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An Examination of Mindfulness-Based Programs in US Medical Schools

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Nicholas Barnes
Nicholas Barnes
Nicholas Barnes
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Patrick Hattan
Patrick Hattan
Patrick Hattan
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David S. Black
David S. Black
David S. Black
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Zev Schuman-Olivier at Harvard Medical School
Zev Schuman-Olivier
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Abstract and Figures

Some medical schools have begun introducing mindfulness concepts to their students, and academic mindfulness centers associated with medical schools (AMCAMS) have started to emerge. However, knowledge of the expansion of mindfulness-based interventions within academic medical institutions is primarily anecdotal. The study objective was to evaluate the scope of mindfulness-related activities across medical schools in the USA and to identify AMCAMS and their programmatic characteristics. First, we conducted a systematic website content search to evaluate mindfulness activities related to wellness, research, clinical use, and education among the 140 accredited US medical schools. Second, we surveyed AMCAMS directors to query the type of programs offered, the type of professionals participating at AMCAMS, and approaches for financial sustainability. Website content analysis showed that mindfulness-related activity was present at 79 % of US medical schools in 2014. Activities for wellness (87/140; 62 %) and research (69/140; 49 %) were most common. A potential AMCAMS was identified at 27 % (38/140) of medical schools, and 33 of 38 directors at those centers completed our survey (87 % response rate). AMCAMS directors reported that the most commonly offered program was Mindfulness-Based Stress Reduction (MBSR) followed by Mindful Movement and Mindfulness-Based Cognitive Therapy (MBCT). Private-pay MBI groups (21/33; 64 %), private donations (17/33; 52 %), and fee-for-service billing (16/33; 48 %) were the most common contributors to financial sustainability. This is the first effort to collect data on all mindfulness-based programming within US medical schools and the first study to describe and identify AMCAMS characteristics. We discuss next steps for research on AMCAMS and dissemination of mindfulness in medicine. View full text at http://rdcu.be/kLlO
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ORIGINAL PAPER
An Examination of Mindfulness-Based Programs in US Medical
Schools
Nicholas Barnes
1
&Patrick Hattan
1
&David S. Black
2
&Zev Schuman-Olivier
3
Published online: 6 October 2016
#Springer Science+Business Media New York 2016
Abstract Some medical schools have begun introducing
mindfulness concepts to their students, and academic mind-
fulness centers associated with medical schools (AMCAMS)
have started to emerge. However, knowledge of the expansion
of mindfulness-based interventions within academic medical
institutions is primarily anecdotal. The study objective was to
evaluate the scope of mindfulness-related activities across
medical schools in the USA and to identify AMCAMS and
their programmatic characteristics. First, we conducted a sys-
tematic website content search to evaluate mindfulness activ-
ities related to wellness, research, clinical use, and education
among the 140 accredited US medical schools. Second, we
surveyed AMCAMS directors to query the type of programs
offered, the type of professionals participating at AMCAMS,
and approaches for financial sustainability. Website content
analysis showed that mindfulness-related activity was present
at 79 % of US medical schools in 2014. Activities for wellness
(87/140; 62 %) and research (69/140; 49 %) were most com-
mon. A potential AMCAMS was identified at 27 % (38/140)
of medical schools, and 33 of 38 directors at those centers
completed our survey (87 % response rate). AMCAMS direc-
tors reported that the most commonly offered program was
Mindfulness-Based Stress Reduction (MBSR) followed by
Mindful Movement and Mindfulness-Based Cognitive
Therapy (MBCT). Private-pay MBI groups (21/33; 64 %),
private donations (17/33; 52 %), and fee-for-service billing
(16/33; 48 %) were the most common contributors to financial
sustainability. This is the first effort to collect data on all
mindfulness-based programming within US medical schools
and the first study to describe and identify AMCAMS charac-
teristics. We discuss next steps for research on AMCAMS and
dissemination of mindfulness in medicine.
Keywords Mindfulness .Mindfulness-based interventions .
