Mindfulness-based Stress Reduction Participants Research Articles

Acceptability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study

BackgroundDepression is very common among stroke survivors with estimated prevalence rates of approximately 33% among stroke survivors, but treatment options are limited. Mindfulness-Based Stress Reduction (MBSR) is an effective treatment for depression generally, but benefits in stroke patients are unclear. The aim of this study was to determine the feasibility of delivering MBSR to stroke survivors and their caregivers in the community. We conducted a study to gain views of MBSR as a potential treatment option among stroke survivors and their caregivers in the community.MethodsParticipants were recruited from an urban community in Scotland (UK) using newspaper adverts, social media and support groups run by health charities. A 2-h MBSR taster session was delivered by two experienced mindfulness instructors, followed by focus group sessions with all participants on their user experience and suggestions for MBSR modifications for stroke survivors. The focus group sessions were audio recorded and transcribed verbatim. Transcript data were analysed thematically using the framework approach.ResultsThe study sample consisted of 28 participants (16 females); there were 21 stroke survivors (11 females) and 7 caregivers (5 females). The median age for participants was 60 years.Most participants described the MBSR taster session as a positive experience. The main challenge reported was trying to maintain focus and concentration throughout the MBSR session. Some participants expressed reservations about the duration of standard mindfulness course sessions, suggesting a preference for shorter sessions. The potential for achieving better control over negative thoughts and emotions was viewed as a potential facilitator for future MBSR participation. Participants suggested having an orientation session prior to starting an 8-week course as a means of developing familiarity with the MBSR instructor and other participants.ConclusionIt was feasible to recruit 21 stroke survivors and 7 caregivers for MBSR taster sessions in the community. A shorter MBSR session and an orientation session prior to the full course are suggestions for potential MBSR modifications for stroke survivors, which needs further research and evaluation.

Investigating Effects and Mechanisms of a Mindfulness-Based Stress Reduction Intervention in a Sample of College Students at Risk for Social Anxiety

The aims of this study were two-fold: (1) to investigate the effectiveness of a 6-week mindfulness-based stress reduction (MBSR) program in a sample of college students at risk for social anxiety and (2) to investigate whether emotion regulation strategies and self-compassion act as mechanisms of MBSR effectiveness. Participants in this study were predominantly female college students identified as at risk for social anxiety, who were randomly assigned to either the MBSR intervention or to the wait list control group. The final sample included 22 participants in the MBSR group and 24 in the wait list control group for whom pre-intervention and post-intervention (1 week after the MBSR intervention was finalized) data were gathered on self-report measures. The results showed that MBSR participation lead to significant reductions in social anxiety and perceived stress. Also, significant post-intervention differences in favor of the MBSR group compared to the wait list control group were found for self-compassion and acceptance, but not for positive reinterpretation. Mediation analyses employing a bootstrap procedure with 95% confidence intervals were conducted to test the potential MBSR intervention mechanisms. The results revealed that acceptance and self-compassion mediated the relationship between MBSR participation and social anxiety, as well as MBSR participation and perceived stress. The current findings indicated that mindfulness-based interventions might work by: (1) reducing self-identification with successes and failures in social and stressful situations and (2) deactivating appraisals concerning anxiety provoking situations.

Mindfulness instruction for HIV-infected youth: a randomized controlled trial

ABSTRACTHIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14–22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P = .03), problem-solving coping (P = .03), and life satisfaction (P = .047), and lower aggression (P = .002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P = .02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P = .04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth.

The many facets of mindfulness and the prediction of change following mindfulness-based stress reduction (MBSR).

Mindfulness-based stress reduction (MBSR) promotes numerous psychological benefits, but few studies have identified for whom MBSR is most effective. The current study tested the hypothesis that lower baseline mindfulness invites more "room to grow" and, thus, predicts greater improvement during MBSR. We examined three facets of mindfulness (awareness, acceptance, decentering) among 131 MBSR participants prior to enrollment, to test the hypothesis that lower baseline mindfulness predicts greater improvements in perceived stress, positive affect (PA), and negative affect (NA) following MBSR. Lower acceptance and decentering predicted greater decreases in perceived stress. Higher awareness, acceptance, and decentering predicted greater increases in PA. Higher awareness predicted greater reductions in NA. Lower decentering predicted greater reductions in NA. Findings partly supported the hypothesis that lower baseline mindfulness predicts greater improvement following MBSR and emphasize the importance of assessing multiple mindfulness facets given their unique, contrasting relations to outcomes.

Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction: A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes

Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) emphasize the importance of mindfulness practice at home as an integral part of the program. However, the extent to which participants complete their assigned practice is not yet clear, nor is it clear whether this practice is associated with positive outcomes.For this systematic review and meta-analysis, searches were performed using Scopus and PubMed for studies published through to the end of 2015, reporting on formal home practice of mindfulness by MBSR or MBCT participants.Across 43 studies (N = 1427), the pooled estimate for participants' home practice was 64% of the assigned amount, equating to about 30 minutes per day, six days per week [95% CI 60–69%]. There was substantial heterogeneity associated with this estimate. Across 28 studies (N = 898), there was a small but significant association between participants’ self-reported home practice and intervention outcomes (r = 0·26, 95% CI 0·19,–0·34).MBSR and MBCT participants report completing substantial formal mindfulness practice at home over the eight-week intervention, albeit less than assigned amounts. There is a small but significant association between the extent of formal practice and positive intervention outcomes for a wide range of participants.

Mindfulness-based stress reduction for breast cancer patients: a mixed method study on what patients experience as a suitable stage to participate

PurposeBreast cancer is associated with high levels of psychological distress. Mindfulness-based stress reduction (MBSR) has proven to be effective in reducing distress in cancer patients. In several studies, patients who are currently undergoing somatic anticancer treatment are excluded from participating in MBSR. Little is known about what would be the most suitable stage of disease to offer MBSR. We examined whether stage of disease facilitated and/or hindered participation in MBSR for breast cancer patients.MethodA mixed method design was used. Self-report questionnaires on psychological distress (HADS) and quality of life (EORTC QLQ-C30) were administered before and after MBSR. Five focus groups and three semi-structured individual interviews were conducted. Qualitative data were analyzed with the constant comparative method in order to develop a grounded theory.ResultsSixty-four females participated in MBSR. In 52 patients who completed the questionnaires, psychological distress improved significantly. Qualitative data showed that participating in MBSR both during and after anticancer treatment has specific advantages and disadvantages. Interestingly, being emotionally ready to take part in MBSR seems equally important as physical ability. Informing patients at an early stage seemed to strengthen autonomy and self-management skills.ConclusionsIn contrast to the common practice to tailoring the timing of MBSR to physical impairments or demands of the anticancer treatment, our findings revealed that emotional readiness is equally important to take into account. These findings might support professionals in their choices whether and when to inform and refer patients to MBSR.

Impact of mindfulness for people with arthritis

ABSTRACTObjectiveTo examine the impact of mindfulness-based stress reduction (MBSR) for people with ankylosing spondylitis (AS). Methods193 People with AS were invited to take part in an MBSR 8 week course. The data linkage component of this study examined number of visits to the general practitioner before and after the course in participants and non-participants of the course (500 people taking part in a cohort study but not invited to the course). ResultsOf 193 people invited, 43 (22%) consented and took part in the course, GP records were available for 41 (95%) of MBSR participants and 457 (91%) of the 500 comparison group. There was a mean of 7.6 (median 3) visits to the GP in the 12 month period before the course for those undertaking MBSR and 4.6 (median 0) visits in the 12 month period after the course. This compared with 5.5 (median 0) visits (12 months before a random date) and 4.1 (median 0) visits (12 months after a random date) in the comparison group. Using Wilcoxon rank-sum (Mann-Whitney) test showed a significant reduction in GP visits in the MBSR group after the course compared to the comparison group. ConclusionsThose who chose to attend an MBSR course had a higher number of visits to the GP before attending the course, than the comparison group. However, after attending the stress reduction course the number of visits to the GP reduced to levels equivalent to the comparison group. This study suggests that mindfulness based stress reduction could be effective in reducing the number of visits to the GP for people with arthritis who regularly see their GP. The findings from this study suggest a full RCT and cost effectiveness analysis is warranted.

