Mindful Breathing Laboratory, Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
Chron Respir Dis. 2013 Aug;10(3):175-82. doi: 10.1177/1479972313497372.
There is no conclusive evidence about the way to a promote behavior change in self-management programs for patients with chronic obstructive pulmonary disease (COPD). The latter is a significant knowledge gap as there is a need to promote a sustained effect in interventions like Pulmonary Rehabilitation or Supporting Programs. Embracing patient's values seems to be a key ingredient to ignite genuine motivation for behavior change. This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. The MI study consisted of a 3-month program of weekly coaching phone calls after one face-to-face visit. The following themes were outstanding: patients value the supportive communication with coach and believe the MI-based coaching created increased level of awareness and accountability. They perceived an increase in physical activity and reported "feeling better" or other benefits not directly related to exercise. The Mindfulness for Health Program was a mandatory 8-week program that consisted on 2-hour classes aimed to cultivate nonjudgmental attention in the moment (through different meditative practices and sharing) plus monthly face-to-face encounters aimed to sustain practice and sharing of life experiences for 1 year. The following themes (at 1 year) were outstanding: appreciating life by seeing hardships as opportunities, valuing the self through compassion and awareness, cultivating connectedness with others, acquiring joy, and adopting healthy behaviors. In the search for the "holy grail" for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously agree with.
目前尚无确凿证据表明如何促进慢性阻塞性肺疾病（COPD）患者的自我管理计划中的行为改变。这是一个重大的知识空白，因为需要在肺康复或支持计划等干预措施中促进持续效果。接受患者的价值观似乎是激发真正改变行为动机的关键因素。本文描述了两项针对严重 COPD 患者进行的试点定性研究，旨在激发患者的内在体验并促进自我管理：一项试验测试了动机性访谈（MI）作为帮助严重 COPD 患者改变行为的一种方式，另一项试验测试了基于正念的干预。MI 研究包括在一次面对面访问后进行为期 3 个月的每周教练电话辅导计划。以下主题引人注目：患者重视与教练的支持性沟通，并相信基于 MI 的辅导提高了他们的意识和责任感。他们认为自己的身体活动有所增加，并报告“感觉更好”或其他与运动无关的益处。“健康计划的正念”是一个强制性的 8 周计划，包括 2 小时的课程，旨在培养当下的非评判性注意力（通过不同的冥想实践和分享），以及每月的面对面会议，旨在维持练习和分享生活经验一年。以下主题（在 1 年内）引人注目：通过将困难视为机会来欣赏生活，通过同情和意识来重视自我，培养与他人的联系，获得快乐，并采取健康的行为。在寻找能够促进行为改变的自我管理计划的“圣杯”时，正念和 MI 似乎很有前途，可以培养一种人们完全投入并自觉认同的生活方式。
