Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial

Mindfulness Training for Primary Care for Portuguese-Speaking Immigrants: A Pilot Study

“…MTPC-Portuguese demonstrated a medium-to-large effect size in decreasing depression symptoms and a medium effect size in reducing anxiety symptoms, in accordance with a previous randomized controlled trial which showed that MTPC in English decreases anxiety when compared with a mindfulness low-dose comparator with significant within-group effect sizes ranging from d = 0.43 (depression) to d = 0.72 (anxiety) (34). The potential mental health benefits described herein are aligned with a small but growing literature described by Cotter et al (97) in a recent review of MBI research among U.S. immigrants with origins in countries from Ibero-America, largely represented by uncontrolled trials, where five of six studies found a significant reduction in depressive symptoms (82,(98)(99)(100)(101) and five of eight studies reported a significant impact on anxiety symptomatology (80,82,99,100,102) after mindfulness training.…”

“…The findings from this pilot study suggest that MTPC-Portuguese is feasible, acceptable, and culturally appropriate among lowincome PSI in primary care settings. Low dropout and a high attendance rate comparable to MTPC studies in English (25,34), standard MBIs (79), and superior to other community-based MBSR studies with immigrants from Ibero-American countries (80)(81)(82) indicate the potential feasibility of the intervention and should be underlined, since low-income immigrants commonly experience attendance obstacles such as transportation cost, long working-hours, and family obligations (19,80,83,84).…”

“…Since lower socioeconomic status and the acculturation process among immigrants are associated with higher morbidity, mortality, and harmful health behaviors ( 1 – 3 , 9 , 108 – 110 ), the finding that a significant proportion of patients initiated the health behavior action plan at rates similar to MTPC studies in English ( 25 , 34 ) cannot be overemphasized. Emotional regulation, mindfulness, self-compassion, and interoceptive awareness appear to be synergistic self-regulation mechanisms through which MBIs exert their salutary effects ( 26 , 111 ), at least among English speakers.…”

“…We recruited adults between 18 and 70 years of age who received primary care within a participating primary care patient-centered medical home (PCMH) and who indicated Portuguese as their primary language in the electronic health record or as part of the referral to the MTPC program (recruitment process described elsewhere) ( 25 , 34 ). All participants had a DSM-5 diagnosis of anxiety, depression, or stress-related disorder and had Portuguese fluency at sixth grade reading level.…”

Mindfulness and Behavior Change

“… 223 Two larger RCTs of an eight-week MBP with self-efficacy as a secondary outcome reported within-group improvements in self-efficacy (d = 0.3 – 0.43), though this result was not significantly different from a low-dose mindfulness comparator. 20 , 224 The ability to practice mindfulness may lead to a greater sense of one’s ability to make health behavior change; however, it is also possible that initial difficulty attaining expected levels of mindfulness practice may cause an opposite, deleterious effect on global self-efficacy and that the feedback from this failure may affect the capacity to succeed in self-regulation itself. 225 , 226 Closer analysis of self-efficacy and self-agentic beliefs are needed to understand their role in mindful self-regulation models.…”