273–1284. https://doi.org/10.1176/appi.ps.59.11.1273.
Lin, E. H., Rutter, C. M., Katon, W., Heckbert, S. R., Ciechanowski, P., Oliver, M. M., et al. (2010). Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care, 33(2), 264–269. https://doi.org/10.2337/dc09-1068.
Lindahl, J. R., Fisher, N. E., Cooper, D. J., Rosen, R. K., & Britton, W. B. (2017). The varieties of contemplative experience: a mixed-methods study of meditation-related challenges in Western Buddhists. PLoS One, 12(5), e0176239. https://doi.org/10.1371/journal.pone.0176239.
Lorig, K. R., & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1–7.
Lorig, K. R., Sobel, D. S., Ritter, P. L., Laurent, D., & Hobbs, M. (2001). Effect of a self-management program on patients with chronic disease. Effective Clinical Practice, 4(6), 256–262.
Lorig, K., Laurent, D. D., Plant, K., Krishnan, E., & Ritter, P. L. (2014). The components of action planning and their associations with behavior and health outcomes. Chronic Illness, 10(1), 50–59. https://doi.org/10.1177/1742395313495572.
Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., Brewer, J. A., & Fulwiler, C. (2015). Mindfulness and cardiovascular disease risk: state of the evidence, plausible mechanisms, and theoretical framework. Current Cardiology Reports, 17(12), 112. https://doi.org/10.1007/s11886-015-0668-7.
Marlatt, G. A., & Donovan, D. M. (2007). Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York City: Guilford Publications.
McCubbin, T., Dimidjian, S., Kempe, K., Glassey, M. S., Ross, C., & Beck, A. (2014). Mindfulness-based stress reduction in an integrated care delivery system: one-year impacts on patient-centered outcomes and health care utilization. The Permanente Journal, 18(4), 4–9. https://doi.org/10.7812/TPP/14-014.
McGregor, M., Lin, E. H., & Katon, W. J. (2011). TEAMcare: an integrated multicondition collaborative care program for chronic illnesses and depression. The Journal of Ambulatory Care Management, 34(2), 152–162. https://doi.org/10.1097/JAC.0b013e31820ef6a4.
McGuire, C., Gabison, J., & Kligler, B. (2016). Facilitators and barriers to the integration of mind-body medicine into primary care. Journal of Alternative and Complementary Medicine, 22(6), 437–442. https://doi.org/10.1089/acm.2016.0043.
Miller, W. R., & Rollnick, S. (1995). Motivational enhancement therapy manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. Michigan: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism.
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: helping people change applications of motivational interviewing series. New York: Guilford Press.
Miller, W. R., C’de Baca J, Matthews D.B., Wilbourne, P.L. (2001). Personal values card sort.
Miranda, J., & Cooper, L. A. (2004). Disparities in care for depression among primary care patients. Journal of General Internal Medicine, 19(2), 120–126.
Morton, V., & Torgerson, D. J. (2003). Effect of regression to the mean on decision making in health care. BMJ, 326(7398), 1083–1084. https://doi.org/10.1136/bmj.326.7398.1083.
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet, 370(9590), 851–858. https://doi.org/10.1016/S0140-6736(07)61415-9.
Nadeem, E., Lange, J. M., & Miranda, J. (2008). Mental health care preferences among low-income and minority women. Archives of Women's Mental Health, 11(2), 93–102. https://doi.org/10.1007/s00737-008-0002-0.
Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44. https://doi.org/10.1002/jclp.21923.
Olfson, M., Kroenke, K., Wang, S., & Blanco, C. (2014). Trends in office-based mental health care provided by psychiatrists and primary care physicians. The Journal of Clinical Psychiatry, 75(3), 247–253. https://doi.org/10.4088/JCP.13m08834.
Ornstein, S. M., Nietert, P. J., Jenkins, R. G., & Litvin, C. B. (2013). The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. Journal of American Board of Family Medicine, 26(5), 518–524. https://doi.org/10.3122/jabfm.2013.05.130012.
Pearson, M. (2007). Patient self-management support programs: an evaluation retrieved from Santa Monica, CA.
