Mindfulness-Based Interventions for Older Adults

Evidence for Practice

Carla Martins

• Publisher: Jessica Kingsley Publishers
• Year: 2014
• Print ISBN: 9781849054874
• eBook ISBN: 9780857008800
• Topic: Psicologia
• Subtopic: Psicologia dello sviluppo

Based on extensive clinical research, this book sheds new light onto how Mindfulness Based Stress Reduction (MBSR) can be used with older adults as an effective complementary intervention, identifying specific ways in which MBSR programmes can be adapted and fine-tuned to meet the needs of this group.

Presenting robust new evidence to support the efficacy of MBSR as a holistic therapeutic approach, the author draws interesting and original conclusions about its positive impact on older people's psychological and spiritual wellbeing, physical health, neuropsychological performance, attitudes towards death and dying and overall quality of life. The lived experiences of older adults taking part in an MBSR programme provide rich first-hand insights into the therapeutic process, and the author draws valuable conclusions about ethical considerations and the responsibilities and personal transformation of the MBSR facilitator.

Professionals involved in delivering mindfulness-based interventions to older adults, including psychologists, counsellors, spiritual directors and physicians, will find this to be essential reading. It will also be of interest to students, academics and researchers wishing to keep abreast of the latest research and developments in the MBSR field.

CHAPTER 1

Mindfulness and MBSR

Meditation and mindfulness

Truth lies in the living present, in this moment, and must be discovered afresh in the present, in the eternal now.

Jiddu Krishnamurti1

The Sanskrit and Pali words for meditation in traditional Buddhism are dhyãna and bhãvana, which mean, respectively, mental cultivation or development (Olendzki, 2009). Sogyal Rinpoche (1993) stated that “meditation is bringing the mind home” (p.60); it is a practice that allows us to “introduce ourselves to that which we really are, our unchanging pure awareness, which underlies the whole of life and death” (p.60). It is a mental discipline by which one attempts to get beyond the conditioned, “thinking” mind into a deeper state of relaxation and awareness (Cahn and Polich, 2006).

Mindfulness is one of the main general types of meditation practices (Goleman, 1988). Mindfulness comes from the Pali word sati and the Sanskrit word smirti, which connotes awareness, attention, and remembering. Mindfulness has been described as the “heart of Buddhist meditation” (Nyanaponika, 1992, p.7) and refers to:

(a) mindful awareness: an abiding presence or awareness, a deep knowing that manifests as freedom of mind (e.g., freedom from reflexive conditioning and delusion) and (b) mindful practice: the systematic practice of intentionally attending in an open, caring, and discerning way, which involves both knowing and shaping the mind. (Shapiro and Carlson, 2009, p.4)

Mindful awareness is a way of being and experiencing each moment of life in an open, receptive, and accepting way (Shapiro and Carlson, 2009) and mindful practice entails the development of skills that foment mindful awareness, including the ability to direct and sustain attention, nonreactivity, discernment, compassion, and recognition and disidentification with one’s self (Shapiro and Carlson, 2009). It is a process of “paying attention in a particular way: on purpose, in the present moment, non-judgmentally” (Kabat-Zinn, 1994, p.4), a deliberate act of cultivating attention in the present moment and remembering to attend with persistent clarity to the object of the present experience (Olendzki, 2009). The object of present experience refers to any manifestation that arises at any given moment from the inner or the outer world, including thoughts, emotion, sensations, actions, sounds, or movement (Brown, Ryan, and Creswell, 2007). There are four foundations of mindfulness that can be used to practice mindfulness, including mindfulness of the body, of feeling (vedanã ), of mind (citta ), and of mental objects (dhammas) (Bucknell and Kang, 1997). Mindfulness involves 12 different attitudes: acceptance, nonjudgment, patience, nonstriving, trust, openness, letting go, gentleness, generosity, understanding, gratitude, and lovingkindness (Shapiro, Schwartz, and Bonner, 1998).

Mindfulness-based stress reduction

In recent years there has been an increasing dialogue between Eastern philosophy—especially Buddhism—and Western psychology and neuroscience (Mind and Life Institute) for the understanding of the nature of the human mind, alleviating human suffering, and healing and enhancing the human mind. These dialogues have led to the understanding that mindfulness meditation would be a very positive and beneficial practice in Western societies (e.g. Ekman, 2008; Goleman, 2003).

Accordingly, several programs have been developed integrating mindfulness meditation and psychological approaches in order to foster emotional and physical health. These programs are detached from any cultural or religious tradition, therefore allowing the application of mindfulness training in mental health and clinical settings (Didonna, 2009).

Jon Kabat-Zinn (1990) was the pioneer of this work, developing a program called mindfulness-based stress reduction (MBSR), designed to be used with nonclinical and clinical populations to address issues such as anxiety and chronic pain. The program uses several techniques, including the rigorous and systematic practice of mindfulness, yoga exercises, and group dialogues on themes associated with mindfulness practice, emotional development, and stress reduction, in order to teach individuals how to live fuller, healthier, and better-adapted lives.

