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

  • Richa Gawande
  • My Ngoc To
  • Elizabeth Pine
  • Todd Griswold
  • Timothy B. Creedon
  • Alexandra Brunel
  • Angela Lozada
  • Eric B. Loucks
  • Zev Schuman-Olivier
Original Research

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.

KEY WORDS

primary care mindfulness self-management health behavior self-regulation patient-centered 

Notes

Funding Information

This study was made possible through grant funding provided by a cooperative agreement supported by the NIH Common Fund Science of Behavior Change Initiative and the National Center for Complementary and Integrative Health: “Mindfulness Influences on Self-Regulation: Mental and Physical Health Implications” (UH2AT009145) (PI: Loucks, Project PI: Schuman-Olivier). Additional funding was provided by the Arthur Vining Davis Foundations (PI: Schuman-Olivier), the Arnold P. Gold Foundation (PI: Schuman-Olivier), as well as with funding from Cambridge Health Alliance.

Compliance with Ethical Standards

This study had a NIH-approved data safety monitoring plan with an independent monitor and was approved by the Cambridge Health Alliance (CHA) Institutional Review Board and procedures followed all provisions of the Declaration of Helsinki.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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Fig. S1

(PNG 122 kb)

11606_2018_4739_MOESM1_ESM.tif (71 kb)
High resolution image (TIF 71 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Richa Gawande
    • 1
    • 2
  • My Ngoc To
    • 2
  • Elizabeth Pine
    • 2
  • Todd Griswold
    • 1
    • 2
  • Timothy B. Creedon
    • 3
    • 4
  • Alexandra Brunel
    • 2
  • Angela Lozada
    • 2
  • Eric B. Loucks
    • 5
  • Zev Schuman-Olivier
    • 1
    • 2
  1. 1.Department of Psychiatry Harvard Medical SchoolBostonUSA
  2. 2.Cambridge Health AllianceCambridgeUSA
  3. 3.The Heller School for Social Policy and ManagementBrandeis UniversityWalthamUSA
  4. 4.IBM Watson HealthCambridgeUSA
  5. 5.Department of EpidemiologyBrown University School of Public HealthProvidenceUSA

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