MTPC works by integrating attentional training, self-compassion cultivation, and behavior change components to support patients in developing self-regulation skills and initiating health behavior changes. The program consists of eight weekly 2-hour sessions, daily home practice, and a 7-hour all-day session.
Throughout the intervention, participants learn to cultivate mindful awareness of emotions, behaviors, body sensations, thoughts, and hedonic tone while focusing on developing a warm and compassionate attitude towards themselves and their experiences. This combination of mindfulness and self-compassion helps participants attain emotional differentiation and break patterns of experiential avoidance.
MTPC also incorporates behavior change elements, such as awareness of autopilot behaviors, savoring pleasant events, stress management, chronic illness self-management education, and action planning for mindful health-related behavior change.
The program teaches informal mindfulness practices, like STOP ACHE GO, to support medication and medical regimen adherence.
By engaging self-regulation targets, such as emotion regulation, self-compassion, and interoceptive awareness, MTPC empowers patients to develop intrinsic motivation and gain clarity on what it means to live well with chronic conditions.
This, in turn, facilitates the initiation of health behavior changes and supports patients in managing their chronic illnesses more effectively.
Gawande, R., Smith, L., Comeau, A., Creedon, T. B., Wilson, C. L., Griswold, T., Cook, B. L., Loucks, E. B., & Schuman-Olivier, Z. (2023). Impact of warm mindfulness on emotion regulation: A randomized controlled effectiveness trial. Health Psychology, 42(10), 699–711. https://doi.org/10.1037/hea0001303
Key Points
- Mindfulness Training for Primary Care (MTPC) is an effective behavior change initiation intervention that engages self-regulation targets of emotion regulation, self-compassion, and interoceptive awareness, while possibly enhancing chronic disease self-efficacy.
- MTPC was associated with significant reductions in difficulties with emotion regulation, particularly in goal-directed behavior and emotion regulation strategies, at 8 and 24 weeks compared to a low-dose mindfulness comparator (LDC).
- Participants in the MTPC arm had greater odds of initiating behavioral action plans than those in the LDC arm.
- The study has limitations, such as a reduced sample size due to the COVID-19 pandemic and a slightly imbalanced baseline regarding major depressive disorder diagnosis between the two study arms.
Rationale
Mindfulness-based interventions (MBIs) have been shown to facilitate behavioral change for chronic medical illnesses, substance use disorders, stress-related disorders, anxiety, and depression (Fulwiler et al., 2015; Bowen et al., 2014; Schuman-Olivier et al., 2020; Goyal et al., 2014).
Self-regulation, particularly emotion regulation, is considered a primary mechanism of health behavior change (Hennessy et al., 2020).
However, there is a need to understand which aspects of self-regulation MBIs should target to help patients develop healthy behaviors (Hoge et al., 2021).
This study aimed to test the hypothesis that MTPC facilitates a greater reduction in difficulties in emotion regulation compared to LDC and to replicate previous findings on behavioral action plan initiation.
Method
A randomized controlled comparative effectiveness trial was conducted to evaluate the impact of Mindfulness Training for Primary Care (MTPC) versus low-dose mindfulness comparator (LDC) on emotion regulation and other self-regulation assays.
Participants were randomized to either MTPC or LDC. The MTPC intervention consisted of eight weekly 2-hour sessions, a recommended 30–45 min/day of guided home practice, and a 7-hour all-day session.
The LDC continued to receive standard mental health care and was provided with a list of digital and community resources to practice mindfulness skills.
Sample
Participants (N = 73) were primary care patients with anxiety, depression, or stress-related disorders, aged 18–70 years old, and able to access a smartphone.
Measures
- The primary outcome measure was the Difficulties in Emotion Regulation Scale (DERS) total score.
- Secondary outcome measures included rates of action plan initiation and changes in other self-regulation targets, such as interoceptive awareness (MAIA), self-compassion (SCS-SF), and self-efficacy for chronic disease (SECD-6).
Statistical measures
Intent-to-treat, repeated measures linear mixed effects modeling was used to evaluate self-regulation and health outcomes.
Bivariate logistic regression was used to assess the effectiveness of MTPC versus LDC on action plan initiation.
Results
- Compared to LDC, MTPC participants had statistically significant reductions in DERS total score at 8 weeks (d = −0.59, p = .01) and 24 weeks (d = −0.61, p = .02).
