Can an adapted mindfulness training program improve interoception and adherence to the DASH diet?

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In a recently published study, Dr JAMA Network OpenResearchers investigated whether the Mindfulness-Based Blood Pressure Reduction (MB-BP) adapted mindfulness program improved interoceptive awareness and Dietary Approaches to Stop Hypertension (DASH) adherence.

Study: Adapted mindfulness training to interoception and adherence to the DASH diet.  Image credit: Antonina Vlasova/Shutterstock.comStudy: Mindfulness training adapted to interoception and adherence to the DASH diet. Image credit: Antonina Vlasova/


High blood pressure, or high blood pressure (BP), can lead to cardiovascular disease, which is a leading cause of death worldwide.

The DASH diet lowers blood pressure and previous studies have superior Mediterranean diet and caloric restriction methods; However, adherence to the diet is low.

Mindfulness practice adapted to improve health habits that lower blood pressure may increase DASH diet adherence through increased interoceptive awareness of food intake.

About the study

In the current study, researchers evaluated the effects of an adapted mindfulness training program on interoception and adherence to the DASH diet.

The phase II, parallel-group randomized controlled trial included English-speaking adults with unexplained hypertension (BP equal to or greater than 120/80 mm Hg), recruited from Rhode Island between June 1, 2017 and November 30, 2020, and six was followed for months.

Of the 348 initially identified, 67 were ineligible, 17 were unwilling to participate, and 63 failed to register before the end of the trial. Consequently, of the 201 individuals randomized to the program (intervention, n = 101) and extended routine care (control, n = 100) groups, 24 (12%) were lost to follow-up.

The MB-BP program included ten sessions, including weekly group sessions of 2.5 hours and one day group sessions of 7.5 hours. Recommended home mindfulness training was 45 minutes or more per day, six days per week, and included yoga, meditation, self-awareness, emotional regulation, and attention control.

An eight-week intervention was modified to address hypertension risk factors including education, personalized feedback, and mindfulness exercises.

Participants in the intervention and control groups were provided with home blood pressure monitoring equipment with physician referral options. Routine care recipients also received brochures for controlling hypertension as recommended by the American Heart Association (AHA).

Outcome assessors and data analysts were blinded to group allocation. Intention-to-treat analyzes were performed between 1 June 2022 and 30 August 2023.

The primary study outcome was interoceptive awareness, assessed using the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Adherence to the DASH diet assessed using the Harvard 2007 Grid Food Frequency Questionnaire was a secondary study outcome. The Five-Facet Mindfulness Questionnaire (FFMQ) was used to assess mindfulness.

Regression modeling was performed using generalized estimating equations for analysis. The team excluded people who practiced meditation more than once per week, those with a history of psychotic or bipolar disorder and self-injurious behavior, and those with serious medical conditions, eating disorders, substance use disorders, or suicidal ideation.


The average participant age was 60 years; Of the participants, 118 (59%) were female, 163 (81%) were white individuals of non-Hispanic ethnicity, and 146 (73%) had a college-level education.

After six months of follow-up, the mindfulness-based blood pressure reduction (MB-BP) mindfulness program significantly improved MAIA and DASH scores by 0.5 and 0.6 points, respectively, compared to controls.

The mindfulness program increased MAIA scores by 0.5 points at six months compared to controls. Among individuals with poor DASH adherence at baseline, mindfulness training also significantly increased DASH scores by 0.6 points at six months compared with extended usual care.

The program showed a 0.3-point elevation in baseline DASH scores among all intervention group participants compared with a 0.04-point change in DASH scores from baseline to six months among control group participants with extended routine care.

In exploratory mediation analyzes performed to investigate whether MAIA may mediate the effect of MB-BP on DASH scores, results showed partial (31%) mediation. The adaptive mindfulness program mainly focuses on emotional awareness, body listening, self-regulation and attention control.

Being a potentially active aspect of the adaptive mindfulness program, the FFMQ score showed 33% mediation. Eight serious adverse events were reported during the six-month follow-up, four in both groups, and physical injury-induced adverse events were similar in both groups. However, none of the adverse events were associated with the study.

Self-awareness can influence eating behavior by being aware of fullness and hunger, the effect of different foods on a person’s mood, and eating habits.

Attentional control can be applied to dietary behavior by paying attention to the sensory qualities of food, making deliberate choices for healthy eating habits, and shopping for health-promoting foods. Emotion regulation can be applied to eating behaviors by reducing craving responses, practicing self-kindness and compassion, and reducing emotional distress.


Overall, study results showed that the adapted mindfulness program improved adherence and adherence to the DASH diet compared to six months of extended usual care. The effect of mindfulness training on MAIA scores was consistent with previous research.

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