Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity.

OBJECTIVES: The purpose of this study was to pilot a brief (6-week) group curriculum for providing mindfulness training to obese individuals, called Mindful Eating and Living (MEAL). SETTING AND DESIGN: Participants were recruited through a local Young Men's Christian Association (YMCA) in spring 2006. Data was collected at three time points: baseline, completion of intervention (6 weeks), and 3-month follow-up (12 weeks). INTERVENTION: Six weekly two-hour group classes (with two monthly follow-up classes). Content included training in mindfulness meditation, mindful eating, and group discussion, with emphasis on awareness of body sensations, emotions, and triggers to overeat. MAIN OUTCOME MEASURES: Key variables assessed included changes in weight, body-mass index (BMI), eating behavior, and psychological distress. In addition, physiological markers of cardiovascular risk were evaluated including C-reactive protein (hsCRP), adiponectin, low-density lipoprotein (LDL), and plasminogen activator inhibitor-1 (PAI-1). RESULTS: Ten obese patients enrolled with a mean BMI of 36.9 kg/m² [SD±6.2]. The mean weight was 101 kg/m² and the mean age was 44 years (SD=8.7; range=31-62). Compared to baseline data, participants showed statistically significant increases in measures of mindfulness and cognitive restraint around eating, and statistically significant decreases in weight, eating disinhibition, binge eating, depression, perceived stress, physical symptoms, negative affect, and C-reactive protein. CONCLUSIONS: This study provides preliminary evidence that a eating focused mindfulness-based intervention can result in significant changes in weight, eating behavior, and psychological distress in obese individuals.

Can we rapidly identify traditional, complementary and alternative medicine users in the primary care encounter? A RIOS Net study.

OBJECTIVE: Pressed for time to address competing clinical demands within the brief clinical encounter, primary care clinicians often rely on observations of patients to select topics to address. Use of traditional, complementary, or alternative medicine (TM/CAM) may be an important topic for discussion with a patient, but identification of patients using TM/CAM is problematic. We conducted this study to determine if observable characteristics--among southwestern Hispanic and Native American persons--might suggest to the clinician that a patient is likely to use TM/CAM. DESIGN: A combination of clinic staff focus groups, patient and clinician interviews, and a clinician focus group was used to explore possible predictors of TM/CAM use among primary care patients in practices serving predominantly Hispanic and Native American communities. RESULTS: No easily observable characteristics were identified that clinicians might use to predict TM/CAM use in their patients. Less readily observable characteristics--identification with culture, family of origin, health condition--were more likely to be associated with TM/CAM use, but not infallibly so. CONCLUSIONS: Rather than attempt to predict TM/CAM use by an individual patient, clinicians may be better served by assuming its use by all, by applying strategies for rapid and effective communications with patients about the topic, by selecting which patients to discuss TM/CAM use with based on clinical circumstances, and/or by gathering information about TM/CAM use as part of routine initial database development.

The marriage of community-based participatory research and practice-based research networks: can it work? -A Research Involving Outpatient Settings Network (RIOS Net) study.

BACKGROUND: Interest in community-based participatory research (CBPR) has surged during the last several years because of its potential to enhance the quality and usefulness of research outcomes. Practice-based research networks (PBRNs) potentially can provide a bridge between the research endeavor and communities; PBRNs have been identified as a promising venue for CBPR. However, this marriage of CBPR and PBRNs faces many challenges, such as locus of project idea generation, time constraints, and funding limitations. METHODS: This was a case study of the application of the CBPR model and CBPR principles specific to PBRN research using a recent PBRN study of communication about traditional, complementary, and alternative medicines. RESULTS: Challenges (eg, added cost, time) and benefits (eg, improved research data collection process, enhanced data analysis) resulted from application of the CBPR model and are detailed. CONCLUSIONS: For practical and ethical reasons, PBRNs need to adopt the CBPR approach for certain types, if not all, of their research. This might require operational adaptations by the PBRN (eg, a community advisory board, community membership in the network board of directors, and outreach to community groups for input into network priorities) as well as dedicated time and funding.

'They don't ask me so I don't tell them': patient-clinician communication about traditional, complementary, and alternative medicine.