- MTPC participants also demonstrated greater interoceptive awareness, self-compassion, and self-efficacy at 8 weeks.
- Regarding action plan initiation, 63.3% of MTPC participants successfully achieved it, compared to 37.5% for LDC (OR = 2.87, p = .04).
Insight
This study demonstrates that MTPC, a warm mindfulness intervention, can effectively enhance emotion regulation and facilitate the initiation of chronic illness self-management and health behavior change among primary care patients with anxiety, depression, and stress-related disorders.
The findings suggest that MTPC’s impact on emotion regulation may explain part of its effect on behavior change, as the intervention helps participants attain emotional differentiation and break patterns of experiential avoidance.
Future research could explore whether emotion regulation improvements mediate behavior change by investigating DERS Goals and DERS Strategies as potential partial mediators.
Strengths
The study had several methodological strengths, including a randomized controlled design, the use of intent-to-treat analysis, and the assessment of multiple self-regulation targets.
Limitations
The study had some limitations, such as a reduced sample size due to the COVID-19 pandemic, which impacted the ability to use multimodal assessments to confirm and triangulate the effects of MTPC.
Additionally, the two study arms were slightly imbalanced on major depressive disorder diagnosis at baseline, and the LDC condition was not matched with the MTPC condition for group leader contact time.
Clinical Implications
The results suggest that MTPC may be a sustainable model for enhancing self-regulation among patients with chronic illnesses in primary care settings.
Testing approaches to implementation in other healthcare systems, replication by independent groups, and replication of MTPC studies in other languages and cultures should be the focus of future work.
The impact of MTPC on healthcare utilization and associated costs should also be evaluated.
References
Primary reference
Gawande, R., Smith, L., Comeau, A., Creedon, T. B., Wilson, C. L., Griswold, T., Cook, B. L., Loucks, E. B., & Schuman-Olivier, Z. (2023). Impact of warm mindfulness on emotion regulation: A randomized controlled effectiveness trial. Health Psychology, 42(10), 699–711. https://doi.org/10.1037/hea0001303
Other references
Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E., & Lustyk, M. K. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: A randomized clinical trial. JAMA Psychiatry, 71(5), 547–556. https://doi.org/10.1001/jamapsychiatry.2013.4546
Fulwiler, C., Brewer, J. A., Sinnott, S., & Loucks, E. B. (2015). Mindfulness-based interventions for weight loss and CVD risk management. Current Cardiovascular Risk Reports, 9(10), Article 46. https://doi.org/10.1007/s12170-015-0474-1
Goyal, M., Singh, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being: A systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357–368. https://doi.org/10.1001/jamainternmed.2013.13018
Hennessy, E. A., Johnson, B. T., Acabchuk, R. L., McCloskey, K., & Stewart-James, J. (2020). Self-regulation mechanisms in health behavior change: A systematic meta-review of meta-analyses, 2006–2017. Health Psychology Review, 14(1), 6–42. https://doi.org/10.1080/17437199.2019.1679654
Hoge, E. A., Acabchuk, R. L., Kimmel, H., Moitra, E., Britton, W. B., Dumais, T., Ferrer, R. A., Lazar, S. W., Vago, D., Lipsky, J., Schuman-Olivier, Z., Cheaito, A., Sager, L., Peters, S., Rahrig, H., Acero, P., Scharf, J., Loucks, E. B., & Fulwiler, C. (2021). Emotion-related constructs engaged by mindfulness-based interventions: A systematic review and meta-analysis. Mindfulness, 12(5), 1041–1062. https://doi.org/10.1007/s12671-020-01561-w
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020). Mindfulness and behavior change. Harvard Review of Psychiatry, 28(6), 371–394. https://doi.org/10.1097/HRP.0000000000000277
Keep Learning
- How might the integration of warm mindfulness practices throughout an MBI contribute to its effectiveness in supporting emotion regulation and behavior change?
- What are some potential mechanisms through which improvements in emotion regulation could mediate the relationship between mindfulness training and successful initiation of health behavior change?
- How could future research further explore the role of specific self-regulation targets, such as interoceptive awareness and self-compassion, in the context of MBIs for chronic illness self-management?
- What adaptations or considerations might be necessary when implementing MTPC or similar MBIs in diverse healthcare settings, languages, or cultures?
- How could the findings of this study inform the development of tailored MBIs for specific chronic illnesses or mental health conditions?