Medical school .Medicine .Sustainability .Mindfulness
center
Introduction
Mindfulness meditation is a mind-body integrative medicine
approach gaining popularity across North American health
care settings to help people better live their life while encoun-
tering the challenges posed by stressors, symptoms, and ill-
ness (Black 2014;Buchholz2015; Gilbert and Waltz 2010;
Ludwig and Kabat-Zinn 2008). Training in mindfulness is the
systematic procedure for honing in on and sensitizing the in-
nate human capacity to inhabit more fully the present moment
and welcoming as best one can, the full range of one’sexpe-
rience, pleasant, unpleasant, and neutral (Black 2014).
Mindfulness-based interventions (MBIs), the modern and sec-
ular programmatic packaging of mindfulness meditation, are
recognized by the National Institutes of Health and represent a
rapidly growing area of medical research and practice that can
potentially benefit both physicians and patients (Black 2014;
Cullen 2011;Epstein1999; Holzel et al. 2011;Ludwigand
Kabat-Zinn 2008). Recentrandomizedclinical trialsand reviews
of the scientific evidence support some beneficial effects of MBIs
for the remediation of anxiety, depression, and psychological suf-
fering associated with pain, chronic illnesses, and other stress-
*Zev Schuman-Olivier
zschuman@cha.harvard.edu
1
Cambridge Health Alliance, Harvard Medical School, Boston, USA
2
Department of Preventative Medicine, University of Southern
California, Los Angeles, CA, USA
3
Department of Psychiatry, Cambridge Health Alliance, Harvard
Medical School, 26 Central Street, Somerville, MA 02143, USA
Mindfulness (2017) 8:489–494
DOI 10.1007/s12671-016-0623-8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... In recent years, mindfulness training (MT) programs aiming to improve student wellness have become more readily available at medical schools [11][12][13][14][15]. Mindfulness is often defined as "moment-to-moment, nonjudgmental awareness, cultivated by paying attention in a specific way… as non-reactively, as nonjudgmentally, and as open-heartedly as possible" [16]. ...
... One manualized, frequently-offered, MT program, Mindfulness-Based Stress Reduction (MBSR), has been shown to benefit medical students' , residents' , and physicians' mental and emotional health [13]. Findings demonstrate that MBSR significantly dampens depression, anxiety, fatigue, stress, and burnout symptoms, while increasing prosocial emotions such as empathy and compassion [12,[17][18][19][20][21]. ...
... Second, issues of contextualization: MT should be contextualized for professional and educational goals, in addition to psychological and wellness improvements [12,39]. While MBSR has been shown to benefit wellness outcomes in medical trainees, this program is frequently not offered by trainers who are embedded within the medical context, and thus, they may not be privy to the specific challenges medical students face. ...
Paying attention to attention: a program evaluation of faculty-delivered mindfulness-based attention training to optimize wellness and professionalism in medical students
Article
Full-text available
Background As physician distress rises, medical schools must provide programs to counter such distress at the earliest stages of training. Mindfulness training (MT) is one intervention that can alleviate stress during medical school. However, framing MT around wellness alone misses the opportunity to connect core cognitive and psychological capacities strengthened by MT to professional goals and skill acquisition inherent to successful medical training. Here, we highlight how the attentional components of MT align with students’ goals of becoming attending physicians while promoting academic, psychological, and interpersonal flourishing. MT courses that focus on strengthening attentional capacities can intuitively link academic and professional development with wellness, appealing to a wide array of students. Methods We iteratively recontextualized an existing short-form mindfulness training program for high-stress pre-professionals, known as Mindfulness Based Attention Training (MBAT), to the medical school context (MBAT-Rx). MBAT-Rx was offered by physician trainers to first-year medical students at Warren Alpert Medical School of Brown University as a tool for improving study habits and focus in addition to the development of both self-care and patient care strategies. MBAT-Rx consists of weekly, two-hour sessions over four weeks, with 10–15 min of daily mindfulness practice between sessions. At the end of the four weeks, students submitted voluntary program evaluation responses detailing their experience of the program. Results Optional program evaluation responses (n = 67) highlight that students found the program to be useful for their academic success and ability to pay attention, their interpersonal relationships, and their psychological health. By framing MT as an opportunity to boost core attentional capacities and connecting this to professional and academic goals in addition to wellness, MBAT-Rx appealed to a wide variety of students. Conclusions Our ongoing work suggests that framing MT as both a professional development and wellness promotion tool, taught by physicians themselves, and structured around students’ time demands, may be a successful model for medical schools looking to increase the impact of their mindfulness offerings. Such programs are needed to equip medical students to navigate the demands of a challenging healthcare training landscape.