Clinical and nonclinical applications of MBSR

The MBSR program has been shown to be an effective intervention in a wide range of clinical applications, resulting in significant improvements in health-related quality of life, reduction of physical symptoms, positive response to treatments and recovery, decreased psychological distress, improvements in objective and subjective well-being, increased ability to deal with stressful situations in daily life, increased ability to relax, increased energy levels, and improved self-esteem, among other measured outcomes (Didonna, 2009).

Several studies presented evidence of the efficacy of MBSR for treating several psychological disorders, such as anxiety and panic disorders (Kabat-Zinn, 1990; Miller, Fletcher, and Kabat-Zinn, 1995), eating disorders (Kristeller and Hallett, 1999; Wolever and Best, 2009), and trauma and post-traumatic stress disorder (Follette and Vijay, 2009). It was also shown that MBSR has very positive effects for treating physical complaints such as psoriasis (Kabat-Zinn et al., 1998); chronic pain (Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, and Burney, 1985); emotional and physical symptoms in individuals facing severe chronic diseases such as cancer (Carlson and Garland, 2005; Carlson et al., 2009); multiple sclerosis (Mills and Allen, 2000); and fibromyalgia (Kaplan, Goldenberg, and Galvin-Nadeau, 1993).

In nonclinical populations, MBSR had significant effects on psychological symptoms, including reduction of intensity and frequency of negative emotions (Brown and Ryan, 2003; Chambers, Lo, and Allen, 2008); reduction in anxiety levels (Shapiro, Schwartz, and Bonner, 1998); improvement of general well-being (Didonna, 2009); and decreased negative self-focused attention (Murphy, 1995). The MBSR program also promoted improvements in the immune system in the general population (Davidson et al., 2003); and quality of life of individuals who had suffered traumatic brain injuries (Bédard et al., 2003).

Although these studies revealed very positive and promising effects of the MBSR intervention, a great number of these investigations suffered from significant methodological and conceptual limitations (e.g., small samples, pre-post designs with no control group, and advanced meditators rather than beginners; Baer, 2003), and most studies were based on quantitative methods, which provide a reductionist view of the participants’ experience of mindfulness meditation. It is important not only to rely on quantitative studies but also to develop studies based on qualitative methodologies and to combine different assessment techniques and research methods to gather a broader and more complete analysis of the experience and effectiveness of the MBSR program (Baer, Walsh, and Lykins, 2009).

Mindfulness and spirituality

The word “spirituality” comes from the Latin root spiritus, which means breath or life, and spiritulis, which refers to a person of the spirit (Hill et al., 2000). Although there is a lack of consensus among definitions of spirituality because its concept overlaps with that of religion (Hill and Pargament, 2008; Wink and Dillon, 2008), spirituality is often associated with a search for meaning in life, a sense of community, an encounter with transcendence, as well as a search for the ultimate truth, respect and appreciation for the mystery of creation, self-growth, and transformation (Wink and Dillon, 2008; Wulff, 1996). “Spirituality” is used to refer to the personal, subjective experience of religion, and it is focused more on the existential and experiential side of an individual’s internalized faith (Moberg, 2008).

Mindfulness is rooted in Buddhist philosophy and is often associated with spirituality and spiritual development. According to Buddhist traditions and Buddhist psychology, meditation is one of the spiritual practices that fosters the cultivation of a “receptive consciousness” (Brazier, 2003) in a practice during which the focus is not on the personal experience of the self but rather “towards the larger reality that contains it” (Andresen, 2000, p.18). Mindfulness is thought to enhance self-development by cultivating qualities such as self-confidence, inner strength, wholesome and positive mental states, presence of mind, and the development of the nonself (Brazier, 2003). The cultivation of nonself is based on the paradigm that individuals need to recognize their existential position in relationship to the world, their dependencies and conditioning, and the impermanent nature of their existence and of the environment (Brazier, 2003).

Selby (2003) considered that practicing meditation cultivates presence and awareness of the present moment and fosters the expansion of consciousness by allowing it to perceive the whole and the wholeness of being. This presence and awareness of the moment encourage spiritual peace, clarity, and awakening.

Moreover, meditation has been associated with several spiritual and religious practices. Most religions and spiritual philosophies (e.g., Buddhism, Christianity, Hinduism, Taoism, and Islam) integrate meditative practices in their routines (Siegel, 2007).

A number of studies have shown that religion and spirituality are positively associated with physical health (George, Ellison, and Larson, 2002; Powell, Shahabi, and Thoresen, 2003) and psychological well-being (Plante and Sherman, 2001). Nevertheless, almost no empirical studies have been developed on the relationship between spirituality and mindfulness.

