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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 2/2019

01-02-2019 | Original Research

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

Authors: Richa Gawande, PhD, My Ngoc To, BA, Elizabeth Pine, BA, Todd Griswold, MD, Timothy B. Creedon, MA, Alexandra Brunel, MA, Angela Lozada, BS, Eric B. Loucks, PhD, Zev Schuman-Olivier, MD

Published in: Journal of General Internal Medicine | Issue 2/2019

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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.
Appendix
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Metadata
Title
Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: a Randomized Controlled Trial
Authors
Richa Gawande, PhD
My Ngoc To, BA
Elizabeth Pine, BA
Todd Griswold, MD
Timothy B. Creedon, MA
Alexandra Brunel, MA
Angela Lozada, BS
Eric B. Loucks, PhD
Zev Schuman-Olivier, MD
Publication date
01-02-2019
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 2/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-018-4739-5

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