Mindfulness As A Complementary And Alternative Approach To Coping

Thesis

Sati, Zen, Meditation. These are words to describe the concept of mindfulness at work in different religions and cultures. But, where does mindfulness fit when it comes to modern day healing? Trauma affects our mind, body, and soul. Children who experience trauma are particularly vulnerable to negative effects on the development of the brain. Trauma rewires the brain, inhibiting the ability to regulate emotions and manage reactions to future stressful experiences, such as hospitalization. Traditional therapies such as medication and behavioral therapies have been used to help children reduce anxiety and regulate their emotions but mindfulness practice can be integrated into traditional care or be a valid and effective alternative.

Adverse Childhood Experiences

Adverse childhood experiences (ACEs) include negative experiences such as emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, domestic violence, household substance abuse, household mental illness, divorce, incarcerated family members, and the list goes on (American Academy of Pediatrics [APA], 2014). Traumatic early experiences for children have become a major public health issue as these experiences have been linked to riskier health behaviors, chronic health conditions, and early death (Centers for Disease Control and Prevention [CDC], 2016).

While these outcomes are of major concern, perhaps even more detrimental is the fact that ACEs can change the development of a children’s’ brain, leading to a lessened ability to regulate their emotions and behaviors.

Stress and Its Effects on the Brain

The brain is the control center of the body.

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It controls what we feel, think, and do. This is done through a neural network that sends information from the brain to other parts of the body. There are three major parts of the brain that make up this neural network. The cerebellum controls functions such as breathing, heartbeat and motor skills. The limbic system controls the reactionary part of the brain such as emotions, fight or flight, pain, and our reward system. The cerebral cortex controls the thinking part of our brain such as reasoning and judgement. If any part of this neural system is changed or affected in some way it changes the way we think, feel, and behave. Toxic stress, a side effect of adverse childhood experiences, negatively affects the brain by changing our coping and reactivity (Frederiksen, 2018).

A moderate amount of stress is healthy for a child in order for them to develop healthy coping mechanisms. Stress can be positive by helping a child to grow and develop, but stress can also be toxic.The impact of toxic stress on a child can negatively affect a child’s undeveloped coping mechanisms and lead to long term issues. Toxic stress occurs from repeated exposure to adversity as a result of any of the ACES listed above. This chronic exposure to adversity repeatedly activates the brain’s stress response system, located within the limbic system. This continuous activation of the ‘fight or flight’ stress response system (FFSR) in the brain can lead to cognitive impairment into adulthood (American Academy of Pediatrics, 2014). Over stimulation of the FFSR is linked to sensitization of brain circuits involved with processing threat (Krystal, 2015).

When the FFSR is chronically activated, but the child has not developed self soothing coping mechanisms, problems arise. They neither fight nor run so the bodily changes that are meant to support these responses build up within the bodily tissues. This leads to both physical and mental problems with development. As a result, children program neural networks to engage the FFSR whenever they are confronted with a triggering event, even events unassociated with the original ACE. When triggered by anxiety, fear, and anger inducing events, their reactionary coping skills and behaviors will kick in because they believe them to be critical to their survival. Common reactionary coping skills include yelling, crying, lashing out physically and verbally, working hard to please everyone, or shutting down entirely (Frederiksen, 2018). In short, their strong reactions to stressful situations bring about unhealthy behaviors. These changes in behavior can present themselves as anxiety, depression, ADHD, and oppositional defiant disorder. Disruptive mood dysregulation disorder is also a fairly new diagnosis characterized by extreme irritability, anger, and intense temper outbursts, either verbal or behavioral. These are symptoms that go beyond simply being a moody child and effect quality of life, school performance, and relationships. Treatment has been very similar to that of disorders such as anxiety and ADHD. Clinicians have used psychological treatment in order to help children regulate their mood, increase tolerance, and learn coping skills for regulating anger (National Institute of Mental Health, 2017). Not only are their reactions to stressful situations affected, but trauma has been suspected to lead to issues with attachment to caregivers and other family members. Difficulties with others is a result of their mistrust of caregivers to keep them safe, behavioral changes, and emotional dysregulation (Foege, 1998).

