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Mindfulness

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A Pilot Randomized Controlled Trial of a Mindfulness-Based Intervention for Caregivers of Veterans

  • Sandraluz Lara-CinisomoEmail author
  • Ryan L. Santens
  • Elinor M. Fujimoto
ORIGINAL PAPER
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Abstract

Objectives

Informal caregivers of veterans are providing care for a population whose specialized care needs require increased investments on the part of caregivers and for longer durations. Empirical evidence shows negative mental health effects on these caregivers at rates that outpace those seen in caregivers in the general population. With a growing need and limited resources, effective interventions are needed to improve mental health outcomes in this special population of caregivers.

Methods

This pilot, randomized control trial tested the effectiveness of a mindfulness-based intervention at improving perceived stress, depressive symptoms, anxiety, and worry compared to waitlist controls in a sample of 23 caregivers of veterans.

Results

The Mann-Whitney U tests used to determine whether groups differed in change scores (post minus pre) indicated that there were significant differences between the mindfulness and waitlist control group in perceived stress (U = 21.5, p = .006, r = .57), anxiety (U = 24.0, p = .009, r = .54), and worry (U = 29.5, p = .024, r = .47). Results from the Wilcoxon signed-rank tests indicated that caregivers in the mindfulness group reported a significant reduction in perceived stress (Z = − 2.50, p = .013, r = .75) and anxiety (Z = − 2.81, p = .005, r = .85), whereas the waitlist control group reported higher mean symptoms at the end of the intervention period.

Conclusions

Given these promising results, policymakers, health practitioners, and veteran-related programs should increase efforts to provide caregivers of veterans with mindfulness-based interventions to improve mental health outcomes.

Keywords

Caregiver Veteran Mindfulness Stress Worry Anxiety Depressive symptoms 

Notes

Acknowledgements

The authors wish to thank the participants for their time, effort, and commitment. The authors also thank veterans and their caregivers for their service abroad and at home. The authors also wish to thank Ellen Ritter for her assistance implementing the intervention, Dr. Sa Shen for her statistical support during revisions, and the Danville Area Community College and Chez Center for Wounded Veterans in Higher Education for providing space to conduct the mindfulness trainings.

Author Contributions

Sandraluz Lara-Cinisomo was the study’s Principal Investigator. She conceptualized the study, secured funding, developed the study protocol, supervised and trained the research team, conducted the data analysis, wrote the methods and results, and edited the entire manuscript. Ryan L. Santens implemented the intervention, wrote the introduction, contributed to the methods, assisted with data management, and reviewed the entire manuscript. Elinor M. Fujimoto collected and entered the data, assisted with coordination of the study, wrote the discussion, contributed to the introduction, and reviewed the entire manuscript.

Funding

This project was funded by the Chez Center for Wounded Veterans in Higher Education at the University of Illinois at Urbana-Champaign. The funder was not involved in the development or execution of the project, including data collection and data analysis.

Compliance with ethical standards

Conflict of Interest

The authors do not have any conflicts of interest to disclose.

Ethics Statement

All study procedures involving human participants were in accordance with the ethical standards of the University of Illinois at Urbana-Champaign Institutional Review Board and with the 1964 Helsinki declaration and amendments or comparable ethical standards. All participants involved in the study provided written informed consent.

