Alleviation of suffering in palliative care needs a combination of good symptom control and psychosocial care. The capacity of mindfulness to promote psychological flexibility opens up possibilities of creating a paradigm shift that can potentially change the landscape of psychosocial care. In this review, we attempt to introduce 4 methods to establish mindfulness based on 'The Discourse on the Foundations of Mindfulness', a core text of Theravada Buddhism, followed by a brief comparison of the concepts and practices of mindfulness in different cultures and religions in Southeast Asia. Next, 2 mindfulness-based interventions specifically designed for palliative psychosocial care - mindfulness-based supportive therapy (MBST) and mini-mindfulness meditation (MMM) are introduced. We hypothesise that mindful practices, tailored to the palliative setting, can promote positive psychosocial outcomes.
In psychiatry, mindfulness based intervention has been increasingly popular as a means of psychosocial intervention over the last decade. With the alvanche of technological advances, there has been a myriad of mindfulness based applications. Recent reviews have highlighted how these applications are lacking in functionalities and without demonstrated efficacy. Other reviews have emphasized that there is a need to take into consideration the design of an application, due to placebo effects. It is the aim of this technical note to illustrate how the 5-Minutes Mindfulness application, which is an application designed to provide mindfulness exercises to relieve distress and suffering amongst palliative patients, have been conceptualized. The conceptualized application builds on previous evidence of the efficacy of 5-Minutes Mindfulness demonstrated by pilot and randomized trials. In terms of design, the currently conceptualized application has been designed such that placebo effects could be controlled for.
Informal caregivers are at risk of being overwhelmed by various sources of suffering while caring for their significant others. It is, therefore, important for caregivers to take care of themselves. In the self-care context, mindfulness has the potential to reduce caregiver suffering. We studied the effect of a single session of 20-minute mindful breathing on the perceived level of suffering, together with the changes in bispectral index score (BIS) among palliative care informal caregivers. This was a randomized controlled study conducted at the University of Malaya Medical Centre, Malaysia. Forty adult palliative care informal caregivers were recruited and randomly assigned to either 20-minute mindful breathing or 20-minute supportive listening. The changes in perceived suffering and BIS were measured preintervention and postintervention. The reduction in suffering score in the intervention group was significantly more than the control group at minute 20 (U = 124.0, n1 = n2 = 20, mean rank1 = 24.30, mean rank2 = 16.70, z = -2.095, P = .036). The reduction in BIS in the intervention group was also significantly greater than the control group at minute 20 (U = 19.5, n1 = n2 = 20, mean rank1 = 29.52, mean rank2 = 11.48, z = -4.900, P < .0001). Twenty minutes of mindful breathing was more efficacious than 20 minutes of supportive listening in the reduction in suffering among palliative care informal caregivers.
A randomized controlled study was conducted to evaluate the efficacy of 20-minute mindful breathing in suffering reduction. Forty palliative care patients with an overall suffering score of 4 or above as measured with the Suffering Pictogram were recruited and randomly assigned to 20-minute mindful breathing or 20-minute supportive listening. There was statistically significant reduction of suffering score in both the groups. For Bispectral Index Score value, there was statistically significant difference between intervention and control. A 20-minute mindful breathing could be useful in the alleviation of suffering in palliative care.
Previous studies have reported a significant association between nature exposure and positive body image, but understandings of the mechanisms that help to explain this link remain nascent. Here, we considered the extent to which trait mindfulness and connectedness to nature, respectively, mediate the aforementioned relationship both in parallel and serially. An online sample of 398 participants (199 women, 196 men, 3 other; age M = 28.1 years) from the United Kingdom completed measures of self-reported nature exposure, mindful awareness and acceptance, connectedness to nature, and body appreciation. Results indicated that inter-correlations between scores on all measures were significant and positive. Following the elimination of non-significant pathways, path analysis resulted in an adequately-fitting model in which the direct relationship between nature exposure and body appreciation was significant. In addition, connectedness to nature - but not trait mindfulness - significantly mediated the direct relationship. Finally, we also found evidence of a serial mediation, where the association between nature exposure and body appreciation was mediated by mindful awareness followed by connectedness to nature. The implications of these results for scholarly and practitioner understanding of the impact of nature exposure on positive body image are discussed in conclusion.
Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (β = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (β = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
A pilot study was conducted to evaluate the efficacy of 5-minute mindful breathing in distress reduction. Twenty palliative care patients and family caregivers with a distress score ≥4 measured by the Distress Thermometer were recruited and randomly assigned to mindful breathing or "listening" (being listened to). Median distress reductions after 5 minutes were 2.5 for the mindful breathing group and 1.0 for the listening group. A significantly larger reduction in the distress score was observed in the mindful breathing group (Mann-Whitney U test: U = 8.0, n1 = n2 = 10, mean rank1 = 6.30, mean rank2 = 14.70, z = -3.208, P = .001). The 5-minute mindful breathing could be useful in distress reduction in palliative care.
The objective of this paper was to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in decreasing depressive symptoms and intellectual disabilities (ID) among individuals with depression in Nigeria. In this randomized controlled trial, 101 participants with depression and ID, aged 18-60 years, who obtained 14 scores in the Beck Depression Inventory (BDI-II), scores 4 and above on Shaheen Disability Scale (SDS), were randomly assigned into the interventions (n = 50) and active control group (n = 51). The MBCT group has shown a statistically significant effect on the SDS and BDI-II variables by decreasing depressive symptoms and disabilities following MBCT (p<0.05). The assessment revealed that participants reported an improvement in their experience of depression and ID. The most significant impact was in the reduced levels of ID reported. The results of the evaluation suggest that depressed people with intellectual disabilities benefit from a structured MBCT group intervention and the results are maintained at 2-months follow-up.
Electroencephalogram based brain-computer interfaces (BCIs) enable stroke and motor neuron disease patients to communicate and control devices. Mindfulness meditation has been claimed to enhance metacognitive regulation. The current study explores whether mindfulness meditation training can thus improve the performance of BCI users. To eliminate the possibility of expectation of improvement influencing the results, we introduced a music training condition. A norming study found that both meditation and music interventions elicited clear expectations for improvement on the BCI task, with the strength of expectation being closely matched. In the main 12 week intervention study, seventy-six healthy volunteers were randomly assigned to three groups: a meditation training group; a music training group; and a no treatment control group. The mindfulness meditation training group obtained a significantly higher BCI accuracy compared to both the music training and no-treatment control groups after the intervention, indicating effects of meditation above and beyond expectancy effects.