Mindfulness and the Medication Management Visit

Poor adherence to psychotropic medication regimens is one of the major roadblocks to improved clinical outcomes. In today’s time-pressed practice of psychiatry, with its emphasis on the brief medication management visit, clinicians and patients often feel rushed and disconnected, which results in a poor therapeutic alliance. When the therapeutic alliance is positive, medication adherence is better and treatment outcomes should improve.¹

Integrating mindfulness into our practices may help foster the therapeutic alliance and ultimately medication adherence.

Engaging in mindfulness activities either individually or with patients who come to us for brief medication visits can have a profound influence on the therapeutic process. Mindfulness can help us and our patients settle down and be more present during the session. This can provide the catalyst for more meaningful engagement and better therapeutic outcome. While there is no universally agreed on definition of mindfulness, it is helpful to understand the concept as embracing humanness and accepting one’s body, thoughts, feelings, and emotions without judgment.

The use of mindfulness exercises has become increasingly prominent in both cognitive-behavioral and psychodynamic practice. In the primary care setting, mindfulness scores following mindfulness training were found to correlate with improvements in empathy and decreased physician burnout.² Our mindfulness practice may directly benefit patients as well. In a recent study, researchers looked at the impact on therapeutic outcome after a clinician took part in a brief, 5-minute mindfulness-centered exercise.³ Results indicate that the patients “perceived the sessions as being more effective when their therapists engaged in the exercise prior to the start of the session.”

Introducing patients to mindfulness may provide them with greater awareness, attention, openness, and insight. Emerging evidence has associated the practice of mindfulness meditation with functional changes in default mode network activity and connectivity during meditation, as well as with neuroplastic changes in brain regions involved in learning and memory, emotion regulation and self-referential processing, and perspective taking.^4,5

Opening a medication management visit with a 2-minute mindfulness exercise may improve the efficiency and therapeutic value of even brief medication management visits and may be an impetus for patients to explore deeper meditative practices that can have a profoundly beneficial effect on overall health and wellness. We encourage clinicians to consider the utility of mindfulness in the clinical setting. The practice can have far-reaching effects for clinician and patient both inside the therapy space and beyond.

This article was first posted online on 5/3/2013 and has since been updated.

Further reading

• McCown D, Reibel DK, Micozzi MS. Teaching Mindfulness: A Practical Guide for Clinicians and Educators. New York: Springer; 2011. This is a wonderful resource for clinicians who are interested in learning more about mindfulness.

References:

1. Zeber JE, Copeland LA, Good CB, et al. Therapeutic alliance perceptions and medication adherence in patients with bipolar disorder.J Affect Disord. 2008;107:53-62.

2. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302:1284-1293.

3. Dunn R, Callahan JL, Swift JK, Ivanovic M. Effects of pre-session centering for therapists on session presence and effectiveness. Psychother Res. 2013;23:78-85.

4. Brewer JA, Worhunsky PD, Gray JR, et al. Meditation experience is associated with differences in default mode network activity and connectivity. Proc Natl Acad Sci U S A. 2011;108:20254-202549.

5. Hölzel BK, Lazar SW, Gard T, et al. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011;6:537-559.