26 Continuing Education Credits For Physicians, Nurses, and MFT's and Psychologists

The eight-week course is offered by Alta Bates Medical Center, a CME-accredited provider, in cooperation with StressCare. Physicians may report up to 26 hours of category 1 credit toward the California Medical Association's Certificate in Continuing Medical Education and the American Medical Association's Physician's Recognition Award. The California Board of Registered Nurses states that programs qualifying for category 1 credit are also acceptable for equal continuing education credit toward relicensing (BRN no. 000689). ABMC is approved as a Continuing Education Provider by the Board of Behavioral Sciences (approval no. PCE 637).

StressCare offers mindfulness-based stress reduction and pain management (MBSR) in the San Francisco Bay Area. Services are provided on an outpatient basis as an adjunct to patients' regular medical care.

StressCare is based on the pioneering efforts of Dr. Jon Kabat-Zinn and the stress reduction clinic at the University of Massachusetts Medical Center (UMSRC) featured in the Bill Moyers PBS presentation Healing and the Mind.

This clinical service is presented as an eight-week course comprised of an orientation, eight weekly class meetings and a six-hour session on a weekend day (altogether 27.5 hours of instruction) plus daily home assignments.

Highly qualified individuals experienced in the clinical application of mindfulness teach StressCare courses.

Patients may be referred to StressCare. Please provide the patient's name, address, telephone number, diagnosis and a brief statement of reasons for the referral. We are happy to notify you of your patient's progress on request.

Reimbursement of patients' costs may be available from some health insurers and HMO's.

StressCare includes:

• Intensive training to develop voluntary attention skills as the major self-regulatory modality (mindfulness meditation)
• A range of techniques in order to optimize the program's appeal and its applicability to patients' circumstances
• Techniques include relaxation, mindful breathing and body awareness, guided meditation, gentle movement adapted to individual needs, group discussion, and exercises in awareness of everyday life
• Reframing of perceptions of stress and chronic pain based on direct experience
• Specific strategies for coping with pain
• Information on attitude and behavior factors known to promote healing
• Two audiotapes and a workbook are provided to guide patients' work between classes.

Key outcomes include:

• Reduced pain and stress
• Improved pain- and stress-coping capability
• Increased stress-hardiness, relaxation, physical strength and flexibility
• Enhanced self-awareness and sense of well-being
• More successful inter-personal relations
• More effective utilization of medical care
• Overall strengthening of parameters for healing

Patients are referred for MBSR who have cancer, heart disease, hypertension, GI distress, HIV/AIDS, anxiety and panic, headaches, sleep disturbance, fatigue, skin disorders and other diagnoses. Patients are taught in groups of 15 to 30, unrestricted by gender, physical ability, diagnosis or referral source. This approach has been shown to be effective for patients with varied economic and social backgrounds.

Compared to in-patient and one-on-one behavioral strategies, StressCare is a low-cost intervention which achieves a high degree of patient compliance during and after the eight-week course.

Outcomes Research

Participants in the UMSRC report an average 34.5% reduction in medical symptoms as reported on a medical symptom checklist based on over 10,000 patients referred by their doctors over the last 25 years for a wide range of disorders.

Such participants report an average 39.7% reduction in psychological distress including sharp reductions in anxiety, depression and hostility.

About 2/3 of all chronic pain patients report "moderate to great improvement" in their conditions at UMSRC. And improvements are shown to be maintained in four-year follow-up studies for most participants.

In a study published in the Journal of Behavioral Medicine in 1985, 61% of chronic pain patients taking the program reported at least a 50% reduction on a pain rating index and 44% reported reduced drug dosages by the end of the program.

In a study published in the American Journal of Psychiatry, participants with anxiety and panic disorders showed dramatic improvement: they achieved more than a 50% average decrease on the Beck Anxiety Inventory and over a 40% average decrease on the Beck Depression Inventory. These results were maintained according to a three-year follow-up study of the UMSRC patients.

Heart patients report a 45% reduction of medical symptoms on a medical symptom checklist, and a 55% reduction in psychological distress at the UMSRC.

Over 200 medical institutions in the U.S. and Canada have set up mindfulness-based stress reduction and pain management programs.

References

Kabat-Zinn, J. An out-patient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. Gen. Hosp. Psychiatry (1982)) 4: 33-47.

Kabat-Zinn, J., Lipworth, L. and Burney, R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J. Behav. Med. (1985) 8: 163-190.

Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers, W. Four year follow-up of a meditation-based program for the self-regulation of chronic pain. Clin. J. Pain (1986) 2: 159-173.

Kabat-Zinn, J. and Chapman-Waldrop, A. Compliance with an outpatient stress reduction program: rates and predictors of completion. J. Behav. Med. (1988) 11: 333-352.

Ockene, J., Sorenson, G., Kabat-Zinn, J., Ockene, I.S., and Donnelly, G. Benefits and costs of lifestyle change to reduce risk of chronic disease. Preventive Medicine (1988) 17: 224-234.

Burnhard, J., Kristeller, J., and Kabat-Zinn, J. Effectiveness of relaxation and visualization techniques as an adjunct to phototherapy and photochemotherapy of psoriasis. J. Am. Acad. Dermatol. (1988) 19: 572-573.

Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K., Pbert, L., Lenderking, W., Santorelli, S.F. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am. J. Psychiatry (1992) 149: 936-943.

Kabat-Zinn, J. Psychosocial Factors in Coronary Heart Disease: Their Importance and Management. In Ockene, I.S., and Ockene, J. (Eds) Prevention of Coronary Heart Disease, Little Brown, Boston, 1993, pp. 299-333.

Miller, J., Fletcher, K., and Kabat-Zinn, J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen. Hosp. Psychiatry (1995) 17: 192-200.

For additional information on program outcomes and related mind-body medicine, see
http://www.umassmed.edu/cfm/index.aspx

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