What if Health Insurance Covered Mindfulness?

Blair T. Johnson, a Board of Trustees Distinguished Professor of psychology, is renowned for his work in health psychology. He leads the SHARP (Systematic Health Action Research Program) lab, which currently comprises around 40 students and several professors. In today's society, he says, stress and coping are particularly pressing issues for health psychology researchers like himself.

Much of his work revolves around "how you introduce behavioral interventions that can help people improve their own lives just through their own actions," Johnson says.

Lately, his lab has taken an interest in what are known as mindfulness-based stress reduction (MBSR) programs. Working with Eric Loucks, director of the Mindfulness Center at Brown University, Johnson is currently pursuing a five-year meta-analysis of MBSR efficacy, thanks to a $3.1 million grant from the NIH's National Center for Complementary and Integrative Health in 2022.

MBSR is an intensive form of outpatient therapy that typically lasts between four and six weeks, during which time patients learn mindfulness-based coping skills. The technique was pioneered in the Western world in the 1990s by trailblazing UMass psychologist Jon Kabat-Zinn, the "father of secular mindfulness," who himself adapted his teachings from traditional Buddhist meditation practices.

Originally designed for treating anxiety and stress, MBSR has also been applied to other chronic conditions like cancer, immune disorders, and diabetes in recent years, and has blossomed into a variety of formats and treatment lengths. During the pandemic, for instance, virtual MBSR therapy emerged alongside the standard in-person courses.

"The sky is the limit in terms of variations that you see in the interventions," Johnson says. "A lot of what we're trying to do at the UConn site is to record all the variations and what the practices have been and then see if we can determine whether doing certain things is facilitative of greater success over the long run, in terms of improving mental health or physical health - what's the best recipe, essentially."

Johnson's meta-analysis will differ from other studies of MBSR and related mindfulness courses in the sheer number of programs it will analyze. At the end of the grant's five-year program, Johnson anticipates there being at least 700 trials that are pooled in the lab's quantitative synthesis.

"To date, we have not seen any synthesis of over about 200 trials - and those have been syntheses of many other varieties of mindfulness training or alternative interventions. Most syntheses include far fewer trials," Johnson explains.

One stakeholder with a keen interest in mindfulness is the health insurance industry. In recent years, many insurance companies have begun covering alternative therapies, like acupuncture. Johnson believes that robust research supporting MBSR's health benefits could be the key to increasing insurance coverage for intensive mindfulness programs, making them accessible to more patients.

In many ways, Johnson argues, framing mindfulness as an "alternative" belies its centuries of success. He hopes his research will help clarify the effects of the technique.

"A strong case can be made that it predates modern medicine - it's more like an original treatment, instead of a temporary one that's alternative," he says. "But you know, it has been gaining a foothold of respectability in the medical and healthcare establishment. That's a positive trajectory that I would expect would continue. Certainly, it is an explosion of interest, broadly speaking."

This explosion of interest has translated into not only grant funding for Johnson's work, but also a steady influx of researchers and students eager to delve into the world of mindfulness research in the SHARP lab. The 40 students earning their research credits in SHARP this semester are "far more than I've ever had in a given academic year, let alone a semester," Johnson says. He credits these students - along with postdoctoral research associate Chen Li - with making SHARP's work possible.

"One of the lab's graduate students is doing a dissertation based on this work. And some of our more senior undergraduate students have started becoming team leaders as well, some doing honors theses. And in this way, we manage to establish new students and have absolutely everyone doing meaningful activities that help us ultimately to achieve the goal. I couldn't do it without them," he says.