Mindfulness moves into the health, education mainstream

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Mindfulness Center at Brown University

Mindfulness moves into the health, education mainstream

By Richard Asinof, ConvergenceRI.com

It is a busy time for Eric Loucks, the director of the Mindfulness Center at Brown, following his recent return from a sabbatical to Europe to meet with the leaders of other academic mindfulness centers in England, Denmark and Wales, discussing further avenues of collaboration.

As governments and health insurers worldwide are starting to “cover” mindfulness stress reduction, which is the primary mindfulness technique taught at the Center, many of the discussions focused on how to create the necessary infrastructure to support and scale up the mindfulness enterprise as a national and international model of health care delivery and educational reform – what Loucks called “the desire for evidence-based mindfulness programs to be both high quality and scalable.”

Here in Rhode Island, programs promoted and supported by the Mindfulness Center are in what could be called a rapid stage of growth:

A program begun as a pilot in the fall of 2017 at Brown, called “Mindfulness-based College,” will be expanded to Rhode Island College this fall semester. Results from the program at Brown, which went through a randomized control trial, showed significant improvements in students’ sleep quality, depressive symptoms and a reduced sense of loneliness as well, according to Loucks.

In rolling out the pilot program at RIC, the Mindfulness Center at Brown will be conducting another randomized control trial, partnering with Professor Jayson Spas in the Psychology Department.

“We will be able to see if the mindfulness program works with more diverse college students, racially and socio-economically,” Loucks told ConvergenceRI in a recent interview, at the new Plant City restaurant, located at one of the terminuses of the new pedestrian bridge across the Providence River.

In expanding the domain of mindfulness programs in higher education, Loucks said that there had been little if any pushback. “In the higher education domain, we’ve received no resistance, just open arms and gratitude.” Loucks said that his team was now in discussions with MIT and also Providence College about bringing the “Mindfulness-based College” program to those campuses, too.

A phone-based mindfulness program for expectant mothers, particularly for mothers that may be at higher risk for adverse outcomes, has been developed by Professor Margaret Bublitz, a faculty member with the Mindfulness Center at Brown, according to Loucks. “The results have been promising so far,” he said, explaining that the pilot program was funded through a grant from the Mindfulness Center and seed money through another agency.

The Mindfulness Center is also working to expand its presence working with teachers to promote their resilience and well-being in the classroom, according to Loucks.

“Most of our relationships have been with schools in Massachusetts,” Loucks said. “We’re currently exploring a partnership with the Center for Resilience right now, Vanessa Weiner’s organization,” where Weiner serves as the executive director.

Under the potential partnership, the Center for Resilience would continue to go into the schools and work with the kids, and the Mindfulness Center would work with the teachers, Loucks explained

Loucks shared the fact that Ray Chambers, a venture capitalist and philanthropist whom he called a “multi-billionaire” from New Jersey, has given the Mindfulness Center at Brown “$100,000 to work with the Providence School System to foster mindfulness in their schools.” But, Loucks continued, it needs a matching grant to become operational. “We haven’t been able to liberate that project yet, until we get the match,” Loucks said. “So, if any of your readers might be interested in helping us liberate that project, it’s ready to go.”

The Mindfulness Center has also embarked on a commitment to bring the practice of mindfulness to diverse populations, according to Loucks.

“One of the things that we are most excited about right now is we have a new faculty member joining us on Sept. 1,” Loucks said. “His name is Jeff Proulx; he is coming from Oregon Health and Sciences University in Portland, Oregon, and he is Native American.”

Proulx is a world expert in working with Native American communities to adapt mindfulness programs to their cultures, with a particular focus on diabetes management, Loucks said, with experience working with African-American communities as well.

“He is a real expert in exploring where mindfulness might appear with the cultural framework of diverse communities,” Loucks said.

In addition, the Mindfulness Center offers numerous programs for the public, offered both online and in person, taught in English and in Spanish.

In the U.S., Loucks continued, “The vast majority of people practicing mindfulness are white and often upper-middle class. There are a lot of other cultures interested in the [practice of] mindfulness but they are not often met by people who really understand their values, their language and their priorities,” he said. “We committed to making that happen at Brown.”