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... Examples include relaxation training, Mindfulness-Based Stress Reduction (MBSR), self-hypnosis, discussion and educational groups on self-care, and support groups (22,23,(25)(26)(27)(28). Among these approaches, mindfulness-based interventions (MBIs) show the greatest promise in both mental health and medical education (29)(30)(31)(32). ...
... However, signi cant heterogeneity exists between studies, the risk of bias-particularly selection bias-is high, the quality of evidence is low to moderate, and most studies have been conducted in the United States (US) (29)(30)(31). As of 2014, mindfulness programs were offered in approximately two-thirds of US medical schools (32). ...
Easing the Burden: A Pilot Study on the Impact of Mindfulness on the Mental Health of Brazilian Medical Students
Preprint
Full-text available
  • Mar 2025
BACKGROUND Mental health disorders, such as anxiety and depression, are more prevalent in medical students than in the general population. Mindfulness-based interventions (MBIs) have shown evidence of effectiveness in treating these conditions. However, findings among medical students are mixed, particularly in Brazilian samples. This study aims to evaluate the feasibility and preliminary effects of the Mindfulness-Based Health Promotion (MBHP) program on perceived stress, mindfulness, and symptoms of anxiety and depression in Brazilian medical students. METHODS This single-arm pilot clinical trial involved medical students participating in the MBHP program for 2.5 hours per week over eight weeks. Outcomes were assessed at baseline and post-intervention. Feasibility was evaluated based on recruitment and retention rates. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7), respectively, while perceived stress and mindfulness were assessed using the Perceived Stress Scale-10 (PSS-10) and the Five Facet Mindfulness Questionnaire (FFMQ). Data were analyzed using descriptive statistics and the Wilcoxon Signed-Rank test. RESULTS Feasibility findings indicated that all 13 eligible participants enrolled and attended at least 50% of the program’s sessions, resulting in recruitment and retention rates of 100%. Participants (76.9% female, 92.3% Caucasian, mean age = 23.6 years) showed significant reductions in depressive ( p = .001; r = .62) and anxiety ( p = .014; r = .41) symptoms post-intervention. Additionally, overall mindfulness increased significantly ( p = .001; r = .62) along with four out of its five facets: observe ( p = .012; r = .49), act with awareness ( p = .009; r = .51), non-judgement ( p = .046; r = .39) and non-reaction (p = .007; r = .52). Perceived stress was not significantly reduced ( p = .059; r = .37). CONCLUSION Our results suggest that the MBHP program is feasible and may be effective in reducing anxiety and depression while enhancing mindfulness in Brazilian medical students. Higher-quality randomized trials with a larger sample size and longer follow-up are needed to confirm these preliminary findings. REGISTRATION: The trial was retrospectively registered with the Registro Brasileiro de Ensaios Clínicos (ReBEC) on February 26, 2025, under registration number RBR-44cvfnq.
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... It is worth mentioning that Mindful Self-Compassion as the eight-week training program has become one of the most widespread mindfulness-based interventions in the US [24]. ...
