Mindfulness has boosted our ED staff’s resilience

Image: Pixabay

.Emergency Nurse

We all know that emergency nurses are regarded as a special breed
with the ability to keep going no matter what is thrown at us, but
that doesn’t stop us feeling fatigue. Resilience is the ability to recover quickly from
the difficulties surrounding us but this has become harder to maintain with the relentless challenges the latest winter has presented.
As a matron at Barnet Hospital’s emergency department (ED), and part of the senior leadership team, I have been concerned with the resilience and well-being of our staff.
Focus on resilience Through the winter months it was evident that early signs of fatigue were setting in with a slow rise in staff sickness, so we decided to focus on resilience to improve morale and lower sickness levels, and hopefully give staff the ability to carry on.
Mindfulness meditation sessions were introduced before the start of each shift.
Handover mainly focused on the challenges of the previous shift, which more often than not put oncoming staff into a negative frame of mind before they even set foot into the clinical area. Our staff were open to suggestions of ways to resolve this.
Some members of the senior team had recently undertaken a training course involving
mindfulness, and one ED consultant practised it daily, so it made sense to use the skills
available to us. We began by using a simple mindfulness breathing and meditation exercise, which takes only a few minutes to centre thoughts and settle the mind. It is not a mandatory exercise – all staff are given the opportunity to leave the staff room before the meditation – but it has been well received and some medical colleagues who have differing shift start times have been joining the sessions.
One nurse was keen to share her experience. She said: ‘Meditation before starting a
shift has helped me to relax and focus the mind before going into what can be a stressful and high-pressured environment. It has provided a new coping mechanism which can be used at work or home to relax and detach from a busy shift. Overall, it has been a great experience and has introduced new ways of winding down which I will continue to use in my career.’

Link to article here

Mindfulness and Fear Extinction: A Brief Review of Its Current Neuropsychological Literature and Possible Implications for Posttraumatic Stress Disorder

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Abstract

Research in the neuroscience of mindfulness has grown rapidly in recent years. This includes empirical investigations into structural and functional changes in several brain regions—particularly, the hippocampus, the prefrontal cortex, and the amygdala—in association with the practice of mindfulness. Of interest to the current paper is that such brain regions are also implicated in empirical research focusing on fear extinction. While fear extinction has, therefore, been suggested as one of the possible mechanisms to underlie the positive effects of mindfulness, the conceptual links and research implications have lacked specific focus and detailed discussion in the literature. The purpose of this paper is, therefore, two-fold. First, this paper briefly reviews the extant literature on the neuropsychological mechanisms underlying mindfulness—particularly that, which has been found to be similarly implied in fear extinction—and hence, suggests future research directions based on its current state in the literature. Second, this paper explores the implications of this for fear-based psychopathologies, specifically for posttraumatic stress disorder (PTSD). Discussion from this paper suggests the idea of fear extinction as an underlying mechanism of mindfulness to be one that is still preliminary, yet promising; in turn, elucidating the need for further methodologically rigorous study to specifically determine fear extinction as a result of mindfulness, as well as to incorporate neuroimaging techniques in supporting the existing literature that have found preliminary support of mindfulness for PTSD.

 

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Effect of Acceptance Versus Attention on Pain Tolerance: Dissecting Two Components of Mindfulness

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Mindfulness, First Online: 01 February 2019

Objectives

Previous studies have shown that brief mindfulness trainings can have significant analgesic effects. However, the effects of the various components of mindfulness on pain analgesia are not well understood. The objective of this study was to examine the effects of two components of mindfulness interventions—attention and acceptance—on pain analgesia.

Methods

One hundred and nineteen healthy college students without prior mindfulness experience underwent a cold-pressor test to measure pain tolerance before and after the training. Pain intensity, tolerance, distress, threshold, and endurance time were also tested. The participants were randomly assigned to one of the following four conditions: (1) acceptance of pain, (2) attention to pain, (3) acceptance of and attention to pain, or (4) control.

Results

The results showed that both the acceptance strategy and the combined acceptance and attention group increased pain endurance and tolerance after training. Furthermore, the acceptance group had longer pain endurance and tolerance times than the attention and control groups.

Conclusions

These results suggest that acceptance of pain is more important than attention to pain. Study limitations and future research directions are discussed.

Link to article here

Mechanisms of Mindfulness in Those with Higher and Lower Levels of Autism Traits

 

Mindfulness February 2019

The effects of brief mindfulness induction on a central trait of autism spectrum disorder (over-selective attention) were examined in order to assess whether different mechanisms act in those with lower and higher levels of autism traits, and determine which intervention may be most appropriate for individuals with different sets of symptoms. Two hundred and 24 volunteer participants (110 male; 114 female) were assessed for levels of autism traits (autism quotient; AQ), anxiety and depression (Hospital Anxiety and Depression Scales), and mindful awareness (Toronto Mindfulness Scale). They were randomly assigned to mindfulness, relaxation, or no-intervention groups. After three 10-min sessions, held on alternate days, participants underwent simultaneous discrimination training between two two-element compound stimuli (AB+ CD−), followed by an extinction test (AvC, AvD, BvC, BvD) to determine the amount of over-selectivity present. Levels of depression, anxiety, and mindfulness were re-assessed. Participants with greater autism traits demonstrated greater over-selectivity, than those with lower autism traits. Mindfulness reduced over-selectivity, and did so independently of the level of AQ displayed by the participants. For lower scoring AQ participants, mindfulness worked more effectively than relaxation. In contrast, for participants with higher AQ scores, there was little difference between the impact of mindfulness and relaxation. The latter group displayed no improvement in mindful awareness. Mindfulness induction can be effective, but may work through different mechanisms for those with higher and lower autism traits, and consideration should be given as to whether this intervention may be the most suitable in all cases where autism traits are present.