Unfortunately, a hospital is an environment in which children encounter stressful situations. They are expected to put their trust in parents as well as multiple members of the medical team. For children who have experienced trauma and rely on the use of reactionary coping skills, stress responses could be triggered by the hospital environment, causing elevation of the body’s physiological response system. In an exploration of whether or not hospitalization can precipitate toxic stress and trigger maladaptive responses, it was suggested that hospitalization could be considered an adverse experience. The toxicity of the response could vary depending on the absence or presence of support, as well as length of stay and illness severity. There is a need to consider a broader approach to what causes stress responses to become toxic, by taking into consideration community and environmental factors (Shah, Jerardi, Auger, & Beck, 2016). The hospital experience inherently presents situations that may challenge or exceed any patient and family’s ability to cope. Situational stressors that one may find in the hospital include an unfamiliar environment, technical equipment, bright lighting, painful and invasive procedures, having to remain still, exposure of private parts, lack of privacy, isolation, consistently being surrounded by unfamiliar adults, and the general unknown. Add in previous traumatization and there may be very little chance a child can experience hospitalization without the use of reactionary coping skills. There are ways to help a child process the stress of hospitalization in the moment, such as comfort positions and adjusting the way information is presented to a child (Goldberger, Mohl, Thompson, 2009). However, it is important to help a child learn to cope so as to positively affect their behavior in the long term.

Mindfulness as a Complementary and Alternative Approach

Mindfulness offers a valid and successful approach to long term improvement of resiliency, and decreasing of reactionary coping skills. Mindfulness is a state of mind. It is a state characterized by awareness of the present moment and non- judgemental acceptance of each moment as it occurs (Liang et al., 2018). While its basic meaning is to be fully aware, mindfulness is so much more. It involves not only being aware, but understanding why we want to focus on this awareness while we calmly accept what is happening to us. This approach helps us to see and understand reality rather than focus on what we think is happening. This less reactive mindset presents the opportunity to make clear choices, with intention, about how we relate to the world around us (Russell, 2017). When we allow ourselves to become upset by our thoughts or emotions, we are reacting to internal events as well as judging our experiences. Mindfulness oriented treatments work toward the realization that thoughts are not fundamentally harmful or destructive but reactions to internal thoughts are what become a problem (Dutton, 2008).

Complementary and alternative medicine (CAM) “is a group of diverse medical and health care systems, practices, and products that are not generally considered to be a part of conventional medicine” (Waldman, Compton, Cannella, & Perlman, 2013, p. 37). CAM can be used as an alternative to or together with conventional medicine. Mind body medicine has been considered by the National Center for Complementary and Alternative Medicine (NCCAM) as one of four main domains of CAM modalities. It uses a variety of techniques that are meant to increase the mind’s ability to affect bodily function and symptoms. Based on a NCCAM survey, the second highest prevalence of CAM use among children was reported by children with emotional, behavioral or mental health conditions. According to the 2009-2010 National Study of Children with Special Health Care Needs (CSHCN), over 4.8 million CSHCN, ages 2-17, in the U.S. were estimated to experience at least one EMB condition or difficulty. Thirteen percent of that population used CAM. Many parents consider CAM, including the use of mind body therapies, as a welcome addition to standard treatments and therapies but are reluctant to report their use for fear that they are not as accepted. However, it is important that parents and caregivers understand CAM practices to their fullest extent so as to deliver them safely and effectively (Waldman, Compton, Cannella, & Perlman, 2013).

Traditional Therapies For Behavioral Disorders and Anxiety Management

Traditional therapies for treating a child’s anxiety or behavior problems include medication and cognitive behavioral therapy. These are change based therapies used to modify one’s thoughts and emotions as well as their external environments (Dutton, 2008). Cognitive behavioral therapy is “based on the idea that how we think and act affects how we feel” (Bubrick, n.d., para. 1). This therapy works to change thinking that is distorted and dysfunctional behavior in order to change our emotions. The goal is to unlearn avoidant or reactionary behaviors. While this has been proven effective, the approach that mindfulness brings is one of acceptance as opposed to change. Instead of restructuring our thoughts, mindfulness practice allows us to to notice and accept our thoughts as events occuring in the mind rather than as truths that define us, which is ultimately more validating (Lau & McMain, 2005).