Meditation and Compassion Therapy in Psychiatric Disorders: A Pilot Study
Article
Full-text available
  • Jul 2024
Introduction Our study aimed to compare meditation and compassion-based group therapy with the standard of care in patients with eating disorders, drug addiction, alcohol addiction, and depression, concerning acceptance, mindfulness awareness, self-compassion, and psychological distress. Methods A controlled designed study was performed, comparing meditation and compassion-focused group therapy added to the standard of care with the standard of care alone, on patients with eating disorders, drug addiction, alcohol addiction, and mood disorders. Four validated questionnaires were administered: the Acceptance and Action Questionnaire-II (AAQ-II), which assesses the ability to be fully in touch with the present moment; the Mindful Attention Awareness Scale (MAAS), which assesses the ability to experience consciously what is happening in the present moment; the Self-Compassion Scale (SCS), which assesses self-compassion characteristics, including loving-kindness; and the Symptom Checklist-90 (SCL-90), which measures psychological distress (anxiety, depression, psychotic behavior, etc.). Results There was a total of 75 subjects, out of which 48 represented the experimental group, and 27 represented the control group. The overall mean age of the subjects was 44.8 ± 13.2 years. There were statistically significant increases in the experimental group (baseline vs. end of study) for the AAQ-II, MAAS, and SCS scores, and a statistically significant decrease in the SCL-90 score. In the control group, there was a statistically significant decrease in the SCL-90 score, but no significant differences for other measurements. The comparisons between the two groups at the end of the study were as follows: AAQ-II: 0.7 (-5.74 to 7.15), p = 0.827; MAAS: 4.78 (-3.19 to 12.75), p = 0.233; SCS: 5.89 (-3.18 to 14.96), p = 0.199; SCL-90: -0.26 (-0.62 to 0.1), p = 0.157. Conclusion Within the experimental group, all scales improved statistically significantly. There were no statistically significant differences at the end of the study concerning the four scales between the groups. The comparison between groups was limited by data availability.
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... According to recent surveys, 15% of adults in the United Kingdom and 20% in Australia have learnt some form of mindfulness, while 5% of United States adults did it in 2017 alone [1,2]. At least 79% of the medical schools in the United States offer some form of mindfulness training [3], as do over 600 companies globally (Jacobs, 2020). Accordingly, mindfulness research has grown rapidly since the beginning of the present century [4,5]. ...
Altered states of consciousness caused by a mindfulness-based programme up to a year later: Results from a randomised controlled trial
Article
Full-text available
Background Mindfulness-based programmes (MBPs) have shown beneficial effects on mental health. There is emerging evidence that MBPs may also be associated with marked deviations in the subjective experience of waking consciousness. We aimed to explore whether MBPs can have a causal role in different types of such states. Methods We conducted a pragmatic randomised controlled trial (ACTRN12615001160527). University of Cambridge students without severe mental illness were randomised to an 8-week MBP plus mental health support as usual (SAU), or to SAU alone. We adapted the Altered States of Consciousness Rating Scale (OAV, 0–100-point range) to assess spontaneous experiences in daily life, and included it as a post-hoc secondary outcome at the end of the one-year follow-up questionnaire. Two-part model analyses compared trial arms, and estimated dose-response effects of formal (meditation) and informal (daily activities) mindfulness practice during the year. Sensitivity analyses correcting for multiple comparisons were conducted. Results We randomised 670 participants; 205 (33%) completed the OAV. In comparison with SAU, MBP participants experienced unity more frequently and intensively (two-part marginal effect (ME) = 6.26 OAV scale points, 95% confidence interval (CI) = 2.24, 10.27, p = 0.006, Cohen’s d = 0.33) and disembodiment more frequently (ME = 4.84, 95% CI = 0.86, 8.83, p = 0.019, Cohen’s d = 0.26). Formal practice predicted spiritual, blissful and unity experiences, insightfulness, disembodiment, and changed meanings. Informal practice predicted unity and blissful experiences. Trial arm comparisons and informal practice effects lost significance after corrections for multiple comparisons, but formal practice dose-response effects remained significant. Conclusions Results provide a novel suggestion of causal links between mindfulness practice and specific altered states of consciousness. To optimise their impact, practitioners and teachers need to anticipate and handle them appropriately. Future studies need to confirm findings and assess mechanisms and clinical implications.
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... employees' health and well-being by incorporating mindfulness-based programmes (MBPs) into their well-being package, [4][5][6][7] as recommended in official guidance. 3 MBPs aim to improve attention and selfregulation through training the ability to maintain awareness of the present moment. ...