Here is the ConvergenceRI interview with Eric Loucks, the director of the Mindfulness Center at Brown University, part of a continuing series of conversations begun in 2014, as the practice of mindfulness appears to be on the cusp of becoming integrated into a scalable program of reimbursable health care by insurers and governments and an accepted methodology for improving classroom education.

ConvergenceRI: What did you learn from visiting the other mindfulness centers in Oxford and other places in Europe? What are they doing in terms of things that you could bring back to apply to your work at Brown?
LOUCKS:
I have been collaborating with them for years, so it’s always amazing about how small the world feels, in a lot of ways, and how connected it is.

I think one of the things that we are seeing is that governments and health insurers worldwide are starting to cover mindfulness stress reduction, which is the primary mindfulness program we teach at the Center.

In Germany, it is being covered; in Scotland. it is starting to be covered. In the United States, the [Centers for Medicare and Medicaid Services] is starting to cover it in some regions.

ConvergenceRI: Have they started to cover it here in Rhode Island?
LOUCKS:
No. Not that I’m aware of, but if it is billed as group therapy by a clinician, I think it can get covered here. But it doesn’t [yet] have something like its own line item [code] yet. That is something we are starting to explore.

One of the things that I learned from these other centers is the desire to allow evidence-based mindfulness programs to be both high quality and scalable.

And, that we are all creating the infrastructure to allow for really high-quality teacher training programs – and looking at best practices amongst all our centers so that there is some standardization.

As health insurers are [beginning to ask]: “Should we start to cover this?” they can look at the evidence. [And, so we can respond to them when they ask]: “Do they have the infrastructure to scale it.”

ConvergenceRI: Can you talk about what it would mean to make evidence-based mindfulness practices for stress reduction scalable, using Rhode Island as an example?
LOUCKS:
I would say that Brown University now has the preeminent mindfulness-based stress reduction teacher-training program in the country. We have high standards and a pretty rigorous training approach, one that is evaluated qualitatively and quantitatively. And, that’s one of the things that makes it scalable.

Say, if Blue Cross and Blue Shield of RI, or Medicare and Medicaid in Rhode Island want to try this out, they can know that the quality and the [services] being delivered in the state is at the highest level.

It’s not a bad place to try it out, [because] we know the quality is really high, and we have the infrastructure to build it out for the nation, and certainly, for New England.

ConvergenceRI: Next week, I will be sitting down and talking with Healthcentric Advisors, which is the quality improvement organization for Medicare in New England. They are rolling out a new project that seeks to decrease uncontrolled hypertension in medically underserved communities, by piloting technology created by Healthcentric Advisors that will simplify and automate digital blood pressure self-monitoring, as well coordinate education and support services for patients and caregivers.

The goal is to make the process of taking blood pressure more streamlined in order to help people living with hypertension prevent heart disease and stroke.

Perhaps the Mindfulness Center might want to reach out to them, to find ways to collaborate with them in the development of their pilot program.
LOUCKS:
If you would help to connect us, I would love to follow up on that. With our mindfulness stress reduction blood pressure study, its first paper is just about to be published.

ConvergenceRI: Where is it going to be published?
LOUCKS:
Probably in PLOS One [a peer-reviewed open access scientific journal published by the Public Library of Science]. We have a randomized control trial in the field right now that’s collecting data. In this program we provide people with home blood pressure monitors.

That’s part of it. That’s part of the biofeedback element. Part of mindfulness is just trying to see clearly – can we clearly see what our blood pressure is.

And then, can we also see clearly how we feel when we are more physically active, and how we can leverage that to see if we can help bring blood pressure down. So far, the results are quite promising.

ConvergenceRI: It seems like a natural fit, call it a convergence.
LOUCKS:
An NIH grant that we are now writing has a major implementation science perspective on it. We are actively seeking out partners in the health insurance and policy domains, so that we can be doing systematic reviews that answer their questions.

I’d like to talk to Healthcentric Advisors. It sounds directly in line with what where we want to go.

