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the births of their babies. Self-hypnosis for relaxation allows women to mobilize their inner resources and focus their minds and bodies to achieve a more satisfying birthing experience.

Chapter 2: Literature Review

Along with the program's growth in availability has been a growing body of research on mindfulness-based stress reduction. The research largely reflects the experience of middle- and working-class patients who have completed the programs. Research has shown that mindfulness-based stress reduction decreases general physical and psychological symptoms (Astin 1997; Hellman, Budd et al. 1990; Tate 1994), decreases physical pain among chronic pain patients (Kabat-Zinn 1982; Kabat-Zinn, Lipworth et al. 1985; Kabat-Zinn, Lipworth et al. 1987), reduces symptoms of anxiety (KabatZinn, Massion et al. 1992; Boswell & Murray 1979; Miller, Fletcher et al. 1995), improves psoriasis (Bernhard & Kabat-Zinn 1988), and decreases symptoms of fibromyalgia (Kaplan, Goldenberg et al. 1993).

A few studies have explored cost-effectiveness and health care utilization by patients who complete mindfulness-based stress reduction programs. Comparing the outpatient medical insurance charges six months prior to and following the mindfulness-based intervention at the University of Massachusetts Stress Reduction Clinic, patients who completed the program demonstrated a statistically significant threefold reduction in average charges per patient, compared to patients who did not complete the program (Kabat-Zinn 1987). At the Harvard Community Health Care Plan, there was a reduction in the number of office visits among patients who completed a behavioral medicine intervention that included training in mindfulness meditation (Hellman, Budd et al. 1990). At a hospital-based program in Utah, six months after completion of the program, patients demonstrated a 60 percent decrease in outpatient clinic visits, a 50 percent decrease in length of hospital stays, and a 90 percent reduction in work absenteeism (Tare 1994).

As I have indicated, mindfulness-based stress reduction has rarely been adapted to meet the needs of racial and linguistic minority communities. One such effort, the Worcester City Campus Program, a satellite of the Stress Reduction Clinic at the University of Massachusetts, teaches mindfulness meditation to English- and Spanish-speaking inner-city residents of Worcester, Massachusetts. A two-year pilot study demonstrated significant decreases in physical and psychologic symptoms

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