Improve Mental Health with Mindfulness
By John M. de Castro, Ph.D.
“Mindfulness is recommended as a treatment for people with mental ill-health as well as those who want to improve their mental health and wellbeing.” – Mental Health Foundation
Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that the development of mindfulness has positive benefits for the individual’s mental, physical, and spiritual life. Mindfulness appears to be beneficial both for healthy people and for people suffering from a myriad of mental and physical illnesses. It appears to be beneficial across ages, from children, to adolescents, to the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity. The breadth and depth of benefits is unprecedented. There is no other treatment or practice that has been shown to come anyway near the range of mindfulness’ positive benefits.
There is a vast array of techniques for the development of mindfulness. It is important to establish the most efficacious techniques and their dosages for the treatment of common mental illnesses. It is particularly important, for reasons of affordability, to employ techniques that qualify for insurance reimbursement.
In today’s Research News article “Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009938/ ) Gawande and colleagues recruited adults with a non-severe mental health diagnosis and randomly assigned them to receive either a high or low dose mindfulness training. The high dose training consisted of 8 weeks of twice a week 1-hour mindfulness trainings along with daily 30-45 minutes of home practice. The mindfulness training was adapted from Mindfulness-Based Cognitive Therapy (MBCT) including meditation, trauma-informed practices, and self-compassion training. The low dose mindfulness training consisted of a single 60-minute introduction to mindfulness and encouragement to practice mindfulness. They were measured before and after training for anxiety, depression, perceived stress, disease self-efficacy, mindfulness, self-compassion, and perceived control of disease.
The most common disorders were anxiety disorders in 37% and depression in 32% of the participants. They found that in comparison to baseline the high dose mindfulness group had significant reductions in anxiety, depression, and perceived stress and significant increases in disease self-efficacy, mindfulness, and self-compassion. The low dose mindfulness group had only a significant reduction in perceived stress. The high dose mindfulness group had significant greater increases in mindfulness and self-compassion and decreases in anxiety than the low dose group. Importantly, the high dose mindfulness intervention was accepted for reimbursement by insurance companies.
The study is important in that it demonstrated that insurance would cover the high dose treatment. This is important for making the treatment affordable for insured clients. The study demonstrated as have a variety of other research studies that mindfulness training produces significant reductions in anxiety, depression, and perceived stress and significant increases in disease self-efficacy, mindfulness, and self-compassion. But the study had a unique control condition of a low dose mindfulness training. The high dose intervention produced significant improvements in mental illness disease symptoms that were for the most part better than those of the low dose. This establishes that participant expectancies and positive biases toward mindfulness training cannot account for the improvements. It also demonstrates that greater doses of mindfulness training produce greater benefits for patients with non-severe mental health issues.
So, improve mental health with mindfulness.
“The research is strong for mindfulness’ positive impact in certain areas of mental health, including stress reduction, emotion and attention regulation, reduced rumination, for reducing mild to moderate depression and anxiety, and preventing depressive relapse.” – Kelle Walsh
CMCS – Center for Mindfulness and Contemplative Studies
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Gawande, R., Pine, E., Griswold, T., Creedon, T., Vallejo, Z., Rosenbaum, E., Lozada, A., & Schuman-Olivier, Z. (2019). Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: A Pilot Randomized Controlled Trial. Mindfulness, 10(9), 1744–1759. https://doi.org/10.1007/s12671-019-01116-8
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.
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.
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).
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.