Plaza, I., Demarzo, M. M., Herrera-Mercadal, P., & Garcia-Campayo, J. (2013). Mindfulness-based mobile applications: literature review and analysis of current features. JMIR Mhealth Uhealth, 1(2), e24. https://doi.org/10.2196/mhealth.2733.
Pollak, S., Pedulla, T., & Siegel, R. (2014). Sitting together: essential skills for mindfulness-based psychotherapy. New York City: Guilford Publications.
Proulx, J., Croff, R., Oken, B., Aldwin, C. M., Fleming, C., Bergen-Cico, D., et al. (2018). Considerations for research and development of culturally relevant mindfulness interventions in American minority communities. Mindfulness (N Y), 9(2), 361–370. https://doi.org/10.1007/s12671-017-0785-z.
Rabe-Hesketh, S. S. A. (2012). Multilevel and longitudinal modeling using stata (3rd ed. Vol. 1 & 2). College Station: Stata Press.
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology & Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702.
Richards, J., Wiese, C., Katon, W., Rockhill, C., McCarty, C., Grossman, D., et al. (2010). Surveying adolescents enrolled in a regional health care delivery organization: mail and phone follow-up--what works at what cost? Journal of American Board of Family Medicine, 23(4), 534–541. https://doi.org/10.3122/jabfm.2010.04.100019.
Ritter, P. L., & Lorig, K. (2014). The English and Spanish self-efficacy to manage chronic disease scale measures were validated using multiple studies. Journal of Clinical Epidemiology, 67(11), 1265–1273. https://doi.org/10.1016/j.jclinepi.2014.06.009.
Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44(10), 2029–2040. https://doi.org/10.1017/S0033291713002535.
Roth, B., & Robbins, D. (2004). Mindfulness-based stress reduction and health-related quality of life: findings from a bilingual inner-city patient population. Psychosomatic Medicine, 66(1), 113–123.
Roth, B., & Stanley, T. W. (2002). Mindfulness-based stress reduction and healthcare utilization in the inner city: preliminary findings. Alternative Therapies in Health and Medicine, 8(1), 60–62 64–66.
Schalet, B. D., Cook, K. F., Choi, S. W., & Cella, D. (2014). Establishing a common metric for self-reported anxiety: linking the MASQ, PANAS, and GAD-7 to PROMIS Anxiety. Journal of Anxiety Disorders, 28(1), 88–96. https://doi.org/10.1016/j.janxdis.2013.11.006.
Schuman, Z. D., & Abrahm, J. L. (2005). Implementing institutional change: an institutional case study of palliative sedation. Journal of Palliative Medicine, 8(3), 666–676. https://doi.org/10.1089/jpm.2005.8.666.
Stata Statistical Software: Release 14. (2015). College Station, TX: StataCorp LP: StataCorp.
Sundquist, J., Lilja, A., Palmer, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. (2015). Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: randomised controlled trial. The British Journal of Psychiatry, 206(2), 128–135. https://doi.org/10.1192/bjp.bp.114.150243.
Sundquist, J., Palmer, K., Johansson, L. M., & Sundquist, K. (2017). The effect of mindfulness group therapy on a broad range of psychiatric symptoms: a randomised controlled trial in primary health care. European Psychiatry, 43, 19–27. https://doi.org/10.1016/j.eurpsy.2017.01.328.
Tang, Y. Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., et al. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences of the United States of America, 104(43), 17152–17156. https://doi.org/10.1073/pnas.0707678104.
Tang, Y. Y., Holzel, B. K., & Posner, M. I. (2015). The neuroscience of mindfulness meditation. Nature Reviews. Neuroscience, 16(4), 213–225. https://doi.org/10.1038/nrn3916.
Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.
Unutzer, J., & Park, M. (2012). Strategies to improve the management of depression in primary care. Primary Care, 39(2), 415–431. https://doi.org/10.1016/j.pop.2012.03.010.
Unutzer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288(22), 2836–2845.