PURPOSE: Although high rates of traditional medicine and complementary and alternative medicine (TM/CAM) use have been well documented, there has been less attention to the factors influencing communication between patients and their primary care clinicians about TM/CAM. Such communication can be important in anticipating possible drug-herb interactions and in assuring agreement about therapeutic plans. METHODS: We used sequential, multistage, qualitative methods, including focus groups, in-depth interviews, and a video vignette, to explore communication about TM/CAM between patients and their primary care clinicians. The study was conducted in RIOS Net (Research Involved in Outpatient Settings Network), a Southwestern US practice-based research network, situated largely in Hispanic and American Indian communities where TM/CAM is an important part of self-care. RESULTS: One hundred fourteen patients, 41 clinic staff members, and 19 primary care clinicians in 8 clinic sites participated. The degree and nature of TM/ CAM communication is based on certain conditions in the clinical encounter. We categorized these findings into 3 themes: acceptance/nonjudgment, initiation of communication, and safety/efficacy. Perceived clinician receptivity to and initiation of discussion about TM/CAM strongly influenced patients' decisions to communicate; perceived clinician expertise in TM/CAM was less important. Clinicians' comfort with patients' self-care approaches and their level of concern about lack of scientific evidence of effectiveness and safety of TM/CAM influenced their communication about TM/CAM with patients. CONCLUSIONS: Specific communication barriers limit patient-clinician communication about TM/CAM. Clinicians who wish to communicate more effectively with their patients about these topics and better integrate the types of care their patients use can change the communication dynamic with simple strategies designed to overcome these barriers.

Who is willing to use complementary and alternative medicine?

OBJECTIVE: The aim of this study was to identify individual differences associated with the willingness to use complementary and alternative medicine (CAM). DESIGN: A questionnaire was administered and the relationship between individual differences and the willingness to use CAM was examined using correlation and multiple regression analyses. PARTICIPANTS: The sample consisted of 276 undergraduate students (64% female) of diverse ethnicity (43% white, 33% Hispanic, 8% Native American, 16% other) and a wide range of incomes. MEASURES: The willingness to use 16 types of CAM was assessed for six categories: whole medical systems, mind-body medicine, biologically based practices, manipulative and body-based practices, energy medicine, and spiritually based practices. The individual differences assessed included age, gender, income, ethnicity, the Big Five personality characteristics, optimism, spirituality, religiosity, and three aspects of emotional intelligence: mood attention, mood clarity, and mood repair. RESULTS: The individual differences accounted for approximately one fifth of the variance in overall willingness to use CAM. Openness to experience, spirituality, and mood attention were the strongest predictors of overall willingness to use CAM and were related to the willingness to use most of the individual types of CAM. Older age or female gender was related to greater willingness to use most of the mind-body medicines. Hispanic ethnicity was related to greater willingness to use curanderismo, and Native American ethnicity was related to greater willingness to use Native American medicine and a spiritual/faith healer.

A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction.

OBJECTIVES: The objective of this pilot study was to compare the effects of two mind-body interventions: mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR). SUBJECTS: Fifty (50) subjects were recruited from the community and took part in MBSR (n = 36) and CBSR (n = 14) courses. Participants self-selected into MBSR or CBSR courses taught at different times. There were no initial differences between the MBSR and CBSR subjects on demographics, including age, gender, education, and income. INTERVENTION: MBSR was an 8-week course using meditation, gentle yoga, and body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive and behavioral techniques to change thinking and reduce distress. DESIGN: Perceived stress, depression, psychological well-being, neuroticism, binge eating, energy, pain, and mindfulness were assessed before and after each course. Pre-post scores for each intervention were compared by using paired t tests. Pre-post scores across interventions were compared by using a general linear model with repeated measures. SETTINGS/LOCATIONS: Weekly meetings for both courses were held in a large room on a university medical center campus. RESULTS: MBSR subjects improved on all eight outcomes, with all of the differences being significant. CBSR subjects improved on six of eight outcomes, with significant improvements on well-being, perceived stress, and depression. Multivariate analyses showed that the MBSR subjects had better outcomes across all variables, when compared with the CBSR subjects. Univariate analyses showed that MBSR subjects had better outcomes with regard to mindfulness, energy, pain, and a trend for binge eating. CONCLUSIONS: While MBSR and CBSR may both be effective in reducing perceived stress and depression, MBSR may be more effective in increasing mindfulness and energy and reducing pain. Future studies should continue to examine the differential effects of cognitive behavioral and mindfulness-based interventions and attempt to explain the reasons for the differences.