Work Engagement and Well-being Study (SWELL): a randomised controlled feasibility trial evaluating the effects of mindfulness versus light physical exercise at work
Article
Full-text available
  • Feb 2024
Background Mindfulness-based programmes (MBPs) are increasingly offered at work, often in online self-guided format. However, the evidence on MBPs’ effect on work performance (WP) is inconsistent. Objective This pragmatic randomised controlled feasibility trial assessed procedural uncertainties, intervention acceptability and preliminary effect sizes of an MBP on WP, relative to an alternative intervention. Methods 241 employees from eight employers were randomised (1:1) to complete a 4-week, self-guided, online MBP or a light physical exercise programme (LE)(active control). Feasibility and acceptability measures were of primary interest. WP at postintervention (PostInt) was the primary outcome for preliminary assessment of effect sizes. Secondary outcomes assessed mental health (MH) and cognitive processes hypothesised to be targeted by the MBP. Outcomes were collected at baseline, PostInt and 12-week follow-up (12wFUP). Prospective trial protocol: NCT04631302. Findings 87% of randomised participants started the course. Courses had high acceptability. Retention rates were typical for online trials (64% PostInt; 30% 12wFUP). MBP, compared with the LE control, offered negligible benefits for WP (PostInt (d=0.06, 95% CI −0.19 to 0.32); 12wFUP (d=0.02, 95% CI −0.30 to 0.26)). Both interventions improved MH outcomes (ds=−0.40 to 0.58, 95% CI −0.32 to 0.18); between-group differences were small (ds=−0.09 to 0.04, 95% CI −0.15 to 0.17). Conclusion The trial is feasible; interventions are acceptable. Results provide little support for a later phase trial comparing an MBP to a light exercise control. To inform future trials, we summarise procedural challenges. Clinical implications Results suggest MBPs are unlikely to improve WP relative to light physical exercise. Although the MBP improved MH, other active interventions may be just as efficacious. Trial registration number NCT04631302.
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Participant Perceptions of a Robotic Coach Conducting Positive Psychology Exercises: A Qualitative Analysis
Article
  • Jan 2025
This paper presents a qualitative analysis of participants’ perceptions of a robotic coach conducting Positive Psychology exercises, providing insights for the future design of robotic coaches. Participants (n=20) took part in a single-session (avg. 31±1031\pm 10 minutes) Human-Robot Interaction study in a laboratory setting. We created the design of the robotic coach, and its affective adaptation , based on user-centred design research and collaboration with a professional coach. We transcribed post-study participant interviews and conducted a Thematic Analysis. We discuss the results of that analysis, presenting aspects participants found particularly helpful (e.g., the robot asked the correct questions and helped them think of new positive things in their life), and what should be improved (e.g., the robot’s utterance content should be more responsive). We found that participants had no clear preference for affective adaptation or no affective adaptation, which may be due to both positive and negative user perceptions being heightened in the case of adaptation. Based on our qualitative analysis, we highlight insights for the future design of robotic coaches, and areas for future investigation (e.g., examining how participants with different personality traits, or participants experiencing isolation, could benefit from an interaction with a robotic coach).
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Mindfulness in Healthcare Training
Chapter
  • Sep 2024
This chapter advocates that implementing mindfulness in medical training is pivotal for enhancing the well-being of healthcare professionals and improving patient care. Integrating mindfulness from the start of medical education can revolutionize healthcare delivery by fostering empathy, compassion, and patient-centered care ideals. Despite challenges such as skepticism and integration into busy schedules, evidence supports mindfulness’s benefits in clinical competencies and self-care. Early adoption in medical training can improve cognitive mastery, interpersonal skills, and empathy, preparing trainees for future challenges and potentially preempting burnout. The inclusion of mindfulness in healthcare training programs, supported by faculty training and comprehensive implementation strategies, can create a resilient, empathetic, and competent healthcare workforce. By embracing mindfulness, medical education can cultivate a culture of self-care, empathy, and excellence, guiding healthcare professionals throughout their careers.
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Mindfulness training in medical education as a means to improve resilience, empathy, and mental health in the medical profession
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The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals. Additionally, we posit that mindfulness-based practices are instrumental for the development of major components of mental capital, such as resilience, flexibility of mind, and learning skills, while also serving as a pathway to enhance empathy, compassion, self-awareness, conflict resolution, and relational abilities. Importantly, the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years, and a growing number of medical schools have already integrated mindfulness into their curricula. While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field, we argue that there is currently an unprecedented opportunity to gather momentum, spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.