ConvergenceRI: How does the work of the Mindfulness Center approach the education domain in grade schools?
LOUCKS:
There are a lot of social and emotional learning programs that come into the schools, there are a lot of other programs that come into schools, like standardized testing, for example. What if the parents and the kids who don’t necessarily want to learn mindfulness? What if the parent doesn’t want their child to learn about mindfulness?

And, if it comes into the whole classroom, then the kids could be potentially be stepping out or doing something else during that time, and that is often how it works.

Again, we don’t go into the classrooms ourselves, we just work with the teachers, so in terms of working with the teachers, we have had no pushback at all.

When going into the school systems themselves, that is one of the things that either local societies, or schools, or national societies need to figure out, in terms of the pros and cons of bringing mindfulness into classrooms, and getting a really clear sense on it.

When I was at Oxford, they have a clinical trial in the field right now, with more than 12,000 children in it, [working with] hundreds of grade schools throughout the country.

They are doing a really big cluster, randomized control trial there, to be able to evaluate the impacts on these kinds of mindfulness programs on learning outcomes and mental health outcomes in the kids.

They are also very closely monitoring adverse events, too. There is a similar study that just got funded in Denmark.

ConvergenceRI: When you talk about adverse events, could you define that?
LOUCKS:
It could be like a panic attack, for example.

ConvergenceRI: Here in the U.S. and in Rhode Island, there have been some new initiatives focused on what is known as trauma-informed health care. The idea is that in order to come with a good treatment plan for patients, you first have to identify and then address the trauma.
LOUCKS:
We use a lot of trauma-informed mindfulness practices.

ConvergenceRI: What are those?
LOUCKS:
There can be mindful practices that involve a body scan. So, we’re taking some time to be with each and every part of the body, in a non-judgmental, kind of curious way.

Just checking in. You can imagine someone who has had some type of physical trauma, so when they get to a part of the body that involved that trauma, that that could be triggering for them.

So, we can be using language or having modifications, to allow them space around that to not necessarily move in any closer than they feel comfortable with.

This past weekend, we had a retreat at the Omega Institute in Rhinebeck, N.Y., on trauma-informed mindfulness practices with John Kabat-Zinn and David Trealeven, he’s really an expert in that area.

My feeling is that there are some really big studies happening in the grade schools, that include thousands and thousands of kids, and they are looking very carefully at both the positive and potentially negative impacts so we can just get to the truth on it.

And then that’s going to inform the parents and the administrators about if they really want it in the schools. And allow that evidence to come through. My guess is that it’s going to be really beneficial to the vast majority of kids.

ConvergenceRI: How is your current work connected with some of your clinical studies you were involved with back in 2014, regarding stress reduction around cardiovascular disease?
LOUCKS:
A lot of the work I did, and I am actually pivoting toward it again, is around early life adversity, the psycho-social environment that kids grow up in.

Kids exposed to adverse psycho-social experiences in the family had higher risk for cardiovascular disease in mid-life.

We’re been told that it is very likely we may be about to get an NIH grant that is focused on reversibility of early life adversity in mid-life, looking at people who had adversity early on, and what can we do for them in mid-life.

And, can mindfulness, or physical activity be an approach to help mitigate some of those early life stressors and provide coping strategies to help reverse and remediate some of those effects?

This is a network grant, one that will be a collaboration between investigators across the United States and the United Kingdom as well, [in order] to be able to help start research in this field [of study]. It will provide us with funds for pilot projects and that sort of thing.

In the mindfulness field, it is one of the few fields that have shown the ability to reverse some of those effects of early life adversity.

Mindfulness-based cognitive therapy for people who have had recurrent depression seems to be more effective in people who had childhood trauma than in those that didn’t.

For those that didn’t, it looks like anti-hypertension medication can be really effective, but for those that did have trauma, you can see how mindfulness actually helps unpack some of that early life trauma and provides skills on how to relate to it and deal with it, in a way that meds alone wouldn’t do.

[The findings] have been replicated [in studies] a couple of times.

So, that is one of the areas that I’m really focused on now. With our blood pressure study, we’re doing very careful analysis of both childhood abuse as well as childhood neglect to see if our mindfulness-based blood pressure reduction program actually has differential effects based on exposure to neglect and abuse.

 

Reprinted with permissions of ConvergenceRI.com