Study investigates mindfulness-based stress reduction for urodynamics

A recent study found that mindfulness-based stress reduction improved levels of anxiety and pain in patients who underwent urodynamics.

This study was presented at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2022 Winter Meeting, in which Andrea Staack, MD, PhD, reported positive outcomes.1 In this interview, she discusses the background, findings, and takeaways of this study along with why urologists should consider implementing more strategies of this effect in their practices. Staack is a urologist at Loma Linda University Health and an associate professor of urology at the Loma Linda University School of Medicine in California.

Please discuss the background for this study.

Urodynamics is frequently used office test in urology for patients with voiding dysfunctions. Urodynamics is an unfamiliar test to most patients and associated to increased levels of anxiety for the unknown. So, we decided to attend to that observed problem and started by investigating our patient population with a retrospective study where we addressed this anxiety related to an unfamiliar test. [We] used the Mindfulness Based Stress Reduction protocol, which was originally invented by Jon Kabat-Zinn in 1970 at University of Massachusetts. The mindfulness-based stress reduction technique has been shown in the past in different settings that it can reduce anxiety and pain. In our pilot study, we have observed reduction in anxiety and pain levels and now conducted a prospective randomized study for further evaluation.

What were the notable findings of this study? Were any of them surprising to you or your coauthors?

We studied two randomly selected, equally distributed cohorts consistent of a total of 60 patients. Both groups underwent an education about the urodynamic test in a quiet, calm environment, and filled out validated questionnaires to measure their stress level using an anxiety score, their pain level, and other voiding measures. One group received the mindfulness meditation whereas the other group just pursued with the urodynamic test. Both groups, [which] was very surprising, reported a significant decrease in their overall anxiety levels after the test. But, the mindfulness meditation group had a significant increase in calmness and relaxation and reported lower pain. So, we found that interesting that both groups really perceived our quiet, educating, calm study environment as an overall reduction of stress and anxiety.

How will these findings affect the way that you manage these patients in the future?

We showed in our prospective randomized study that the mindfulness meditation decreases pain levels, has a positive effect on staying calm and relaxed, and on patient satisfaction. Therefore, we were thinking to implement this calm and quiet study environment to other patient populations who are undergoing invasive tests in our office, such as cystoscopies or biopsies.

What advice would you give to fellow urologists on factoring in mental health when providing care to patients?

I think we must address the entire body as a whole, not just focusing on one organ system while conducting a test. We need to implement stress-reducing strategies, like the mindfulness mediation technique, to overall improve patients' anxiety level for the unknown. That's my advice for urology physicians, nurse practitioners, [or] nurses who are conducting invasive studies, tests, or treatments—to adhere to patients’ needs for staying mentally calm and relaxed. In our study, we [have] now showed that the mindfulness-based relaxation medication, which can be downloaded from the Internet, can be applied in every patient setting.

Is there anything else you feel our audience should know about this topic?

Personally, when I learned more about Jon Kabat-Zinn’s work on mindfulness-based stress reduction, I found it very interesting [to see] in how many ways this concept can be used.I was really amazed how much applying breathing techniques, awareness, focusing on the present moment with a mindful openness, having a non-judgmental acceptance of this specific moment and awareness can alter the perception and decrease the sensation of anxiety and pain. It has been demonstrated that this mindfulness-based stress reduction can decrease anxiety and depression by modifying the cognitive affective processing by breath focusing, attention, and distraction. In a way, it's not clearly understood, but it alters the response of the anterior cingulate cortex with the prefrontal cortex and the amygdala. So, it's a very interesting field. And I believe, with those simple behavioral techniques, in contrast to medicating patients with anti-anxiety drugs or pain killers—which is a sensitive topic now—we are doing our patients a huge favor.

Reference

1. Drury S, Kuang A, Amayali, et al. Mindfulness based-stress reduction is associated with decreased levels of patients’ anxiety after urodynamics- A prospective randomized controlled trial. Paper presented at: Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction 2022 Winter Meeting; San Diego, California. February 22-26, 2022. Poster #14