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Mindfulness meditation and the immune system: a systematic review of randomized controlled trials
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Mindfulness meditation represents a mental training framework for cultivating the state of mindful awareness in daily life. Recently, there has been a surge of interest in how mindfulness meditation improves human health and well-being. Although studies have shown that mindfulness meditation can improve self-reported measures of disease symptomatology, the effect that mindfulness meditation has on biological mechanisms underlying human aging and disease is less clear. To address this issue, we conducted the first comprehensive review of randomized controlled trials examining the effects of mindfulness meditation on immune system parameters, with a specific focus on five outcomes: (1) circulating and stimulated inflammatory proteins, (2) cellular transcription factors and gene expression, (3) immune cell count, (4) immune cell aging, and (5) antibody response. This analysis revealed substantial heterogeneity across studies with respect to patient population, study design, and assay procedures. The findings suggest possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging, but these results are tentative and require further replication. On the basis of this analysis, we describe the limitations of existing work and suggest possible avenues for future research. Mindfulness meditation may be salutogenic for immune system dynamics, but additional work is needed to examine these effects.
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Stress and burnout in residents: impact of mindfulness-based resilience training
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Background and objective Stress and burnout impact resident physicians. This prospective study tests the hypothesis that a mindfulness-based resilience intervention would decrease stress and burnout in residents. Methods Resident physicians from the Departments of Family Medicine, Psychiatry, and Anesthesia at Duke University, Durham, NC, USA, participated in two or three 1-hour sessions of mindfulness-based resilience activities, which introduced mindful-awareness and included practical exercises for nurturing resilience. Anonymous surveys were distributed before (completed by 47 residents) and after the intervention (both completed by 30 residents); a follow-up survey was distributed 1 month later (seven residents completed all three surveys). The survey included the Depression Anxiety Stress Scale, 21-question version (DASS-21), the Oldenburg Burnout Inventory, the Mindful Attention Awareness Scale, and ten questions from the Cognitive Failures Questionnaire. Results At baseline, most residents’ scores were in the normal range with respect to stress; however, female residents had higher DASS-21 scores than male residents (31.7, females vs 18.4, males; P=0.002). Most residents’ burnout scores were in the abnormal range, both with respect to exhaustion (38/47 residents, subscore ≥2.25) and disengagement (37/47 residents, subscore ≥2.1). Higher perceived levels of stress correlated with the instruments. Analysis of the surveys before and after the intervention showed no significant short-term change in stress, burnout, mindful-awareness, or cognitive failure. There was a trend for females and post-medical school graduate year 1 and 2 (PGY1 and PGY2) residents to have a reduction in DASS-21 scores after intervention. There was also a trend of reduced stress and burnout in residents who perceived higher stress. Conclusion Residents who are female, PGY1 and PGY2, and who perceive residency to be stressful may benefit most from a mindfulness-based resilience intervention.
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Effects of Brief Group Mindfulness-based Cognitive Therapy for Stress Reduction among Medical Students in a Malaysian University
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Effects of a brief mindfulness-based intervention program for stress management among medical students: the Mindful-Gym randomized controlled study
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Full-text available
  • Feb 2015
Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f 2 = 0.05), perceived stress (β = −0.26, ΔR2 = 0.07, p = .009, f 2 = 0.10); mental distress (β = −0.28, ΔR2 = 0.10, p = .003, f 2 = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f 2 = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f 2 = 0.08); but there was no difference in other outcome measures. More than 90 % of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
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The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions
Article
  • Oct 2015
  • PERS INDIV DIFFER
Objective: Mindfulness-based interventions (MBIs) include the application of meditation and mind-body practices used to promote mindful awareness in daily life. Operationalizing the construct of mindfulness is important in order to determine mechanisms of therapeutic change elicited by mindfulness practice. In addition to existing state and trait measures of mindfulness, process measures are needed to assess the ways in which individuals apply mindfulness in the context of their practice. Method: This report details three independent studies (qualitative interview, N = 8; scale validation, N = 134; and replication study, N = 180) and the mixed qualitative-quantitative methodology used to develop and validate the Applied Mindfulness Process Scale (AMPS), a 15-item process measure designed to quantify how mindfulness practitioners actively use mindfulness to remediate psychological suffering in their daily lives. Results: In Study 1, cognitive interviewing yielded a readily comprehensible and accessible scale of 15 items. In Study 2, exploratory factor analysis derived a potential three-factor solution: decentering, positive emotion regulation, and negative emotion regulation. In Study 3, confirmatory factor analysis verified better model fit with the three-factor structure over the one-factor structure. Conclusions: AMPS functions as a measure to quantify the application of mindfulness and processes of change in the context of MBIs and general mindfulness practice.