Medications may also be used to treat behavioral problems that come about as a result of trauma but there is always the risk of side effects. Medications such as psychostimulants, used to treat ADHD, mood stabilizers, and antipsychotics are used to treat aggressive behavior in youth. Low doses of antipsychotics and mood stabilizers can be effective in treating aggression but can produce adverse side effects and require frequent monitoring (Jacob, 2006). Stimulants may help anyone to focus and be more attentive but they can cause stomach aches, insomnia, and overall unhappiness and discomfort. Other medication used to treat anxiety in children are called Benzodiazepines. While they may be effective in the short term their usefulness in the long term is weak. While they are effective in managing acute anxiety, over time a tolerance is developed and the dose must be increased (Walkup, 2018). Medications may be a solution in the present moment but they come at the price of adverse side effects and high costs. Ideally medications shouldn’t be the first course of action and, if needed, should be administered along with psychosocial treatments and interventions (Jacob, 2006). Mindfulness based interventions may encourage the coping skills needed for children to self regulate and thrive into adulthood. They provide long term solutions by getting to the root of the problem.

Effects on Health Care Reform

As health care reform continues to be a important and urgent topic of discussion mindfulness should be considered as an intervention, as it could play a role in reducing health care costs, helping to treat illness, and preventing illness in the first place. There is a habit of neglecting low tech, low cost strategies for preventing illness and promoting health in favor of high tech, high cost interventions such as the use of pharmaceutical drugs and expensive surgeries. Paying closer attention to disease prevention and health promotion can help to create a healthier population overall and lessen the need for expensive medical interventions (Ruff & Mackenzie, 2009). 90 % of the nation’s 3.3 trillion in annual health care expenditures are for people with chronic and mental health conditions. Chronic diseases boost health costs significantly and preventing diseases such as heart disease, stroke, obesity, diabetes, and hypertension, or managing symptoms when prevention isn’t possible, can help to lower costs (CDC, 2018). For children with ACES toxic stress can lead to any of these chronic diseases. While in the hospital, children with maladaptive behavioral disorders often require pharmacological approaches. Premedication modifies behavior by providing amnesia, sedation, and inhibiting anxiety (Karam & Barakat, 2011). While these are effective for improving behavior but they come at high costs and there is always the possibility of side effects. It’s essential that coping strategies are put in place in order to prevent disease and to be able to process stress if hospitalization is necessary.

Mind-body medicine, by focusing on connections between the mind, body, brain, and behavior, assists in maintaining and achieving health. The mind-body approach, by being integrated with existing health care systems, can also help to lower health care costs. Interventions such as meditation and mindfulness based stress reduction (MBSR) directly affect health by normalizing blood pressure, enhancing immunity, and lowering stress. Meditation even has a direct effect on the brain by producing more adaptive functioning through increasing grey matter of the prefrontal cortex, the part of the brain responsible for emotional regulation and increased resilience in the face of stress. MBSR is an effective intervention for chronic disease, possibly due to its ability to influence the stress response. For children who are at risk for chronic diseases, behavioral problems, and substance abuse, due to psychological stress, mindfulness training in schools can provide coping skills to prevent the development of mental and physical disease later in life (Ruff & Mackenzie, 2009). In this way, if children do end up in the hospital, they will have tools in hand to face the stress associated with hospitalization.

Mindfulness and Resilience

The ability to thrive despite challenges that arise from trauma is the result of resilience. Resilience offers the skills necessary to adapt to trauma, tragedy and other sources of stress while managing feelings of anxiety and fear (American Psychological Association, n.d.). Resilience can assist in preventing retraumatization as well as prevent the cycle of adverse childhood experiences from affecting future generations. Over recent years studies have been done in order to support the idea that mindfulness based interventions, whether structured therapies, or in integration with less structured everyday activities, can increase resilience and improve the ability to cope with trauma with greater self regulation. The positive effects of mindfulness not only help those children affected by trauma but can assist caregivers in mindful parenting in order to improve their children’s well being. Without resilience and proper coping techniques children are apt to react to future trauma in maladaptive ways. Mindfulness can help to increase resilience so as to help children cope with adversity in the long term.

