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Mindful : August 2016
to widespread adoption. Many promising ideas never find their way into adoption in the real world. For example, a pilot program for increas- ing nutrition in public schools may report astounding results, but can it be made to work for the 50.1 million public school students in the US? In short, taking something that works on a small scale and making it work on a large scale is the ultimate public health challenge. What Segal and Dimidjian recom- mend for mindfulness-based interven- tions is to take “a pause in the forward movement” of the large amount of research on mindfulness, to identify the biggest obstacles to reaching unmet health needs. “Simply accumu- lating a g reater number of the same types of studies” without identifying the real gaps is unlikely to advance the field. One challenge in the research is controlling for teacher/trainer quality and methodology. The range of trainer styles and methods and abilities is mind-boggling, not to mention the possibility of trainers injecting per- sonal belief systems into their work. Another is following up on partici- pants and seeing how much mindful- ness practice—the “dosage”—is effec- tive and how much it is sustained over the years. These are tough problems if you’re trying to make general state- ments about learning mindfulness. If the research program doesn’t step up to a new level, mindfulness could easily remain, as Dimidjian said to me, “a boutique-ish interven- tion offered by a handful of people to small populations. If it doesn’t have the capacity to have broad impact, it’s not a public-health intervention—like seatbelts or penicillin. Our work as clinical scientists addressing unmet mental health needs is not finished until we figure out how to make treatments as effective for the many as they are for the few.” Early on in her work with MBCT, Dimidjian saw the difficulties that pregnant women and young mothers experienced in gaining access to a program like this. They’re too busy, and yet they are at very high risk for depression if they are among the many who have experienced depres- sion in the past. This opened a whole area of applied research for her (to see a report on her work with pregnancy and motherhood and depression by parenting columnist Heather Grimes, go to mindful.org). But it also helped her to think about how technolog y could be used to reach more people where they live. The ubiquity of the web and smartphones and tablets led Segal and Dimidjian to obtain a grant to develop a web-based version of MBCT. They spent several years on this project in partnership with a commercial devel- oper, Mindful Noggin. Mindful Mood Balance is the result. MMB aims to serve the same target group as MBCT. As Dimidjian says, “It’s not intended for, nor has it been tested for, people when they’re in the depths of an acute episode of depression. Its aim is to prevent relapse and help people work more skillfully to reduce residual depressive symptoms.” MMB is not publicly available, and probably will not be for some time. Segal and Dimidjian are committed to studying its effectiveness and refin- ing the understanding of whom it is appropriate for, before it’s introduced in a widespread way. So far, they have conducted a study in conjunction with Kaiser Permanente Colorado Institute for Health Research with 100 subjects. It showed “significantly reduced depressive severity, which was sustained over six months, and improvement on rumination and mindfulness,” according to a paper in Behaviour Research and Therapy. The same work was also reported on in the Journal of Medical Internet Research. A form of MMB has also been made available to clinicians, to enable them to test drive it and offer critique. My press pass enabled me to obtain entry to MMB to get a feel for what an in-person mindfulness-program would be like transported to my iPad. The program follows an arc from simply learning to pay attention at the beginning, through encountering difficulties, to developing plans and → SALLY 53, Marketing Researcher What’s attracted me to mindfulness is that it’s not theoretical. It gives me strategies. I like listening to other people in MBCT and hearing what’s going on in their lives. That kind of just-talking is a great thing— so helpful. Mindfulness is adaptable. I’ve been able to find ways to bring it into life that work for me. When I’m on the subway, I will just sit still sometimes and take in the clickity clack of the train on the tracks. I’ve always been a worrier, a what-if per- son. What if this, what if that... now instead of spinning I can breathe through it. That’s had a huge impact—even though it’s just a small thing—on my ability to cope. depression is the leading cause of disability for people in midlife and for women of all ages, The World Health Organization estimates. ILLUSTRATIONBYKEVINVANAELST(LEFT)ANDISTOCK.COM/ARTVEA(RIGHT) August 2016 mindful 55 psychology