Can mindfulness-based interventions improve the quality of life of patients with moderate/severe alopecia areata? A prospective pilot study

Can mindfulness-based interventions improve the quality of life of patients with moderate/severe alopecia areata? A prospective pilot study

The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder

Mindfulness-Based interventions have increased in popularity in psychiatry, but the impact of these treatments on disorder-relevant biomarkers would greatly enhance efficacy and mechanistic evidence. If Generalized Anxiety Disorder (GAD) is successfully treated, relevant biomarkers should change, supporting the impact of treatment and suggesting improved resilience to stress. Seventy adults with GAD were randomized to receive either Mindfulness-Based Stress Reduction (MBSR) or an attention control class; before and after, they underwent the Trier Social Stress Test (TSST). Area-Under-the-Curve (AUC) concentrations were calculated for adrenocorticotropic hormone (ACTH) and pro-inflammatory cytokines. MBSR participants had a significantly greater reduction in ACTH AUC compared to control participants. Similarly, the MBSR group had a greater reduction in inflammatory cytokines’ AUC concentrations. We found larger reductions in stress markers for patients with GAD in the MBSR class compared to control; this provides the first combined hormonal and immunological evidence that MBSR may enhance resilience to stress.

Effects of mindfulness meditation on occupational functioning and health care utilization in individuals with anxiety

ObjectivesTo examine the effect of mindfulness meditation on occupational functioning in individuals with Generalized anxiety disorder (GAD). MethodsFifty-seven individuals with GAD (mean (SD) age=39 (13); 56% women) participated in an 8-week clinical trial in which they were randomized to mindfulness-based stress reduction (MBSR) or an attention control class. In this secondary analysis, absenteeism, entire workdays missed, partial workdays missed, and healthcare utilization patterns were assessed before and after treatment. ResultsCompared to the attention control class, participation in MBSR was associated with a significantly greater decrease in partial work days missed for adults with GAD (t=2.734, df=51, p=0.009). Interestingly, a dose effect was observed during the 24-week post-treatment follow-up period: among MBSR participants, greater home mindfulness meditation practice was associated with less work loss and with fewer mental health professional visits. ConclusionMindfulness meditation training may improve occupational functioning and decrease healthcare utilization in adults with GAD.

Abstract 11402: Mindfulness Based Stress Reduction and Group Support Decrease Stress, Anxiety and Depression in Adolescents With Cardiac Diagnoses: A Randomized Two-Group Study

Introduction: Adolescents with cardiac diagnoses face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac diagnoses and may also impact adolescents’ adjustment. This study compares a Mindfulness Based Stress Reduction (MBSR) program to a video online support group (VG) for adolescents with cardiac diagnoses. MBSR is a structured psycho-educational program which includes yoga, meditation, cognitive restructuring and group support. A published feasibility study by our group showed significant reduction in anxiety following MBSR intervention. Methods: This study was a prospective, randomized, two-group design. Participants were randomized to MBSR or VG and completed measures of anxiety and depression (A/D) (Hospital Anxiety and Depression Scale), stress and coping (Responses to Stress Questionnaire) pre-and post their 6-session intervention. Qualitative data were obtained from post-intervention interviews. Results: Mean age of the sample (N=46) was 14.8 yrs; 63% were female. Eleven participants (24%) had an ICD, 7 (15%) had a pacemaker, 24 (52%) had congenital heart disease, 22 (48%) had POTS. There were 26 (56%) participants in the MBSR group and 20 (43%) in the VG. Study completion rate was 95% (44/46). Stress significantly decreased in both groups [t(44)=3.7, p=.001]. Greater use of coping skills predicted lower levels of post-intervention depression (r=-.30, p=.04). Higher baseline A/D scores predicted improved A/D scores post-intervention (A: r=.43, p=.01, D: r=.36, p=.02). Qualitatively, both groups reported the benefits of social support, with MBSR participants reporting using learned coping skills to help manage stress and heart symptoms. Conclusion: Both interventions were effective in reducing distress in this adolescent sample. Qualitative data elucidated the added benefits of using MBSR techniques to manage stress. The video group format is useful for teens who are unable to meet in person but can benefit from group support. Both groups spontaneously exchanged contact information, wanting to continue as a group. Psychosocial interventions with stress management techniques and/or group support can reduce distress in adolescents with cardiac diagnoses.

