Mindfulness Helps With Disease Self-Management Skills

Norra MacReady

December 26, 2018

An 8-week program of mindfulness training may enhance disease self-management among people with chronic illnesses such as diabetes and arthritis, a study has found. The researchers used rates of initiation of health behavior action plans to measure improvement in the patients' self-management skills.

The insurance-reimbursable intervention was associated with higher rates of action-plan initiation than those seen in people exposed to a low-dose comparator (LDC) consisting of a 60-minute introduction to mindfulness, digital and community resources, and standard mental health care.

The study, which was conducted by Richa Gawande, PhD, Harvard Medical School, Boston, and Cambridge Health Alliance, both in Massachusetts, and colleagues, was published online December 3 in the Journal of General Internal Medicine.

The program, called Mindfulness Training for Primary Care (MTPC), "was more effective for improving emotion regulation, interoceptive awareness, self-compassion, and mindfulness at 8 weeks" compared with the low-dose approach, the researchers explain.

However, at a 24-week follow-up examination, the LDC also was associated with positive changes in mental health, suggesting that access to high-quality mental health care combined with at least modest exposure to mindfulness training "may moderately reduce stress, depression, and anxiety," the investigators write.

The study's primary outcome was the impact of the MTPC program compared with that of the LDC on patients' initiation of an action plan within 2 weeks of setting a goal for health behavior self-management. Secondary outcomes included changes in levels of anxiety, depression, and stress 8 and 24 weeks after the intervention, compared with baseline.

Patients were recruited from 11 primary care medical homes, were at least 18 years of age, had a DSM-5 diagnosis but no serious mental illnesses, such as psychosis, and no active substance use disorders.

All study participants received a 60-minute introduction to mindfulness, which included the basic principles of mindfulness, brief guided mindfulness practices, and a review of resources for further information. They were then randomly assigned to receive either the MTPC or the LDC.

The MTPC consisted of eight weekly 2-hour sessions, co-led by two trained providers, one 7-hour session, and a recommendation for 30 to 45 minutes of daily practice at home, using guided recordings. Patients in the LDC group were encouraged to use the mindfulness techniques demonstrated in the 60-minute introduction and to supplement that with digital and community resources, while continuing their standard mental health care.

During week 7, all participants were instructed to create a short-term action plan relating to health maintenance or self-management of a chronic disease. At weeks 8 and 9, they completed an action plan initiation (API) survey that measured the degree to which they had started the plan. Scores on the survey ranged from 1 (not at all) to 7 (completely). "Evidence of plan initiation was defined as an API score ≥5," the authors write.

The final analysis included 92 patients in the MTPC group, of whom 68 developed an action plan, and 44 in the LDC group, of whom 33 developed an action plan. Fifty-three patients (77.9%) in the MTPC group reported initiation of the action plan, compared with 14 patients (42.4%) in the LDC group (odds ratio [OR], 2.91; P = .006). Of the 101 participants who responded to the API survey, MTPC was associated with higher API rates (OR, 4.8; P = .001).

Overall, in an intention-to-treat analysis, MTPC was associated with significantly higher odds of API, compared with the LDC (OR, 2.28; 95% confidence interval, 1.02 - 5.06; P = .025).

The authors also found large within-group effect sizes with MTPC for anxiety, mindfulness, self-compassion, and interoceptive awareness at 8 and 24 weeks, and for emotional regulation at 24 weeks. They observed moderate to large within-group effect sizes associated with MTPC for depression and stress at 8 and 24 weeks, but also within the LDC group for self-compassion and stress at 8 and 24 weeks, along with anxiety and depression at 24 weeks.

Anxiety, depression, trauma, and stress are common comorbidities in patients with chronic illnesses and may interfere with the self-regulation skills necessary for effective management of those illnesses. Mindfulness-based programs "are evidence-based treatments that seem to harness self-regulatory mechanisms and could help people with self-regulation challenges catalyze behavior change related to managing chronic disease," the authors say.

The findings suggest that "integrating MTPC into the health care system as an insurance-reimbursable, referral-based treatment is effective in facilitating health behavior change for primary care patients with a variety of chronic conditions," the authors conclude. The program "facilitates self-management of chronic disease and represents a compelling model for dissemination within primary care patient-centered medical homes."

Study limitations include variations in the mental health care received by patients in the control group, which limited the conclusions that could be drawn about their outcomes, and use of self-assessments when measuring patients' initiation of their action plans.

The authors have disclosed no relevant financial relationships.

J Gen Intern Med. Published online December 3, 2018. Abstract

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