In a study of US population based connections between the prevalence of emotional, mental, or behavioral conditions in children ages 0-17 and exposure to adverse childhood experiences, researchers sought to discover the rate of use of mindfulness based, mind-body approaches as risk regulating protective factors and their potential to address social and emotional trauma. Using surveys from the 2007 National Health Interview Survey, The NHIS Child Complementary and Alternative Medicine Supplement, and the 2008 Medical Expenditure Panel Survey, it was concluded that across children’s aces status the prevalence of emotional mental and behavioral conditions is 2.64 to 3.35 times greater when children lack resilience. Findings support the idea that despite the underuse of MBMB approaches and the delayed use of MBMB approaches after more conventional medical care is administered, these approaches in conjunction with other clinical approaches should more strongly be taken into consideration. Findings suggest growing evidence on the the ability of MBMB to reduce symptoms associated with many types of EMB such as ADHD, depression, anxiety, and conduct disorders. This study confirmed the importance of use of MBMB to increase protective factors such as resilience, parental coping, and parent child engagement. MBMB is promising in its ability to stop the cycle of intergenerational ACES and the contribution to EMB disorders in youth (Bethell, Gombojav, Solloway, & Wissow, 2016).

How Mindfulness Works

However, the question remains, how does mindfulness actually work? How does it help to treat maladaptive coping in children? Mindfulness has been shown to benefit individuals with a history of ACEs by both negating the acute response to trauma and stress and also by inhibiting the long term physical and psychological consequences of chronic trauma. It can play a role in both relieving the consequences of toxic stress as well as in encouraging long term coping and influencing the effects that toxic stress has on the brain. In a review of research done on children exposed to adverse experiences and the effectiveness of mindfulness interventions, it was found that mindfulness can improve coping and resilience in those who have faced trauma. This could be due to the fact that is provides an alternative to psychological dissociation that can prevent healthy coping. Traits of mindfulness such as accepting without judgement and acting with awareness are inversely associated with PTSD symptoms. This is likely a result of non judgmental acceptance of negative thoughts and the practice of decreased reactivity to them (Ortiz & Sabinga, 2017).

Mindfulness can assist in becoming more aware of internal signals that might go unnoticed. Paying attention to inward thoughts, emotions, and needs, and objectively identifying them, allows one to more easily identify when changes must be made to meet those needs. By stepping back and separating oneself from negative environmental factors, and taking the time to lower the resulting stress, mindfulness may assist in increasing resiliency when future adverse experiences arise (Kraayenbrink, Skaar, & Clopton, 2018).

Types of Mindfulness

Mindfulness can be associated with structured clinical programs such as Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT), as well as integrated into everyday activities such as breathing, walking, talking, and creative activities.

In a review of literature on mindfulness training as a clinical intervention Baer (2003) touched upon the more structured approaches to mindfulness and how it can be used to treat specific disorders and diseases. Developed by Jon Kabat-Zinn, MBSR is an 8 to 10 week course for groups of up to 30 people who meet weekly for about 2 and a half hours to practice mindfulness meditation skills, along with discussion of stress, coping, and work outside of the program. With the use of such skills as sitting medication, yoga, and simply paying attention to everyday movements, participants learn to observe emotions, sensations, and cognitions non judgmentally. They are instructed to notice their thoughts, emotions, and sensations, realize they are fleeting, but not become attached or absorbed in them. MBCT is another structured intervention that is based on MBSR. It follows the same format but instead of learning to bring a non judgemental and accepting attitude to all experience, MBCT focuses on specific patterns of negative thinking so as to avoid ruminative thinking. This intervention was developed specifically to help those suffering from depression to prevent relapses. A specific focus on turning toward low mood and negative thought early on allows participants to recognize these symptoms and gain confidence in responding skillfully (Center for Mindfulness, n.d.).

By incorporating mindfulness into activities that children naturally enjoy it’s possible that it may motivate them to practice mind body interventions more frequently. One such activity includes creative arts based practice. Because using creative methods with youth has long been used in helping professions, it is accepted and understood that many children are comfortable expressing their feelings through creative activity. Arts based methods engage youth who might have a harder time reaching out and communicating as well as encourage youth to devote more effort and time to something they enjoy. In a study exploring the effectiveness of a 12 week arts based mindfulness group program for vulnerable children around the age of 10 Coholic and Eys (2005) developed a holistic arts based program (HAP). HAP was created in response to the discovery that childhood adversity impairs a child’s ability to regulate emotions, thoughts, and behaviors, leading to social, emotional, and behavioral problems. HAP encourages awareness through paying attention on purpose, non judgmentally, in the present. Through activities such as sculpting, creation of thought jars and ‘me trees’, drawing feelings evoked by music, painting activities that focused on making their days better, HAP used a strengths based approach in order to help children improve self concept and self awareness, develop empathy, and increase resiliency. In order to find out the effectiveness of the intervention, self concept and resiliency self report scales as well as post intervention interviews with children and guardians were utilized. It was discovered that the benefits of HAP included improved emotion regulation, mood, coping skills, confidence and self esteem. Of particular note, improved emotion regulation meant more and better expression of feelings and more effective coping skills led to improved relationships. One child reported a better ability to make decisions and improvement in his ability to step back and communicate his feelings effectively. The results of this study show a promising future for helping vulnerable children move away from reactive coping skills towards a healthier, stronger, and more focused approach to facing adversity.