A Secondary Analysis of Sleep Quality Changes in Older Adults From a Randomized Trial of an MBSR Program.

This secondary analysis examined changes in sleep quality associated with participation in a Mindfulness-Based Stress Reduction (MBSR) program among healthy older adults. Data were collected at baseline, 8-weeks post-treatment, and a 6-month follow-up from adults aged ≥ 65 ( N = 200), randomly assigned to MBSR or a waitlist control. Group differences were examined using mixed analysis of covariance with repeated measures on the total Pittsburgh Sleep Quality Index (PSQI) score. A small-sized, significant effect was found on overall sleep among MBSR participants with baseline PSQI scores > 5, indicative of a sleep disturbance, F(2, 80) = 4.32, p = .02, ηp2 = .05. A medium-sized, significant effect was found for MBSR participants with baseline PSQI scores ≥ 10, F(2, 28) = 3.13, p = .04, ηp2 = .10. These findings indicate that improved sleep quality for older adults who have higher levels of sleep disturbance may be associated with participation in MBSR.

Mindful Mates: A Pilot Study of the Relational Effects of Mindfulness-Based Stress Reduction on Participants and Their Partners.

Very little is currently known about how increases in dispositional mindfulness through mindfulness training affect the quality of participants' romantic relationships, and no previous studies have examined how increases in specific facets of mindfulness differentially contribute to relationship health. Additionally, even less is known about how an individual's development of mindfulness skills affects the relationship satisfaction of his or her romantic partner. Thus, the purpose of this pilot study was to examine associations between changes in facets of mindfulness and relationship satisfaction among participants enrolled in a Mindfulness-Based Stress Reduction (MBSR) course and their nonenrolled romantic partners. Twenty MBSR participants and their nonenrolled partners (n=40) completed measures of mindfulness and relationship satisfaction pre- and post-enrolled partners' completion of an MBSR course. Results indicated that enrolled participants significantly improved on all facets of mindfulness and relationship satisfaction, while nonenrolled partners did not significantly increase on any facet of mindfulness or relationship satisfaction. Moreover, enrolled participants' increases in Acting with Awareness were positively associated with increases in their own and their nonenrolled partners' relationship satisfaction, whereas increases in enrolled participants' Nonreactivity were positively associated with increases in their nonenrolled partners' (but not their own) relationship satisfaction. These results suggest that increasing levels of mindfulness (particularly specific aspects of mindfulness) may have positive effects on couples' relationship satisfaction and highlight mindfulness training as a promising tool for education and intervention efforts aimed at promoting relational health.

Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors.

Cancer-related fatigue (CRF) is a disruptive symptom for many survivors. Despite promising evidence for efficacy of mindfulness-based stress reduction (MBSR) in reducing CRF, no trials comparing it to an active comparator for fatigued survivors have been published. The purpose of this trial was to compare MBSR to psychoeducation for CRF and associated symptoms. Breast (n=60) and colorectal (n=11) cancer survivors (stage 0-III) with clinically significant CRF after completing chemotherapy and/or radiation therapy an average of 28months prior to enrollment were randomized to MBSR or psychoeducation/support groups (PES). MBSR focused on mindfulness training; PES focused on CRF self-management. Outcomes included CRF interference (primary), CRF severity and global improvement, vitality, depression, anxiety, sleep disturbance, and pain. Outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3) using intent-to-treat analysis. Between-group differences in CRF interference were not significant at any time point; however, there was a trend favoring MBSR (d=-0.46, p=0.073) at T2. MBSR participants reported significantly greater improvement in vitality (d=0.53, p=0.003) and were more likely to report CRF as moderately to completely improved compared to the PES group (χ2 (1)=4.1765, p=0.041) at T2. MBSR participants also reported significantly greater reductions in pain at T2 (d=0.53, p=0.014). In addition, both MBSR and PES produced moderate-to-large and significant within-group improvements in all fatigue outcomes, depression, anxiety, and sleep at T2 and T3 compared to T1. MBSR and PES appear efficacious for CRF and related symptoms. Larger trials including a usual care arm are warranted. ClinicalTrials.gov Identifier: NCT01724333.

