Mindfulness TrainingType I Hybrid Effectiveness-Implementation Trial of Primary Care Brief Mindfulness Training for Veterans

Inclusion Criteria:

To be eligible, participants must be:

• enrolled in VA primary care through the local VA site
• report clinically significant psychological distress as measured in at least one of three areas:

• PTSD operationalized by 30 on the PCL-5 plus endorsing a criteria A stressor
• depression operationalized as 10 on the PHQ-9
• anxiety operationalized by 10 on the GAD-7

Exclusion Criteria:

Exclusion criteria are minimized to allow inclusion of any primary care patients with psychological distress that would normally receive treatment in primary care. Patients will be excluded if they demonstrate symptoms that would not allow them to actively participate in the interventions:

• gross cognitive impairment
• suicide attempt or desire to commit suicide in the last month

To allow the study to isolate the effects of the intervention and ensure patient treatment preferences are honored, patients will be excluded if they:

• had a psychotherapy appointment outside of primary care within the last month and have future appointment scheduled
• had a change in psychiatric medication outside of VHA primary care in the last 2 months
• voice a preference to be directly referred to specialty mental health care

Veterans with mild TBI, and alcohol/ substance use disorders will not be excluded because these problems commonly co-occur with psychological distress, and individuals with these conditions have previously benefited from mindfulness and problem-solving training. Patients who receive Primary Care Mental Health Integration (PCMHI) services will not be excluded as this is part of the usual primary care services that all Veterans receive.