As children grow into adolescence they can incorporate mindfulness into activities and programs that can help them thrive through adulthood. Many everyday activities, such as creative arts used in the HAP program, can incorporate mindfulness and put children on the path to a healthier lifestyle. In Bolinas, California a program entitled Commonweal works within 3 core fields- health and healing, art and education, and environment and justice. Within those fields Commonweal has created a number of programs to support healing in a variety of ways. Within their health and healing programs Commonweel cares for at risk children, people with cancer, health professionals, all of whom benefit from the power of the mind. The Commonweal Cancer Help Program (CCHP) is a week long retreat during which patients explore mainstream and complementary therapies as well as emotional and spiritual dimensions of cancer. The integrated program includes support sessions incorporating yoga, meditation, deep relaxation, imagery work, and symbolic learning. These are encouraged as complementary approaches to health as participants are required to be under the care of a physician. Their Beyond Conventional Cancer Therapies program explores the uses, safety, and research behind a number of therapies including mind-body practices, prayer and spiritual healing, and exercise and movement. Commonweel helps patients to truly understand their bodies and how best to help themselves heal (Commonweel, 2018).

Mindfulness and Child Life

In order to prevent trauma and toxic stress from commandeering the hospital experience it is important that patients and families receive the right kind of support, based on their history and specific wants and needs. Being able to identify factors, such as parental history of aces and their inability to support their child, or a behavioral issues that have arisen as a result of ACEs, that determine whether or not stress responses will be tolerable or toxic is critical for the clinical team and their ability to provide the right support. Conversations with patients and families should be done so in the context of trusting relationships and a movement from maladaptive coping with adversity to promotion of resilience enhancing actions (Shah, Jerardi, Auger, & Beck, 2016). Events that trigger extreme, frequent or extended activation of the stress response system, without the buffering of supportive adults, are toxic (Johnson, Riley, Granger, & Riis, 2013) Child life specialists, in conjunction with other members of the psychosocial support team such as social workers, counselors, and clinical psychologists have the knowledge and training to be those supportive roles for children and families in the hospital.

Child life specialists have a dedication and professional responsibility to assess the developmental and psychosocial needs of infants, children, youth, and families, in addition to maintaining meaningful and therapeutic relationships with those families. By identifying factors that impact a child and a family’s vulnerability to stress and trauma, child life specialists can help to prevent hospitalization from triggering a toxic stress response and develop a coping plan for a patient to face stress in a resilient manner (Association of Child Life Professionals, 2016). Through a stress potential assessment child life specialists take into consideration health care, family variables, and child variables in order to determine how patients will respond to the stress of hospitalization. Such factors might include ability to communicate, coping skills, recent and current life stresses, ability of family members to provide support, as well as the degree of the child’s diagnosis and anticipated treatments (Gaynard et al., 1998).

In working with patients with past trauma experience, mindfulness based interventions can mitigate consequences of toxic stress for patients exposed to high stress environments by enhancing long term coping and influencing the physiologic effects of stress (Ortiz & Sibinga, 2017). These interventions can replace or work alongside other pharmaceutical interventions if needed.

Child life specialists also have the ability to provide opportunities for play in a safe, therapeutic and healing environment (Association of Child Life Professionals, 2016). Play has been shown to promote cognitive and social aspects of development by allowing for opportunities to communicate feelings, using their own verbal and behavioral expression. It teaches children how to handle the world and social roles within their environment. Therapeutic play, specifically, supports development and the emotional wellbeing of patients. It has the ability to increase psychological well being through emotional expression and “reduce apprehensive physiological responses, such as palm sweating, excessive body movement, escalating pulse rate, and high blood pressure” (Koller, 2011). Overall therapeutic play provides long term by encouraging healthier behavioral responses and reducing psychological and physiological stress, a major symptom of aces trauma. Providing space for children to play where they feel in control and safe is ideal for helping a child to cope with the stress of hospitalization.