References

  1. Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143.  https://doi.org/10.1093/clipsy.bpg015.Google Scholar
  2. Bass, D. M., Judge, K. S., Snow, A. L., Wilson, N. L., Looman, W. J., McCarthy, C., et al. (2012). Negative caregiving effects among caregivers of veterans with dementia. The American Journal of Geriatric Psychiatry, 20(3), 239–247.CrossRefGoogle Scholar
  3. Beck, J. G., Stanley, M. A., & Zebb, B. J. (1995). Psychometric properties of the Penn State Worry Questionnaire in older adults. Journal of Clinical Geropsychology, 1(1), 33–42.Google Scholar
  4. Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behaviour Research and Therapy, 30(1), 33–37.CrossRefGoogle Scholar
  5. Carlozzi, N. E., Kratz, A. L., Sander, A. M., Chiaravalloti, N. D., Brickell, T. A., Lange, R. T., et al. (2015). Health-related quality of life in caregivers of individuals with traumatic brain injury: development of a conceptual model. Archives of Physical Medicine and Rehabilitation, 96(1), 105–113.  https://doi.org/10.1016/j.apmr.2014.08.021.CrossRefGoogle Scholar
  6. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.CrossRefGoogle Scholar
  7. Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.CrossRefGoogle Scholar
  8. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.CrossRefGoogle Scholar
  9. Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: the development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29(3), 177.CrossRefGoogle Scholar
  10. Fischer, E. P., Sherman, M. D., Han, X., & Owen, R. R., Jr. (2013). Outcomes of participation in the REACH multifamily group program for veterans with PTSD and their families. Professional Psychology: Research and Practice, 44(3), 127.CrossRefGoogle Scholar
  11. Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102–119.  https://doi.org/10.1111/j.1600-0447.2011.01704.x.CrossRefGoogle Scholar
  12. Fortune, D. G., Richards, H. L., Griffiths, C. E., & Main, C. J. (2005). Worry and pathological worry in patients with psoriasis: cross sectional and longitudinal analyses of the Penn State Worry Questionnaire (PSWQ) in four samples of patients. Journal of Clinical Psychology in Medical Settings, 12(2), 143–152.CrossRefGoogle Scholar
  13. George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: a multidimensional examination of family caregivers of demented adults. The Gerontologist, 26(3), 253–259.CrossRefGoogle Scholar
  14. Ghasemi, A., & Zahediasl, S. (2012). Normality tests for statistical analysis: a guide for non-statisticians. International Journal of Endocrinology and Metabolism, 10(2), 486.CrossRefGoogle Scholar
  15. Griffin, J. M., Lee, M. K., Bangerter, L. R., Van Houtven, C. H., Friedemann-Sanchez, G., Phelan, S. M., et al. (2017). Burden and mental health among caregivers of veterans with traumatic brain injury/polytrauma. American Journal of Orthopsychiatry, 87(2), 139–148.  https://doi.org/10.1037/ort0000207.CrossRefGoogle Scholar
  16. Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43.  https://doi.org/10.1016/s0022-3999(03)00573-7.CrossRefGoogle Scholar
  17. Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12.  https://doi.org/10.1016/j.cpr.2015.01.006.CrossRefGoogle Scholar
  18. Guillen-Riquelme, A., & Buela-Casal, G. (2014). Meta-analysis of group comparison and meta-analysis of reliability generalization of the State-Trait Anxiety Inventory Questionnaire (STAI). Revista Española de Salud Pública, 88(1), 101–112.CrossRefGoogle Scholar
  19. Hayes, J., Wakefield, B., Andresen, E. M., Scherrer, J., Traylor, L., Wiegmann, P., et al. (2010). Identification of domains and measures for assessment battery to examine well-being of spouses of OIF/OEF veterans with PTSD. Journal of Rehabilitation Research and Development, 47(9), 825–840.CrossRefGoogle Scholar
  20. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169.CrossRefGoogle Scholar
  21. Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559.  https://doi.org/10.1177/1745691611419671.CrossRefGoogle Scholar
  22. IBM_Corp. (2015). IBM SPSS statistics for Windows (version 23). Armonk: IBM Corp.Google Scholar
  23. Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12.CrossRefGoogle Scholar
