By Carrie Heeter, Ph.D, August 23, 2014
High users of health services drive up health care costs. Individuals who are anxious and depressed often focus on and worry about physical sensations and symptoms. As a result, they may seek out health care appointments sooner and more often than necessary to maintain health.
A recent 8 year retrospective analysis of health care utilization comparing high users of health services who were treated with Mindfulness Based Cognitive Therapy (MBCT) and patients who received other forms of group in a Canadian hospital system found a significant reduction in health care utilization in the year following MBCT treatment (Kurdyak, Newman, and Sengal, 2014). Specifically, the researchers found one fewer non-mental health visit per year for every two MBCT patients treated.
The researchers analyzed hospital system billing records between 2003 and 2010 and were able to identify and compare 10,633 patients of MCBT physicians and psychiatrists to 29,795 patients of non-MBCT physicians and psychiatrists. (The non-MBCT patients would have experienced group therapy, including cognitive behavioral therapy (CBT), interpersonal psychotherapy, and/or psychodynamic group psychotherapy). Among patients in the study who were high utilizers of health care, MBCT resulted in a reduction in non-mental health service utilization, and also resulted in fewer psychiatrist visits in the year following therapy.
The authors speculate that high anxiety and depression symptoms may be factors that drive increased health care utilization. MBCT was developed to treat depression, but a side benefit, supported by this study, is that MBCT may help high health-care utilizers manage their distress about physical sensations and symptoms without needing to go to a doctor.
Mindfulness-based cognitive therapy (MBCT) integrates Cognitive Behavioral Therapy with Jon Kabat-Zinn’s Mindfulness Based Stress Reduction (MBSR) program. Like MBSR, MBCT is taught to groups, over 8 weekly, 2 hour sessions. The bullet points below offer a glimpse into MBCT — they are chapter titles in Mindfulness-Based Cognitive Therapy for Depression by Sega, Williams, and Teasdale, 2012.
- Awareness and automatic pilot;
- Living in Our Heads;
- Gathering the Scattered Mind;
- Recognizing Aversion;
- Allowing/Letting Be;
- Thoughts Are Not Facts;
- How Can I Best Take Care of Myself; and
- Maintaining and Extending New Learning.
In the MBCT program, exercises and meditations provide experiential components to accompany the teachings, Participants experience and explore things such as doing versus being, kindness and self-compassion, and a variety of mindful practices.
Teasing out which specific aspect or aspects of the 8-week MBCT group program were responsible for reducing primary health care utilization cannot be known from this study. The authors do note that most if not all of non-MBCT patients were treated with Cognitive Behavioral Therapy. So they were exposed to similar CBT teachings, but not to the mindfulness meditation components.
Was there one particularly impactful mindfulness meditation experience? Was it the culmination of all 8 weeks? Was it the combination of mindfulness meditation plus cognitive behavioral therapy? Were different individuals most affected by different elements, or was one or a few experiences the most essential?
So many fascinating questions to be explored…
REFERENCES AND RESOURCES
Paul Kurdyak, Alice Newman, Zindel Segal (2014). “Impact of mindfulness-based cognitive therapy on health care utilization: A population-based controlled comparison,” Journal of Psychosomatic Research, Volume 77, Issue 2 , Pages 85-89.
Sega, Williams, Teasdale, and Kabat-Zinn (2012). Mindfulness-Based Cognitive Therapy for Depression.
MBCT resource by Segal, Williams, and Teasdale:
Center for Mindfulness, founded by Kabat-Zinn