Implementation Strategies
Implementation strategies are the actions needed to implement mindfulness-based interventions for pain. Ideally, implementation strategies should be selected to address the barriers to implementation discussed in the "Common Barriers and Facilitators" tab. Click the buttons on the left to read more about implementation strategies people have used to implement mindfulness-based interventions for pain and to access educational resources. In addition, view the RASC guide Strategies Timeline, Activities & Resources (STAR) log to discover a practical way to track these strategies and The Partner Engagement Guide to access practical recommendations to engage partners in your implementation strategies.
Mindfulness-Based Interventions can be modified to improve accessibility, cost-effectiveness, fidelity, and engagement.
The treatment protocol for Mindfulness-Based Stress Reduction typically includes two and a half-hour sessions and a half-day retreat, which requires a high level of facility-level resources, such as provider time and physical space. Treatment protocols can be modified to reduce session time to 90 minutes (which involves modifications such as shorter experiential practices and in-session instructions) and omit the half-day retreat. One study used a four-week protocol with 90-minute sessions, which participants reported made it much more manageable to fit into their schedules.
Mindfulness-Based Interventions can be adapted to meet the needs of participants with a trauma history, including giving participants the opportunity to modify or opt out of specific components of the intervention that may be difficult to practice.
Mindfulness-Based Interventions have been adapted to be delivered virtually in both live, group-based, and self-guided formats. In the group-based format, eight 90-minute weekly group sessions were delivered via telehealth supplemented by a workbook, mobile application, and study website. The self-guided version included the same supplemental materials along with three (25-60 minute) phone calls from a facilitator at the beginning, middle, and end of the program to discuss logistical challenges and participant progress.
In an effort to deliver Mindfulness-Oriented Recovery Enhancement (MORE) in a more cost-effective manner while maintaining fidelity, a virtual reality (VR) adaptation of MORE was developed. MORE-VR sessions were self-guided under the supervision of a research assistant. Notable adaptations from the MORE protocol include immersive mindfulness practices and the use of virtual cues (e.g., drug-related cues during cue-exposure exercises) in lieu of mental visualizations.
To effectively deliver MORE, a validated fidelity monitoring procedure can be used to assess and improve clinician competence and adherence to the treatment manual.
MORE can typically be reimbursed through psychotherapy, health behavior assessment and intervention, and/or group medical visit procedure codes.
A 10-15 minute structured Motivational Interviewing after the first session of Mindfulness-Based Cognitive Therapy was associated with five times higher odds of completing the group than those who did not receive the phone call.