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Exploring the Promise of Mindfulness as Medicine
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  • Oct 2015
  • J Am Med Assoc
A new frontier in treatment for mental illnesses and other chronic conditions may not come from pharmaceutical companies, but from within, as mindfulness practices gain traction.
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The Impact of Mind–Body Medicine Facilitation on Affirming and Enhancing Professional Identity in Health Care Professions Faculty
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  • Apr 2015
Georgetown University School of Medicine (GUSOM) offers medical students a course in mind-body medicine (MBM) that introduces them to tools that reduce stress and foster self-awareness. Previous studies reported decreases in students' perceived stress and increases in mindfulness-changes that were associated with increased empathic concern and other elements of professional identity formation. However, no reports have described the impact of an MBM course on the facilitators themselves. To explore whether MBM facilitation is associated with changes in professional identity, self-awareness, and/or perceived stress, 62 facilitators, trained by the GUSOM MBM program, were invited to complete two validated surveys: the Freiburg Mindfulness Inventory (FMI) and the Perceived Stress Scale (PSS). Forty-two participants also completed a six-item open-ended questionnaire addressing their experience in the context of their professional identity. Facilitators' scores were significantly lower on PSS and higher on FMI compared with normative controls (P < .05), and the two parameters were inversely correlated (-0.46, P < .01). Qualitative analysis revealed three main themes: (1) aspects of professional identity (with subthemes of communication; connections and community; empathy and active listening; and self-confidence); (2) self-care; and (3) mindful awareness. Preliminary findings will be extended with larger studies that examine longitudinal quantitative assessment of communication, connection, and self-confidence outcomes in MBM facilitators, and the impact of MBM facilitation on burnout and resilience.
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On Taking Notice — Learning Mindfulness from (Boston) Brahmins
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  • Mar 2015
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Although the great physicians of past centuries might have called it something else, proficiency at promoting mindfulness has always been and should remain part of a doctor's clinical toolkit.
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Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances A Randomized Clinical Trial
Article
  • Feb 2015
Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep. To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances. Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5). A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework. The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)-κB. Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05). The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life. clinicaltrials.gov Identifier: NCT01534338.
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Integrative Medicine in America—How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States
Article
  • Jul 2012
The impetus for developing and implementing integrative medicine strategies is rooted in the desire to improve patient care. The Bravewell Collaborative, a philanthropic organization that works to improve healthcare, defines integrative medicine as “an approach to care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person's health. Employing a personalized strategy that considers the patient's unique conditions, needs, and circumstances, it uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help people regain and maintain optimum health.” Over the past 2 decades, there has been documented growth in the number of clinical centers providing integrative medicine, the number of medical schools teaching integrative strategies, the number of researchers studying integrative interventions, and the number of patients seeking integrative care. But whether integrative medicine was being offered in the same, similar, or disparate ways was unknown. In addition, while previous studies focused on the prevalence and use of complementary or alternative medicine (CAM) by patients 1,2 or by practitioners in hospital settings ³ by enumerating the use of single CAM therapies, very little information had been collected regarding the actual practice of integrative medicine, which by definition treats the whole person. In 2011, The Bravewell Collaborative commissioned a survey to determine how integrative medicine was currently being practiced across the United States by (1) describing the patient populations and health conditions most commonly treated, (2) defining the core practices and models of care, (3) ascertaining how services are reimbursed, (4) identifying the values and principles underlying the care, and (5) determining the biggest factors driving successful implementation. Twenty-nine integrative medicine centers and programs across the nation were chosen to participate in the study. This group included the nine centers in The Bravewell Clinical Network plus 20 others that, directed by either a physician, other doctoral level healthcare practitioner, or nurse, were chosen on the basis of length of time in operation (a minimum of 3 years), patient volume, and/or prior clinical contributions to the field.
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