The work of a child life specialist also promotes patient and family- centered care (PFCC). Through PFCC the health care team incorporates dignity and respect, information sharing, collaboration, and participation into the plan of care. This approach to care helps families to feel involved and in control (Johnson & Abraham, 2012). In keeping with a family centered approach child life has an obligation to support the entire family, which can lead to a better outcome for patients. Providing parents with information and emotional support can reduce their anxiety and in turn reduce the anxiety and discomfort of their children, as parental anxiety can easily be transmitted to patients (Gaynard et al., 1998). Mindfulness can promote PFCC by involving the patient and their family in interventions. Youth outcomes can improve when the adults they are surrounded by learn mindfulness as well. Teaching parents mindfulness can increase resilience for youth by reducing parental stress, increasing parental warmth, and increasing parental attention, leading to buffering against poor outcomes associated with ACEs. Mindful parenting interventions have positive influences on health and psychobehavioral outcomes by increasing the quality of relationships. Given the positive impact of mindful parenting training, this should be included in youth interventions by partnering parents and children for family interventions (Ortiz & Sibinga, 2017).

When behavioral problems from ACEs inhibit the success of procedures and treatment child life can enlist the help of mindfulness interventions, in conjunction with play, to help a child learn healthier, less reactive, and more positive coping skills. Keeping in mind the goals of improving responses to stress, increasing resilience, improving emotional dysregulation, and behavioral responses, and decreasing reliance on pain medication, child life specialists can use a number of mind body interventions to assist with coping at the hospital that will hopefully continue to have a positive affect in the long term.

Common mind-body interventions include activities such as relaxation, visual imagery, yoga, meditation, prayer, deep breathing, and progressive muscle relaxation. Guided Imagery, mindfulness and yoga are some of the mind body interventions have some of the best evidence of being effective for children for symptoms of anxiety and stress (NCCIH, 2017). They are also effective complements to medical therapy for conditions such as chronic and acute pain, habitual disorders, attention disorders, asthma, cancer, and diabetes. These techniques can be used in the hospital before, during, and after procedures, or during any periods of overwhelming stress.

Guided Imagery is a powerful tool used for psychological support in the hospital. It is a technique that assists patients in imagining sights, sounds, smells, and tastes or other sensations to create a daydream that removes the mind from their current situation such as feeling general stress from hospitalization or during a procedure. This technique helps to give a sense of well being and a feeling of control over the situation by allowing children to decide where their imagination goes. This technique involves envisioning a goal to help coping with health problems or a skill a child is attempting to master, such as more control over emotional reactions. It is often used to help the mind and body relax and this helps manage stress, anxiety, and depression. This technique is particularly helpful because it can be taught to children so as to use it on their own when they leave the hospital (Children’s Hospital of Orange County, n.d.).

Breathing exercises for relaxation is another technique that incorporates mindfulness in order to generate relaxation. Deep breathing exercises starts with finding a comfortable place to sit or lie down. From there children can choose how they go about it. But one way to go about is to place on hand on the stomach and one in the middle of the chest. Take a breath and pay attention to how it feels when you feel the hands rise as first the stomach fills with air and then the lungs. Hold each breath briefly and slowly breathe out and feel the abdomen and chest slowly lower. Paying attention to the air entering the nose and mouth, your body rising and falling, and imagining that you are blowing stress from your muscles will lead to relaxation (Children’s Hospital of Philadelphia, 2018). For more playful options with younger children, items such as bubbles, pinwheels, party blowers, and pretend birthday candles can assist in turning breathing techniques into a game (Children’s Hospital of New Jersey, 2018).

While these technique have proven effective more technologically advanced interventions are making their way to the forefront. In a pilot study, meditation experts evaluated the feasibility of virtual reality to facilitate mindfulness. Virtual reality (VR) is a new technology that captures participant’s attention, provides the illusion of entering into a 3D computer generated environment, and facilitates a sense of presence. This practice, in addition to increasing presence in the moment, limits distractions from the real world, and provides an interesting place to practice the art of mindfulness. By applying VR to traditional dialectical behavioral therapy (DBT), a mindfulness skills training program and clinical treatment designed for people who have difficulty concentrating, this platform provides mindfulness techniques more appropriate for severe patients who show extreme difficulty or lack of motivation to practice mindfulness during the training. During a mindfulness conference 44 participants put on an Oculus Rift DK2 Virtual reality helmet and floated down a 3D computer generated virtual river while listening to DBT skills training instructions. Participants reported improvements in their state of mindfulness and relaxation, and reduced sadness, anger, and anxiety (Navarro-Haro, 2017).

