Brief Mindfulness-Based Cognitive Therapy in Women With Myocardial Infarction: Results of a Multicenter Randomized Controlled Trial.
Tanya M Spruill, Chorong Park, Jolaade Kalinowski, Milla E Arabadjian, Yuhe Xia, Amanda J Shallcross, Pallavi Visvanathan, Nathaniel R Smilowitz, Anaïs Hausvater, Sripal Bangalore, Hua Zhong, Ki Park, Puja K Mehta, Dwithiya K Thomas, Jeffrey Trost, Kevin R Bainey, Bobak Heydari, Janet Wei, Victoria Vaughan Dickson, Gbenga Ogedegbe, Jeffrey S Berger, Judith S Hochman, Harmony R Reynolds
JACC. Advances February 1, 2025 DOI: 10.1016/j.jacadv.2024.101530
Summary
Women with elevated stress after myocardial infarction (MI) experienced significant improvements through a mindfulness-based intervention. In a clinical trial involving 130 women, those participating in the 8-week mindfulness program reported a decline in perceived stress scores by 0.52 points, compared to just 0.19 points in the control group. Notably, participants who practiced mindfulness more frequently showed even greater reductions in stress and depressive symptoms. Engaging women in consistent mindfulness practice may enhance recovery outcomes following MI.
Abstract
Elevated perceived stress is associated with adverse outcomes following myocardial infarction (MI) and may account for poorer recovery among women vs men. This randomized controlled trial tested effects of a mindfulness-based intervention on stress levels among women with MI. Women with elevated stress (Perceived Stress Scale [PSS-4]≥6) at least 2 months after MI were enrolled from 12 hospitals in the United States and Canada and via community advertising. Participants were randomized to a remotely delivered mindfulness intervention (MBCT-Brief) or heart disease education, both 8 weeks long. Follow-up was 6 months. Changes in stress (PSS-10; primary outcome) and secondary outcomes (depressive symptoms, anxiety, quality of life, disease-specific health status, actigraphy-assessed sleep) were compared between groups. The sample included 130 women with MI (mean age 59.8 ± 12.8 years, 34% racial/ethnic minorities). In intention-to-treat analysis, PSS-10 scores declined in the MBCT-Brief arm (-0.52 [95% CI: -0.77 to -0.28]) but not the heart disease education arm (-0.19 [95% CI: -0.45 to 0.06]; group×time interaction P = 0.070). The effect was stronger in per-protocol analysis of participants who completed ≥4 intervention sessions (P = 0.049). There were no significant differences in secondary outcomes in intention-to-treat or per-protocol analyses. Within the MBCT-Brief arm, more frequent mindfulness practice was associated with greater reductions in stress (P = 0.007), depressive symptoms (P = 0.017), and anxiety (P = 0.036). MBCT-Brief was associated with greater 6-month reductions in stress than an active control among adherent participants. More frequent mindfulness practice was associated with greater improvements in psychological outcomes. Strategies to engage women with MI in mindfulness training and support regular home practice may enhance these effects.