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Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial.

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BJOG. 2019 Feb

Abstract

OBJECTIVE:

To assess the short- and long-term effects of mindfulness-based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk-reducing salpingo-oophorectomy (RRSO).

DESIGN:

Randomised controlled trial.

SETTING:

A specialised family cancer clinic of the university medical center Groningen.

POPULATION:

Sixty-six women carriers of the BRCA1/2 mutation who developed at least two moderate-to-severe menopausal symptoms after RRSO.

METHODS:

Women were randomised to an 8-week MBSR training programme or to care as usual (CAU).

MAIN OUTCOME MEASURES:

Change in the Menopause-Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time.

RESULTS:

At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0-3.9) and 3.8 (95% CI 3.3-4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1-4.0) and 3.9 (95% CI 3.5-4.4). No significant differences were found between the MBSR and CAU groups in the other scores.

CONCLUSION:

Mindfulness-based stress reduction was effective at improving quality of life in the short- and long-term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress.

Link to article here

Mindfulness-based Stress Reduction in Pregnancy: an App-Based Programme to Improve the Health of Mothers and Children (MINDFUL/PMI Study).

Geburtshilfe Frauenheilkd. 2018 Dec

Abstract

in English, German

Unfavourable intrauterine environmental factors increase the risk of delivery complications as well as postpartum developmental and behavioural problems in children and adolescents with ongoing effects into older age. Biomarker studies show that maternal stress and the use of alcohol and tobacco during pregnancy are associated with a higher intrauterine testosterone exposure of the child. The antenatal testosterone load, in turn, is a risk factor for lasting adverse health effects which extend into adulthood. A 15-week, mindfulness-oriented, app-based programme for the reduction of stress as well as for the reduction of alcohol and tobacco use in pregnant women is established. In the monocentre, prospective, controlled, and investigator-blinded MINDFUL/PMI (Maternal Health and Infant Development in the Follow-up after Pregnancy and a Mindfulness Intervention) study, pregnant women carry out the programme. Its effect on antenatal testosterone exposure of the child is examined by assessing the index/ring finger length ratio and other biomarkers in the 1-year-old children. In addition, the programme’s effects on self-regulation, the developmental status and the mental health of the children at the age of one year will be investigated. Additional aspects of the course of the pregnancy and delivery represent exploratory study objectives. This longitudinal study project is intended to improve the understanding of the impact of intrauterine environmental factors on early childhood development and health. Maternal stress as well as alcohol and tobacco use during pregnancy are modifiable factors and represent potential preventive targets.

Link to article here

Mindfulness-Based Group Cognitive Behavior Therapy for Provoked Localized Vulvodynia: A Randomized Controlled Trial.

J Low Genit Tract Dis. 2019 Jan 25

Abstract

OBJECTIVE:

The aim of the study was to compare the effectiveness of mindfulness-based group cognitive behavior therapy (M-gCBT) versus education support group therapy for the pain and distress associated with provoked localized vulvodynia.

MATERIALS AND METHODS:

Participants were randomized to M-gCBT or education support group therapy. Mindfulness-based group cognitive behavior participants attended 8 weekly sessions. Education support group participants received 8 weeks of online education with 3 in-person group visits. Vaginal insertion pain (tampon test) was the primary outcome. Secondary outcomes (Generalized Anxiety Disorder 7, Beck’s Depression Index, Female Sexual Distress Scale, Female Sexual Function Index, and Pain Catastrophizing) were administered before intervention and at the completion of the study period, 3 months, and 6 months. Sample size was based on the ideal number for group dynamics of 6 to 12 participants per group.

RESULTS:

Participants were enrolled from August 1, 2016, to January 30, 2017. Thirty-two participants were enrolled and 31 were randomized: 14 to M-gCBT and 17 to education support. Baseline characteristics did not differ significantly. Vaginal insertion pain decreased in both groups but was not statistically different between groups (difference of 1.23; 95% CI = -0.52 to 2.98). At 6 months, participants in the M-gCBT group showed statistically significant improvement in the Female Sexual Function Index, Generalized Anxiety Disorder 7, and Beck’s Depression Index compared with the education support group.

CONCLUSIONS:

Mindfulness-based group cognitive behavior and education support group therapy are effective in reducing pain and distress. However, women in the M-gCBT program showed greater improvement in certain secondary outcomes, indicating that M-gCBT may offer some advantages in reducing distress associated with provoked localized vulvodynia.

