Worry is defined as a chain of thoughts and images, negatively affect-laden and relatively uncontrollable. It has been conceptualized as a coping strategy to reduce the experience of anxiety. Though worry is a normal part of life, when it is persistent, it may exceed one’s ability to cope and become harmful stress. In a recent Kaiser Family Foundation poll, nearly half of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over COVID-19. This stress manifests itself physiologically, leading to increased incidence of multiple health problems which are already a concern for many African Americans and others living in disadvantaged communities across the country. The introduction of COVID-19 has further exacerbated the profound inequities in health care for communities of color. Due to shelter-in-place orders and social distancing policies, patients and the healthcare system have encountered challenges as behavioral health interventions have traditionally been delivered in-person. With the emergence of COVID-19, there is an urgency to expand the use of technology to help people who need routine behavioral health care, while also keeping vulnerable populations in their homes to ensure safety while maintaining access to the care they need.
The proposed research aims to use a randomized, controlled, comparative-effectiveness trial to: (1) compare the effectiveness of a teleconference mindfulness-based stress reduction (MBSR) versus an MBSR mobile app in reducing worry (primary outcome) and improving other mental health outcomes including anxiety, stress, depression, loneliness, isolation, sleep, mindfulness, and quality of life (secondary outcomes) among adults living in predominantly low-income, mental health-underserved and minority neighborhoods: and (2) examine if the effectiveness of these two MBSR interventions can sustain at three month follow-up. We will also examine the implementation potential of teleconferencing and the mobile app MBSR.
A total of 178 participants, 89 for each group, will be recruited. Inclusion criteria include: (1) age 18 years and older; (2) a baseline score greater than 26 on the Penn State Worry Questionnaire-Abbreviated; (3) have access to a smart phone; (4) can communicate in English; (5) have a reading level of 6 or higher; and (6) reside in one of the census-identified underserved, primarily African-American communities in Buffalo, New York.
Exclusion criteria will include: (1) severe depression; (2) active suicidal intent; (3) moderate or severe substance use disorder in the past month, psychosis, or bipolar disorder; (4) global cognitive impairment; (5) currently receiving psychotherapy behavioral counseling; (6) change in psychotropic medications within the last month; and (7) unable to communicate.
This study addresses an important question of finding ways to effectively address mental health concerns during the COVID-19 pandemic expressed by our community partners, and will provide guidance for providers on ways to overcome barriers of access to mental health care in underserved communities that are being disproportionately affected by the pandemic, both during COVID-19 and beyond, yielding lessons on strategies for personalized and culturally-appropriate tailoring of interventions considering mental health needs, social determinates of health, and cultural values of African American communities. The technology involved in the proposed study including teleconferencing and a mobile app has been currently utilized in clinical settings and is not technology that needs extensive development.
Furthermore, the MBSR is an evidence-based manualized intervention with flexibility for personalization. Therefore, our study, if successful, will provide actionable findings that can be immediately adopted by healthcare providers, patients, and the community during the COVID-19 pandemic while following necessary public health safety measures, and can be easily replicated throughout the country.