MBSR and spirituality

Carmody et al. (2008) developed a study to assess the effects of the MBSR program on mindfulness and spirituality and to analyze the association between mindfulness, spirituality, and self-reported medical and psychological symptoms. The researchers found that, after completing the MBSR program, participants showed significant increases in mindfulness and spirituality scores, including increases in sense of inner meaning and peace as measured by the Toronto Mindfulness Scale, the Mindfulness Attention Awareness Scale, and the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale. These increases were associated with reductions in medical and psychological symptoms as measured by the Medical Symptoms Checklist (MSCL) and the Hopkins Symptom Checklist 90, respectively. The researchers suggested that spirituality might be developed in a secular context and that the MBSR program might be an adequate context for individuals to develop spirituality outside of a religious context.

Similarly, MacKenzie et al. (2007), in a qualitative study with nine oncological patients and based on data from interviews and group discussions, found that participants in the MBSR program revealed a higher sense of spirituality. Researchers suggested that this high sense of spirituality was associated with the increased awareness “of the intricate interconnections among themselves, other individuals and eventually all aspects of nature through direct experience” (MacKenzie et al., 2007, p.62). Conversely, Leigh, Bowen, and Marlatt (2005) examined the relationship between spirituality, mindfulness, and substance abuse in 196 undergraduate students who completed questionnaires on mindfulness and spirituality. Results revealed no correlations between mindfulness and spirituality.

Many studies have supported the benefits of the MBSR program and other mindfulness-based interventions in physical and psychological well-being (Grossman et al., 2004), but very few examined the relationship between the mindfulness/MBSR program and spirituality. It is necessary to develop further controlled studies to identify and understand the association between particular types of mindfulness techniques and spirituality and their relationship with health and psychological well-being.

MBSR and older adults

There is a vast amount of scientific literature on the clinical applications of MBSR (Didonna, 2009). Nevertheless, only a few studies have been conducted with older adult groups.

Smith (2004) developed a study based on data from three MBSR courses conducted with older adults with anxiety disorders and/or chronic pain and three mindfulness-based cognitive therapy (MBCT) programs with older adults with major depressive episodes. Results from a thematic analysis revealed cognitive, emotional, physiological, psychological, and behavioral changes. However, this report is not clear about how the qualitative data were collected and analyzed, it does not look at the separate effects of MBCT and MBSR for older adults, and no information is presented on the number of participants involved in the study.

Smith (2006) conducted an MBSR program for six groups of elders with approximately 11 participants per group. All participants suffered from some kind of anxiety disorder and no cognitive impairment or psychosis. Some manifested additional physical conditions and/or depression. Anecdotal evidence revealed mixed results, with some participants showing benefits (e.g., participants with primary chronic pain and secondary anxiety and/or depression) while others did not report any improvement (e.g., participants with severe depression). The major limitation of this study is that results are not based on quantitative or qualitative analysis, but rather on anecdotal evidence.

Ernst et al. (2008) developed a quantitative study analyzing the effects of MBSR on the quality of life in nursing home residents. Twenty-two residents of a nursing home—16 females and 6 males, aged 72 to 98 years—were recruited for the study. Participants were screened for cognitive impairment using the Mini Mental State Examination (MMSE) and...

Table of contents

• Cover
• Praise
• Of Related Interest
• Title Page
• Copyright
• Dedication
• Contents
• Foreword by Shauna Shapiro, Ph.D.
• Acknowledgements
• Preface
• Chapter 1 Mindfulness and MBSR
• Chapter 2 Methodology
• Chapter 3 Quantitative Results
• Chapter 4 Qualitative Results
• Chapter 5 Mixed-Methods Results
• Chapter 6 Integral Results
• Chapter 7 Discussion
• Appendix 1 Description of Quantitative Measures
• Appendix 2 Interview Protocol
• Appendix 3 Treatment of Data
• Appendix 4 Maas Statistical Results
• Appendix 5 FFMQ Statistical Results
• Appendix 6 SCS Statistical Results
• Appendix 7 EQ Statistical Results
• Appendix 8 SWLS Statistical Results
• Appendix 9 PANAS Statistical Results
• Appendix 10 PWBS Statistical Results
• Appendix 11 POMS Statistical Results
• Appendix 12 PSS Statistical Results
• Appendix 13 WHOQOL-BREF Statistical Results
• Appendix 14 WHOQOL-100 Statistical Results
• Appendix 15 SHCI Statistical Results
• Appendix 16 Death Perspectives Statistical Results
• Appendix 17 SWBQ Statistical Results
• Appendix 18 Working Memory Index Statistical Results
• Appendix 19 Processing Speed Index Statistical Results
• Appendix 20 Memory Statistical Results
• Glossary
• References
• Subject Index
• Author Index
• Also available