Meditation and Mindfulness to receive medical rebates?

Who will be the first health insurer in Australia to provide medical rebates for the therapeutic application of meditation and mindfulness? Currently, very few providers in the USA or elsewhere provide reimbursement for these widely used treatments. 

Recent research has added to compelling, existing evidence that reinforce the fact it may well be time; mindfulness-based stress reduction has been found to be as effective as a commonly used antidepressant drug for treating anxiety disorders. 

"Our study provides evidence for clinicians, insurers, and healthcare systems to recommend, include and provide reimbursement for mindfulness-based stress reduction as an effective treatment for anxiety disorders,” says Elizabeth Hoge, MD, the lead author. 

So this week we look at this new evidence, and what it means for individuals and the medical system – including medical rebates and Allevi8, but first

  

   Thought for the day

           Wisdom without compassion 

           Feels no pain

                    Gary Snyder

Significant recent research published this year in JAMA Psychiatry demonstrated guided mindfulness-based stress reduction program was as effective as use of the gold-standard drug - the antidepressant drug escitalopram - for patients with anxiety disorders. 

Researchers at Georgetown University Medical Center have found mindfulness-based stress reduction is as effective as a common antidepressant drug for treating anxiety disorders.

Anxiety disorders can be highly distressing; they include generalized anxiety, social anxiety, panic disorder and fear of certain places or situations, including crowds and public transportation, all of which can lead to an increased risk for suicide, disability and distress and therefore are commonly treated in psychiatric clinics. 

Drugs that are currently prescribed for the disorders can be very effective, but many patients either have difficulty getting them, do not respond to them, or find the side effects (e.g., nausea, sexual dysfunction and drowsiness) a barrier to consistent treatment. 

Standardized mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR), can decrease anxiety, but prior to this study, the interventions had not been studied in comparison to effective anti-anxiety drugs. 

Of note, approximately 15% of the U.S. population tried some form of meditation in 2017.

"A big advantage of mindfulness meditation is that it doesn't require a clinical degree to train someone to become a mindfulness facilitator. Additionally, sessions can be done outside of a medical setting, such as at a school or community center."

For this study, MBSR was offered weekly for eight weeks via two and a half-hour in-person classes, a day-long retreat weekend class during the 5th or 6th week, and 45-minute daily home practice exercises. 

Patients' anxiety symptoms were assessed upon enrollment and again at completion of the intervention at 8 weeks, along with post-treatment assessments at 12 and 24 weeks after enrollment. 

The patients were relatively young, with a mean age of 33 and included 156 women, which comprised 75% of the enrollees, mirroring the disease prevalence in the U.S.

Both the MBSR and the drug treatment groups saw a statistically equivalent reduction in their anxiety symptoms. 

The drop in the severity of their anxiety was significant – around 30%.

The researchers added, "It is important to note that although mindfulness meditation works, not everyone is willing to invest the time and effort to successfully complete all of the necessary sessions and do regular home practice which enhances the effect," 

"Also, virtual delivery via videoconference is likely to be effective, so long as the 'live' components are retained, such as question-and-answer periods and group discussion."

Hoge points out many phone apps do offer guided meditation, but researchers are yet to assess how apps compare with the full in-person, weekly group class experience. However, the researchers did conduct a second phase of the study during the pandemic that involved moving the treatments to an online, videoconference which will be the focus of future analyses. The researchers also hope to explore the effects of MBSR on sleep and depression.

RELEVANCE

1. This study adds to the evidence base in support of the Allevi8 app being used in therapeutic settings for anxiety disorders. Our app includes live components - direct interaction is available with experienced meditation teachers.

2. The evidence supporting health funds reimbursing meditation and mindfulness programs is now compelling. My guess is it will not be long before companies are adding these rebates as an edge to attract and retain new members. In the process, they are likely to make significant cost savings…

 

Mindfulness and sleep – more research

Also this year, research been published by Gao and colleagues exploring the benefits mindfulness might offer to those with sleep disorders. 

This study demonstrated a mechanistic link between mindfulness practice and increased emotional nonreactivity, decreased worry, and a reduction in reported sleep disturbances, suggesting that app-based mindfulness training may be a viable option to help individuals who report worry interferes with their sleep.

NOTE The Allevi8 app also features a sleep section

REFERENCES

1. Hoge AE et al. Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults with Anxiety Disorders. JAMA Psychiatry, 2023;80(1):13–21. DOI: 10.1001/jamapsychiatry.2022.3679

2. Gao M et al. Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training. Psychosomatic Medicine 84(5):p 632-642, June 2022.