  24. Jaffray, L., Bridgman, H., Stephens, M., & Skinner, T. (2016). Evaluating the effects of mindfulness-based interventions for informal palliative caregivers: a systematic literature review. Palliative Medicine, 30(2), 117–131.CrossRefGoogle Scholar
  25. Julian, L. J. (2011). Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care & Research, 63(S11), S467–S472.CrossRefGoogle Scholar
  26. Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.CrossRefGoogle Scholar
  27. Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.Google Scholar
  28. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., et al. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771.CrossRefGoogle Scholar
  29. Knight, R. G., McMahon, J., Skeaff, C. M., & Green, T. J. (2008). Normative data for persons over 65 on the Penn State Worry Questionnaire. New Zealand Journal of Psychology, 37(1), 4–9.Google Scholar
  30. Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1), 163–173.CrossRefGoogle Scholar
  31. Ladebue, A. C., Helfrich, C. D., Gerdes, Z. T., Fihn, S. D., Nelson, K. M., & Sayre, G. G. (2016). The experience of patient aligned care team (PACT) members. Health Care Management Review, 41(1), 2–10.CrossRefGoogle Scholar
  32. Levine, C., Halper, D., Peist, A., & Gould, D. A. (2010). Bridging troubled waters: family caregivers, transitions, and long-term care. Health Affairs, 29(1), 116–124.  https://doi.org/10.1377/hlthaff.2009.0520.CrossRefGoogle Scholar
  33. Liu, Z., Chen, Q. L., & Sun, Y. Y. (2017). Mindfulness training for psychological stress in family caregivers of persons with dementia: a systematic review and meta-analysis of randomized controlled trials. Clinical Interventions in Aging, 12, 1521–1529.  https://doi.org/10.2147/cia.s146213.CrossRefGoogle Scholar
  34. Lorig, K., Thompson-Gallagher, D., Traylor, L., Ritter, P. L., Laurent, D. D., Plant, K., et al. (2012). Building better caregivers: a pilot online support workshop for family caregivers of cognitively impaired adults. Journal of Applied Gerontology, 31(3), 423–437.  https://doi.org/10.1177/0733464810389806.CrossRefGoogle Scholar
  35. Lynn, J. (2014). Strategies to ease the burden of family caregivers. Journal of the American Medical Association, 311(10), 1021–1022.  https://doi.org/10.1001/jama.2014.1769.CrossRefGoogle Scholar
  36. Matthey, S. (2004). Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders, 78(3), 269–272.CrossRefGoogle Scholar
  37. McBee, L. (2003). Mindfulness practice with the frail elderly and their caregivers: changing the practitioner-patient relationship. Topics in Geriatric Rehabilitation, 19(4), 257–264.CrossRefGoogle Scholar
  38. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495.  https://doi.org/10.1016/0005-7967(90)90135-6.CrossRefGoogle Scholar
  39. National Alliance for Caregiving (2010). Caregivers of veterans—serving on the homefront: report of study findings. Bethesda: Author.Google Scholar
  40. Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29(6), 798–803.CrossRefGoogle Scholar
  41. Oken, B. S., Fonareva, I., Haas, M., Wahbeh, H., Lane, J. B., Zajdel, D., & Amen, A. (2010). Pilot controlled trial of mindfulness meditation and education for dementia caregivers. Journal of Alternative and Complementary Medicine, 16(10), 1031–1038.  https://doi.org/10.1089/acm.2009.0733.CrossRefGoogle Scholar
  42. Pagnini, F., Phillips, D., Bosma, C. M., Reece, A., & Langer, E. (2016). Mindfulness as a protective factor for the burden of caregivers of amyotrophic lateral sclerosis patients. Journal of Clinical Psychology, 72(1), 101–111.  https://doi.org/10.1002/jclp.22235.CrossRefGoogle Scholar
  43. Palmeira, L., Pinto-Gouveia, J., & Cunha, M. (2017). Exploring the efficacy of an acceptance, mindfulness & compassionate-based group intervention for women struggling with their weight (Kg-Free): a randomized controlled trial. Appetite, 112, 107–116.  https://doi.org/10.1016/j.appet.2017.01.027.CrossRefGoogle Scholar
  44. Patel, B. R. (2015). Caregivers of veterans with "invisible" injuries: what we know and implications for social work practice. Social Work, 60(1), 9–17.CrossRefGoogle Scholar
  45. Phillipot, P., & Segal, Z. (2009). Mindfulness based psychological interventions: developing emotional awareness for better being. Journal of Consciousness Studies, 16(10–1), 285–306.Google Scholar
