title: Self-directed Mindfulness Training and Improvement in Blood Pressure, Migraine Frequency, and Quality of Life.
abstract: BACKGROUND
  Interest in case studies has undergone a resurgence concurrent with increasing prioritization of illustrations of patient-centered care. However, substantial inclusion of the patient in these reports remains limited. Here, a doctor and patient collaborate to present her case report of self-directed mindfulness training and the subsequent changes in blood pressure, migraine frequency, and quality of life.
  
  
  METHODS
  After receiving encouragement from her naturopathic doctor, the patient initiated an 8-week program in mindfulness training following the Kabat-Zinn protocol and logged her daily blood pressure and symptoms before and after meditation sessions over an 11-week period.
  
  
  RESULTS
  Patient-reported outcomes included decreased perceived stress, increased focus, and a newfound sense of centeredness and calm. Changes in objective outcomes were clinically and statistically significant, including reductions in mean systolic and diastolic blood pressure between week 1 and week 11 (P = .0001 and P = .0004 for systolic and diastolic, respectively, by paired, 2-sided t-tests). Self-reported frequency of chronic migraine was also reduced. Critical to the patient's success was that mindfulness training was first approached in a simple, accessible manner prior to embarking on a deeper, extended experience.
  
  
  CONCLUSIONS
  Self-directed mindfulness training can have a meaningful impact on both subjective and objective health outcomes. It may take years of encouragement from a healthcare provider before a patient is ready to adopt a mind-body practice; it is important to recognize and counsel patients with messages appropriate to their stage of change and self-efficacy. Additionally, case studies that combine the voice of the clinician and the patient can provide useful illustrations of truly patient-centered care.
authors.affiliation: Bastyr University-California, San Diego, United States.
authors.forename: Erica B
authors.initials: EB
authors.lastname: Oberg
authors.forename: Margaret
authors.initials: M
authors.lastname: Rempe
authors.forename: Ryan
authors.initials: R
authors.lastname: Bradley
keywords: Mindfulness; case report; complementary and alternative medicine; hypertension; meditation; migraine; patient-centered care