Feasibility and effectiveness of a brief meditation-based stress management intervention for patients diagnosed with or at risk for coronary heart disease: A pilot study
Extensive research has led to the development of a psychobiological model of cardiovascular disease. This model suggests that psychological factors such as depression, anxiety, hostility, and stress may affect the development and progression of coronary heart disease (CHD). Recent studies have also demonstrated that meditation-based stress reduction programs are useful interventions for patients with various medical and psychological symptoms. The objective of this pilot study was to gather preliminary information regarding the feasibility of implementing a brief meditation-based stress management (MBSM) program for patients with CHD, and those at high risk for CHD, at a major metropolitan hospital that serves a predominately non-local patient population. The secondary aim of this study was to investigate the possibility that such an intervention might reduce depression, as well as perceived stress, anxiety, and hostility, while improving general health scores. The overall feasibility results indicate that this MBSM intervention was highly feasible with regard to both recruitment and retention of participants. In fact, 40% of patients requested further training. In addition, after completion of the 4-week intervention, participants reported significant reductions in depression and perceived stress. In conclusion, the present study demonstrated that the brief meditation-based stress management program was well-received by patients and can successfully be used as a supportive program for patients at risk or diagnosed with CHD.
[Show abstract] [Hide abstract] ABSTRACT: Background: Evidence is accumulating that mindfulness training has favorable effects on psychological outcomes, but studies on physiological outcomes are limited. Patients with heart disease have a high incidence of physiological and psychological problems and may benefit from mindfulness training. Our aim was to determine the beneficial physiological and psychological effects of online mindfulness training in patients with heart disease. Methods: The study was a pragmatic randomized controlled single-blind trial. Between June 2012 and April 2014 we randomized 324 patients (mean age 43.2 years, 53.7% male) with heart disease in a 2:1 ratio (n = 215 versus n = 109) to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were other physiological parameters (heart rate, blood pressure, respiratory rate, and NT-proBNP), subjective health status (SF-36), perceived stress (PSS), psychological well-being (HADS), social support (PSSS12) and a composite endpoint (all-cause mortality, heart failure, symptomatic arrhythmia, cardiac surgery, and percutaneous cardiac intervention). Linear mixed models were used to evaluate differences between groups on the repeated outcome measures. Results: Compared to UC, mindfulness showed a borderline significant improved 6MWT (effect size, meters: 13.2, 95%CI: -0.02; 26.4, p = 0.050). There was also a significant lower heart rate in favor of the mindfulness group (effect size, beats per minute: -2.8, 95%CI: -5.4;-0.2, p = 0.033). No significant differences were seen on other outcomes. Conclusions: Mindfulness training showed positive effects on the physiological parameters exercise capacity and heart rate and it might therefore be a useful adjunct to current clinical therapy in patients with heart disease. Trial registration: Dutch Trial Register 3453.0Comments 0Citations
- "To date, very few studies have evaluated mindfulness training in patients with cardiac disease . A pilot study that offered a brief mindfulness-based stress-reduction program to patients with, or at risk of, coronary artery disease showed significant but moderate reductions on two psychological outcomes, depression (Cohen's d = 0.54) and perceived stress (d = 0.68). Unlike in our study, the participants were not randomized and the intervention was fairly short (4-weeks). "
[Show abstract] [Hide abstract] ABSTRACT: Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program "dose" in determining outcomes.0Comments 31Citations
- "In addition to pre-post studies showing improvements on a range of psychological outcomes in people with heart disease [82–84], two very small RCTs comparing MBSR to waitlist control groups were reported by Tacón and colleagues [85, 86], who reported benefits in anxiety, emotional regulation and less use of reactive coping styles in MBSR participants, as well as slower breathing frequency post-interventions in a laboratory stress test. In another study, 19 very ill elderly patients with congestive heart failure were randomized to a meditation group which participated in weekly sessions and listened to a meditation tape at home for 30 minutes, twice daily, for 12 weeks, or a control group that only attended weekly meetings . "
[Show abstract] [Hide abstract] ABSTRACT: We have developed a low dose Mindfulness-Based Intervention (MBI-ld) that reduces the time committed to meetings and formal mindfulness practice, while conducting the sessions during the workday. This reduced the barriers commonly mentioned for non-participation in mindfulness programs. In a controlled randomized trial we studied university faculty and staff (n=186) who were found to have an elevated CRP level,>3.0mg/ml, and who either had, or were at risk for cardiovascular disease. This study was designed to evaluate if MBI-ld could produce a greater decrease in CRP, IL-6 and cortisol than an active control group receiving a lifestyle education program when measured at the end of the 2month interventions. We found that MBI-ld significantly enhanced mindfulness by 2-months and it was maintained for up to a year when compared to the education control. No significant changes were noted between interventions in cortisol, IL-6 levels or self-reported measures of perceived stress, depression and sleep quality at 2-months. Although not statistically significant (p=.08), the CRP level at 2-months was one mg/ml lower in the MBI-ld group than in the education control group, a change which may have clinical significance (Ridker et al., 2000; Wassel et al., 2010). A larger MBI-ld effect on CRP (as compared to control) occurred among participants who had a baseline BMI <30 (-2.67mg/ml) than for those with BMI >30 (-0.18mg/ml). We conclude that MBI-ld should be more fully investigated as a low-cost self-directed complementary strategy for decreasing inflammation, and it seems most promising for non-obese subjects.0Comments 42Citations
- "This has reduced the barriers commonly mentioned for non-participation in MBSR programs. Similar modifications to weekly/daily mindfulness programs based on MBSR have emerged, for example shortened programs for oncology patients (Ott et al., 2006) and those who are at risk or have cardiovascular disease (Olivo et al., 2009 ). In our trial we studied university faculty and staff who were found to have an elevated CRP level, >3.0 mg/ml, and who either had or were at risk for cardiovascular disease. "