Improve Psychological Well-Being of Recovered Cardiorespiratory Patients with Mindfulness
By John M. de Castro, Ph.D.
“Meditation can be a useful part of cardiovascular risk reduction. I do recommend it, along with diet and exercise. It can also help decrease the sense of stress and anxiety.” – Deepak Bhatt
Patients who experience cardiorespiratory failure have now a high likelihood of survival if they are treated promptly in an intensive care unit. Unfortunately, after physical recovery and discharge the patients often experience negative physical and psychological consequences. These include physical symptoms and psychological issues such as depression, anxiety, and post-traumatic stress symptoms, stress, fear and foreboding, emotional disability, and social disruption. Treatments are needed to help alleviate these troubling residual symptoms.
Mindfulness practices have been shown to improve depression, anxiety, and post-traumatic stress disorder (PTSD), stress, fear and foreboding, emotional disability, and social function. It would seem reasonable then to project that mindfulness practice may be beneficial for the psychological well-being of patients who have recovered from cardiorespiratory failure. But such patients generally find it difficult or impossible to come to a clinic for treatment. As an alternative, mindfulness training can be delivered remotely with smartphone apps. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations for treatment. But the question arises as to the effectiveness of these programs.
In today’s Research News article “Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460929/ ), Cox and colleagues recruited patients who had been released from the intensive care unit following cardiorespiratory failure and were at home. They were randomly assigned to receive a 4-session mindfulness training either by phone or smartphone app, or receive a web-based education program. They completed online measures of acceptability, feasibility, and usability and also were measured before and 3 months after the intervention for anxiety, depression, symptom severity, post-traumatic stress, physical distress, quality of life, coping skills, stress, and mindfulness.
The program was found to be acceptable, feasible, and usable as 83% of the patients completed the study with no significant differences between conditions. They found that in comparison to baseline and the education group, both mindfulness training groups had significant improvements in physical symptoms, posttraumatic stress symptoms, depression and anxiety. They also found that the greater the use of the mobile app the greater the improvement in depression.
The results of the study are encouraging and show that mindfulness training delivered either by telephone or a smartphone app is acceptable, feasible, and usable and is effective for the treatment of patients who were recovering from cardiorespiratory failure improving their physical and mental health. This is important as these patients are suffering and, like many others, have difficulty coming to a particular location at a particular time to receive therapist delivered mindfulness training. So, smartphone and phone-based programs are a valuable solution.
So, improve psychological well-being of recovered cardiorespiratory patients with mindfulness.
“Not only can meditation improve how your heart functions, but a regular practice can enhance your outlook on life and motivate you to maintain many heart-healthy behaviors, like following a proper diet, getting adequate sleep, and keeping up regular exercise,” – John Denninger
CMCS – Center for Mindfulness and Contemplative Studies
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Cox, C. E., Hough, C. L., Jones, D. M., Ungar, A., Reagan, W., Key, M. D., … Porter, L. S. (2019). Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial. Thorax, 74(1), 33–42. doi:10.1136/thoraxjnl-2017-211264
Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs.
Pilot randomized clinical trial with 3-month follow up conducted at two academic medical centers. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomized after discharge home to one of three month-long interventions: a self-directed mobile app-based mindfulness program; a therapist-led telephone-based mindfulness program; or a web-based critical illness education program.
Among 80 patients allocated to mobile mindfulness (n= 31), telephone mindfulness (n=31), or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomization 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27.6 [standard deviation 3.8]), and usability (mean Systems Usability Score 89.1 [SD 11.5]). For secondary outcomes, mean values (and 95% confidence intervals) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (−4.8 [−6.6, −2.9]), telephone (−3.9 [−5.6, −2.2]), education (−3.0 [−5.3, 0.8]); the Generalized Anxiety Disorder scale (mobile −2.1 [−3.7, −0.5], telephone −1.6 [−3.0, −0.1], education −0.6 [−2.5, 1.3]), the Post-Traumatic Stress Scale (mobile −2.6 [−6.3, 1.2], telephone −2.2 [−5.6, 1.2], education −3.5 [−8.0, 1.0]), and the Patient Health Questionnaire physical symptom scale (mobile −5.3 [−7.0, −3.7], telephone −3.7 [−5.2, 2.2], education −4.8 [−6.8, 2.7]).
Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability, and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led program. A larger trial is warranted to formally test the efficacy of this approach.