Mindfulness-based stress reduction as a novel treatment for interstitial cystitis/bladder pain syndrome: a randomized controlled trial.

Mindfulness-based stress reduction (MBSR) is a standardized meditation program that may be an effective therapy for interstitial cystitis/bladder pain syndrome (IC/BPS), a condition exacerbated by stress. The aims of this study were to explore whether MBSR improved IC/BPS symptoms and the feasibility/acceptability of MSBR among women with IC/BPS. This randomized controlled trial included women with IC/BPS undergoing first- or second-line therapies. Women were randomized to continuation of usual care (UC) or an 8-week MBSR class + usual care (MBSR). Participants completed baseline and 8-week post-treatment questionnaires, including the O'Leary-Sant Symptom Problem Index (OSPI), the visual analog pain scale (VAS), the Short Form Health Survey (SF-12), the Female Sexual Function Index (FSFI), and the Pain Self-Efficacy Questionnaire (PSEQ). The Global Response Assessment (GRA) was completed post-treatment. Analyses were performed using Student's t test, Chi-squared, and MANOVA where appropriate. Eleven women were randomized to UC and 9 to MBSR, without differences in group characteristics. More MBSR participants' symptoms were improved on the GRA (7 out of 8 [87.5%] vs 4 out of 11 [36.4%], p = 0.03). The MBSR group showed greater improvement in the OSPI total (p = 0.0498) and problem scores (p = 0.036); the OSPI symptom score change did not differ. PSEQ scores improved in MBSR compared with UC (p = 0.035). VAS, SF-12, and FSFI change did not differ between groups. Eighty-six percent of MBSR participants felt more empowered to control symptoms, and all participants planned to continue MBSR. This trial provides initial evidence that MBSR is a promising adjunctive therapy for IC/BPS. Its benefit may arise from patients' empowerment and ability to cope with symptoms.

Stress Reactivity, Depressive Symptoms, and Mindfulness: A Gulf Arab Perspective

Explorations of the relationship between stress reactivity and depression are relatively scarce outside of Europe and North America. This research examined the relationship between emotional reactivity to daily life stressors (stress reactivity) and depressive symptoms among citizens of the United Arab Emirates (UAE). Emirati college students ( N = 286, 76% females) completed a culturally grounded measure of daily life stress, along with measures of depression and anxiety symptoms. Stress reactivity was associated with elevated depression and anxiety symptoms. In a second study, we examined the efficacy of a Mindfulness-Based Stress Reduction (MBSR) program within the same population. Emirati College women ( N = 24) were randomly assigned to either an 8-week MBSR program or a waiting list control group (WLC). MBSR participants demonstrated significantly greater reductions in stress reactivity and depressive symptoms compared with the WLC group. These findings extend the stress reactivity literature to an Arabian Gulf nation. Interventions that help young adults better manage responses to daily life stress may play an important role in reducing the prevalence of depressive illness in the region.

A Mixed-Methods Pilot Study of Mindfulness-Based Stress Reduction for HIV-Associated Chronic Pain

ABSTRACTTreatment guidelines for chronic pain recommend nonpharmacologic modalities as part of a comprehensive management plan. Chronic pain is common among people living with HIV/AIDS, but there is little data to guide the choice of nonpharmacologic therapies in this complex population. We performed a mixed-methods feasibility study of Mindfulness-Based Stress Reduction (MBSR) versus health education control with 32 inner city, HIV-infected participants. Outcome measures included: the Brief Pain Inventory, Perceived Stress Scale, HIV Symptoms Index, autonomic function testing, and audiotaped focus groups. Post-intervention, participants reported modest improvements in pain measures and perceived stress, but no effect of group assignment was observed. At 3-month follow-up, 79% of MBSR participants were still practicing, and pain intensity was improved, whereas in the control group pain intensity had worsened. Qualitative analysis revealed a strong sense of community in both groups, but only MBSR was perceived as useful for relaxation and pain relief.