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Role of Yoga and Mindfulness in Severe Mental Illnesses: A Narrative Review.

Int J Yoga. 2019 Jan-Apr

Abstract

BACKGROUND:

Yoga has its origin from the ancient times. It is an integration of mind, body, and soul. Besides, mindfulness emphasizes focused awareness and accepting the internal experiences without being judgemental. These techniques offer a trending new dimension of treatment in various psychiatric disorders.

AIMS:

We aimed to review the studies on the efficacy of yoga and mindfulness as a treatment modality in severe mental illnesses (SMIs). SMI includes schizophrenia, major depressive disorder (MDD), and bipolar disorder (BD).

METHODS:

We conducted a literature search using PubMed, Google Scholar, and Cochrane Library with the search terms “yoga,” “meditation,” “breathing exercises,” “mindfulness,” “schizophrenia spectrum and other psychotic disorders,” “depressive disorder,” and “bipolar disorder” for the last 10-year period. We also included relevant articles from the cross-references.

RESULTS:

We found that asanas and pranayama are the most commonly studied forms of yoga for schizophrenia. These studies found a reduction in general psychopathology ratings and an improvement in cognition and functioning. Some studies also found modest benefits in negative and positive symptoms. Mindfulness has not been extensively tried, but the available evidence has shown benefits in improving psychotic symptoms, improving level of functioning, and affect regulation. In MDD, both yoga and mindfulness have demonstrated significant benefit in reducing the severity of depressive symptoms. There is very sparse data with respect to BD.

CONCLUSION:

Both yoga and mindfulness interventions appear to be useful as an adjunct in the treatment of SMI. Studies have shown improvement in the psychopathology, anxiety, cognition, and functioning of patients with schizophrenia. Similarly, both the techniques have been established as an effective adjuvant in MDD. However, more rigorously designed and larger trials may be necessary, specifically for BD.

Link to article here

Effects of an Online Mindfulness Intervention Focusing on Attention Monitoring and Acceptance in Pregnant Women: A Randomized Controlled Trial.

Image: Unsplash

J Midwifery Womens Health. 2019 Jan

Abstract

INTRODUCTION:

Attention monitoring and acceptance underlie the effects of mindfulness meditation. This study tested the feasibility and acceptability of an online mindfulness intervention for pregnant women as an approach to reduce depressive and anxious symptoms.

METHOD:

We developed an 8-week mindfulness intervention program that trained participants to monitor their internal and external experiences in an accepting way. The mindfulness course was based on the Wechat platform. This study was conducted in a women’s hospital in China. A total of 123 women with scores on the Generalized Anxiety Disorder Scale and Patient Health Questionnaire suggesting mild or moderate symptoms of depression and anxiety were recruited from the outpatient department between April and June 2018. The participants were randomized to receive the mindfulness intervention or routine prenatal care. The Generalized Anxiety Disorder Scale, the Patient Health Questionnaire, and the Five Facets of Mindfulness Questionnaire were used to evaluate the levels of anxiety, depression, and mindfulness, respectively, before and after the intervention.

RESULTS:

Of the 123 women enrolled in this study, 10 in the intervention group and 11 in the control group did not complete the intervention. The retention rate and feedback suggested that the mindfulness intervention was feasible and acceptable among pregnant women. Participants in the intervention group showed greater declines in depressive and anxious symptoms compared with those in the control group, as well a significant improvement in mindfulness skills (eg, attention monitoring and acceptance).

DISCUSSION:

These results suggest that an online mindfulness intervention may be a promising technique to help women use mindfulnessskills to reduce depressive and anxious symptoms. The mindfulness intervention could constitute part of the psychological care provided to pregnant women.

Link to article here

Mindfulness Training among Parents with Preterm Neonates in the Neonatal Intensive Care Unit: A Pilot Study.

Image: Flickr.com

Am J Perinatol. 2019 Jan 31

Abstract

OBJECTIVE:

To evaluate the feasibility of a mindfulness-based training session (MBTS) for parents of neonates born at ≤32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU).

STUDY DESIGN:

Within 14 days of admission, parents completed the Parental Stressor Scale: Neonatal Intensive Care Unit Questionnaire (PSS:NICU), Cognitive and Affective Mindfulness Scale (CAMS-R), and a survey on stress management techniques. Parents then participated in a MBTS with instruction in mindfulness-based practices and were asked to practice the techniques during the NICU stay. At discharge, parents repeated the surveys to evaluate their mindfulness-based practice experience.

RESULTS:

Of the 98 parents approached, 51 consented to participate (52%). Of these, 28 completed MBTS, initial, and discharge surveys. One parent had previously practiced mindfulness. The majority of parents (79%) reported that mindfulness practice was helpful, and 71% stated that they would continue their practice after NICU discharge. There was no difference in PSS:NICU or CAMS-R at discharge.

CONCLUSION:

An MBTS was feasible to provide to parents in our NICU. Parents practiced the mindfulness-based techniques and reported benefit from their mindfulness-based practice. Future studies are needed to evaluate if an MBTS is a valuable resource for NICU parents’ coping.

Link to article here