Vilagut, G., Forero, C. G., Adroher, N. D., Olariu, E., Cella, D., Alonso, J., & investigators, I. N. (2015). Testing the PROMIS(R) depression measures for monitoring depression in a clinical sample outside the US. Journal of Psychiatric Research, 68, 140–150. https://doi.org/10.1016/j.jpsychires.2015.06.009.
Wahbeh, H., Goodrich, E., Goy, E., & Oken, B. S. (2016). Mechanistic pathways of mindfulness meditation in combat veterans with posttraumatic stress disorder. Journal of Clinical Psychology, 72(4), 365–383. https://doi.org/10.1002/jclp.22255.
Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2015). Managing patients with multimorbidity in primary care. BMJ, 350, h176. https://doi.org/10.1136/bmj.h176.
Waller, G. (2009). Evidence-based treatment and therapist drift. Behaviour Research and Therapy, 47(2), 119–127. https://doi.org/10.1016/j.brat.2008.10.018.
Woods-Giscombe, C. L., & Gaylord, S. A. (2014). The cultural relevance of mindfulness meditation as a health intervention for African Americans: implications for reducing stress-related health disparities. Journal of Holistic Nursing, 32(3), 147–160. https://doi.org/10.1177/0898010113519010.
Zeidan, F., Emerson, N. M., Farris, S. R., Ray, J. N., Jung, Y., McHaffie, J. G., & Coghill, R. C. (2015). Mindfulness meditation-based pain relief employs different neural mechanisms than placebo and sham mindfulness meditation-induced analgesia. The Journal of Neuroscience, 35(46), 15307–15325. https://doi.org/10.1523/JNEUROSCI.2542-15.2015.
Acknowledgments
The following individuals are acknowledged: Susan Pollak, Alexandra Oxnard, Laura Warren, Paula Gardiner, Eric Loucks, Timothy Martin, Fabio Marcovski, My Ngoc To, Thomas Fatkin, Alexandra Brunel, Bridget Kiley, Pedro Barbosa, Jillian Burley, Cristian Onofrei, Barbara Hamm, Janet Yassen, Nicholas Barnes, Chris Carter-Husk, Nayla Khoury, Alaine Fredericksen, David Lovas, Emily Benedetto, Colleen O’Brien, Robert Joseph, Michael Williams, Mark Albanese, Adam Elias, Somava Stout, Elizabeth Gaufberg, Ben Cook, David Bor, Randy Wertheimer, Assaad Sayah, Jay Burke, and Patrick Wardell.
Funding
This study was supported by the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Center for Complementary and Integrative Health (NCCIH) (UH2AT009145), as well as The Arthur Vining Davis Foundations—Healthcare System Transformation Grant, The Arnold P. Gold Foundation, Cambridge Health Alliance, and Harvard Medical School Department of Psychiatry.
Author information
Authors and Affiliations
Contributions
RG: edited intervention, oversaw and executed the study, analyzed the results, co-wrote the manuscript; EP: co-designed intervention, designed and executed the study, assisted with data analyses, edited the introduction and methods; TG: co-designed intervention, designed and oversaw the study, co-wrote the introduction, methods and discussion; TC: analyzed results, edited the methods and results; ZV: co-designed intervention and oversaw supervision of intervention group leaders, edited the methods; ER: co-designed and oversaw supervision of the intervention group leaders, edited the methods; AL: executed study, led patient focus group, and edited the manuscript; ZSO: co-designed intervention, designed and oversaw the execution of the study, co-wrote the manuscript. All authors approved the final version of the manuscript for submission.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethics Statement
This study was approved by the Cambridge Health Alliance Institutional Review Board and procedures followed all provisions of the Declaration of Helsinki.
Prior Presentations
Partial data from initial analysis was presented to scientific advisory board for NIH Science of Behavior Change Network Meeting, Bethesda, MD (January 10, 2017).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic Supplementary Material
ESM 1
(DOCX 29 kb)
Rights and permissions
About this article
Cite this article
Gawande, R., Pine, E., Griswold, T. et al. Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial. Mindfulness 10, 1744–1759 (2019). https://doi.org/10.1007/s12671-019-01116-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-019-01116-8