A pilot randomized controlled trial of mindfulness-based stress reduction for caregivers of family members with dementia

Objectives: The majority of care for those with Alzheimer's disease and other age-related dementias is provided in the home by family members. To date, there is no consistently effective intervention for reducing the significant stress burden of many family caregivers. The present pilot randomized controlled trial tested the efficacy of an adapted, eight-week mindfulness-based stress reduction (MBSR) program, relative to a near structurally equivalent, standard social support (SS) control condition for reducing caregiver stress and enhancing the care giver–recipient relationship.Method: Thirty-eight family caregivers were randomized to MBSR or SS, with measures of diurnal salivary cortisol, and perceived stress, mental health, experiential avoidance, caregiver burden, and relationship quality collected pre- and post-intervention and at three-month follow-up.Results: MBSR participants reported significantly lower levels of perceived stress and mood disturbance at post-intervention relative to SS participants. At three-month follow-up, participants in both treatment conditions reported improvements on several psychosocial outcomes. At follow-up, there were no condition differences on these outcomes, nor did MBSR and SS participants differ in diurnal cortisol response change over the course of the study.Conclusion: Both MBSR and SS showed stress reduction effects, and MBSR showed no sustained neuroendocrine and psychosocial advantages over SS. The lack of treatment condition differences could be attributable to active ingredients in both interventions, and to population-specific and design factors.

Challenges to Enrollment and Participation in Mindfulness-Based Stress Reduction Among Veterans: A Qualitative Study.

Mindfulness-Based Stress Reduction (MBSR) is associated with reduced depressive symptoms, quality of life improvements, behavioral activation, and increased acceptance among veterans. This study was conducted to increase the reach and impact of a veterans' MBSR program by identifying barriers to enrollment and participation to inform modifications in program delivery. Verify or challenge suspected barriers, and identify previously unrecognized barriers, to enrollment and participation in MBSR among veterans. A retrospective qualitative analysis of semistructured interviews. VA Puget Sound Health Care System (Seattle, WA). 68 interviewed, and 48 coded and analyzed before reaching saturation. Content analysis of semistructured interviews. Of the participants who enrolled, most (78%) completed the program and described MBSR positively. Veterans identified insufficient or inaccurate information, scheduling issues, and an aversion to groups as barriers to enrollment. Participants who discontinued the program cited logistics (e.g., scheduling and medical issues), negative reactions to instructors or group members, difficulty understanding the MBSR practice purposes, and struggling to find time for the practices as barriers to completion. Other challenges (cohort dynamics, teacher impact on group structure and focus, instructor lack of military service, and physical and psychological challenges) did not impede participation; we interpreted these as growth-facilitating challenges. Common conditions among veterans (chronic pain, posttraumatic stress disorder, and depression) were not described as barriers to enrollment or completion. Women-only MBSR groups and tele-health MBSR groups could improve accessibility to MBSR for veterans by addressing barriers such as commute anxiety, time restrictions, and an aversion to mixed gender groups among women. Educating MBSR teachers about veteran culture and health challenges faced by veterans, adding psychoeducation materials that relate mindfulness practice to conditions common among veterans, and improving visual aids for mindful movement exercises in the workbook could better accommodate veterans who participate in MBSR.

Cost-Effectiveness of the Mindfulness-Based Stress Reduction Methodology

The conflicting challenges of increased patient demand and decreased health care resources require a partial shift in responsibility from the health care system back to the individual. Our objective was to see if participation in a group program (mindfulness-based stress reduction (MBSR)) that reduces stress and fosters self-care impacted health care utilization. We did a prospective study of 1730 patients participating in an MBSR program comparing their health care utilization for 1- and 2-year pre-/post-periods with three different matched comparison groups. In both pre-intervention periods, cases had higher overall costs, numbers of physician claims, and utilization of lab facilities when compared with all three comparison groups. Participation in an MBSR program resulted in consistent decreases in utilization across all outcome variables at the 1-year pre/post interval. These decreases were significantly different than the patterns shown by the matched comparisons. Assuming 1500 MBSR participants (close to the number in the “closest” match) times an average savings of $250 would result in $375,000 in savings. These differences disappeared at the 2-year pre/ post interval with the exception of laboratory utilization. Our findings suggest that mindfulness training is effective for short-term reductions in health care use among a group of complex and heavy users. Anecdotal reports suggest MBSR participants stop their formal mindfulness practice within months of completing the program. It may well be that continuing the formal practice of mindfulness is a necessary prerequisite for maintaining the reductions in health care utilization.