  46. Piersol, C. V., Canton, K., Connor, S. E., Giller, I., Lipman, S., & Sager, S. (2017). Effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders: a systematic review. American Journal of Occupational Therapy, 71(5), 7105180020p7105180021–7105180020p7105180010.CrossRefGoogle Scholar
  47. Ramchand, R., Tanielian, T., Fisher, M. P., Vaughan, C. A., Trail, T. E., Epley, C., et al. (2014). Hidden heroes: America's military caregivers. Santa Monica, CA: Rand Corporation.CrossRefGoogle Scholar
  48. Ryum, T., Kennair, L. E. O., Hjemdal, O., Hagen, R., Halvorsen, J. O., & Solem, S. (2017). Worry and metacognitions as predictors of anxiety symptoms: a prospective study. Frontiers in Psychology, 8, 924.  https://doi.org/10.3389/fpsyg.2017.00924.CrossRefGoogle Scholar
  49. Schwarz, K. A., & Dunphy, G. (2003). An examination of perceived stress in family caregivers of older adults with heart failure. Experimental Aging Research, 29(2), 221–235.  https://doi.org/10.1080/03610730390176077.CrossRefGoogle Scholar
  50. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press.Google Scholar
  51. Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality (complete samples). Biometrika, 52(3/4), 591–611.CrossRefGoogle Scholar
  52. Sheets, C., & Mahoney-Gleason, H. (2010). Caregiver support in the Veterans Health Administration: caring for those who care. Generations, 34(2), 92–98.Google Scholar
  53. Spadaro, K. C. (2017). Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: a randomized controlled trial. Journal of Complementary and Integrative Medicine, 15(2).  https://doi.org/10.1515/jcim-2016-0048.
  54. Spielberg, C., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1970). Manual for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists Press.Google Scholar
  55. Tanielian, T., Bouskill, K. E., Ramchand, R., Friedman, E. M., Trail, T. E., & Clague, A. (2017). Improving support for America's hidden heroes: a research blueprint. Santa Monica: RAND Corporation.CrossRefGoogle Scholar
  56. Tanielian, T., Ramchand, R., Fisher, M. P., Sims, C. S., Harris, R. S., & Harrell, M. C. (2013). Military caregivers: cornerstones of support for our nation's wounded, ill, and injured veterans. Rand Health Quarterly, 3(1), 3.Google Scholar
  57. Teasdale, J. D., Williams, J. M. G., & Segal, Z. V. (2014). The mindful way workbook: an 8-week program to free yourself from depression and emotional distress. New York: The Guilford Press.Google Scholar
  58. Thorpe, J. M., Sleath, B. L., Thorpe, C. T., Van Houtven, C. H., Blalock, S. J., Landerman, L. R., et al. (2006). Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia. Medical Care, 44(8), 713–721.  https://doi.org/10.1097/01.mlr.0000215905.36968.76.CrossRefGoogle Scholar
  59. U.S. Bureau of the Census. (2012). Statistical abstract of the United States: 2012 (131st ed.). Washington: U.S. Bureau of the Census.Google Scholar
  60. Uphold, C. R., Jordan, M., & Freytes, M. (2014). Family caregivers of veterans: a critical review of the empirical literature and recommendations for future research. Annual Review of Nursing Research, 32(1), 155–202.CrossRefGoogle Scholar
  61. Van Houtven, C. H., Friedemann-Sánchez, G., Clothier, B., Levison, D., Taylor, B. C., Jensen, A. C., . . . Griffin, J. M. (2012). Is policy well-targeted to remedy financial strain among caregivers of severely injured US service members? INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 49(4), 339–351.CrossRefGoogle Scholar
  62. Zou, L., Yeung, A., Quan, X., Boyden, S. D., & Wang, H. (2018). A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases. International Journal of Environmental Research and Public Health, 15(2), 206.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sandraluz Lara-Cinisomo
    • 1
    Email author
  • Ryan L. Santens
    • 1
  • Elinor M. Fujimoto
    • 2
  1. 1.College of Applied Health Sciences, Department of Kinesiology and Community HealthChampaignUSA
  2. 2.Family Resiliency Center, Department of Human Development and Family StudiesUniversity of Illinois Urbana-ChampaignUrbanaUSA

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