While the use of VR to treat adult disorders has been studied in more depth and the study of its effects on children is limited, results are still encouraging for treatment of anxiety disorders in children. VR may be beneficial for those children who have a great interest in and success with computer, console or video games. Studies have reported the clinical use of VR for children with autistic spectrum disorder and the efficiency of VR as a support tool in therapy. Studies using the virtual reality classroom, which provides a more realistic environment and the ability to record measures in a standardized conditions, has shown to be a valuable tool in the evaluation of children with ADHD and the treatment of other disorders alongside traditional treatment techniques such as CBT (Bioulac, 2018).

Slowly but surely VR has been integrated into hospitals as a coping strategy for use with pediatric patients. Cedars Sinai has used the technology on more than 2,500 patients since 2016, more than any hospital in the world. Applied VR, a company that sells VR and it’s own therapeutic content, has partnered with more than 100 hospitals including Boston Children’s and Children’s Hospital Los Angeles. Research on VR began in the 1990s and has come a long way since then, producing more affordable, lightweight systems. It has become a welcome technology in improving patient experience and helping to lessen the need for opiods for pain management (Kim, 2018). At Lucile Packard’s Children’s Hospital Stanford pediatric Cardiologists are incorporating VR into three separate projects within the Children’s Heart Center. This hospital is one of the first to establish a comprehensive VR program with this amount of medical specialization. One of the projects, Project Brave Heart, is currently studying the impact of VR preparation and relaxation therapy. VR headsets are sent home with patients who have a cardiac catheterization scheduled so that they can learn about the procedure and prepare with relaxation techniques (Lucile Packard Children’s Hospital Stanford, 2018). There is still much research to be done on the effects of VR but so far the results are encouraging.

Mindfulness Sensory Pathways

While advanced technology such as VR is still in being investigated and implemented into routine clinical use, and more studies are needed to prove it’s effectiveness, routinely used techniques that incorporate the senses and a greater focus on the present can be of great use.

Simply making uses of the 5 senses can be a great way to encourage mindfulness and focus on the present moment. Sensory pathways within schools and hospitals are a great way to encourage focus on the senses while releasing physical energy, ultimately leading to a better ability to process information. Combining play, focus, sensory stimulation, sensory pathways are an excellent intervention for calming anxiety and helping children focus on the present moment.

Attached is a grant proposal for a pathway program to be placed throughout a pediatric hospital unit. It explains the benefits and possible outcomes of patients’ use of the pathways.

Conclusion

There is no question that ACEs are detrimental to development and the ability to cope. But, with the right strategies children don’t have to pass the effects of trauma onto the next generation. Mindfulness has proven to be an extremely effective practice in helping to build resilience. It can be incorporated into plans of care in a variety of ways with structured programs as well as with simple everyday activities. As hospitalization presents the possibility of triggering toxic stress responses in patients, child life specialists are in a position to buffer stress filled reactive responses by being a strong supportive adult and presenting them with coping techniques to improve emotional, behavioral, and mental health disorders. Overall, mindfulness, as an alternative to or alongside traditional medical interventions, can help children to face stress head on in a skillful, focused, non reactive way. Aces shouldn’t stop children from leading healthy lives and thriving, physically and psychologically, for years to come.

The purpose of Meaghan Leahy Children’s Center Child Life Program is to support patients and their families by preparing them for medical procedures with developmentally appropriate information, advocating for families’ needs, and promoting coping through play. There is a need for a more child friendly sensory supported environment throughout the hospital in order to reduce anxiety and calm children before procedures. Through the act of mindfulness, sensory pathway floor decals provide an anxiety decreasing sensory play experience by promoting focus, a sense of calm, and a release of energy. In addition to supporting children through a sensory play experience the pathways will support patient flow by allowing doctors to focus on delivering quality care in an efficient way. The funds will be spent on multiple sets of floor decals to be placed on five pediatric units throughout the hospital. They will be placed outside of minor procedure rooms for use before scheduled procedures. They will also be placed in playrooms, rehabilitation centers and other areas of the hospital in need. Funds will also be spent on wax to more permanently seal the decals and protect from damages incurred by foot traffic.