Assessing Mindfulness for Adolescent Syndrome

According to Wikipedia, the definition of Mindfulness is “the psychological process of bringing one’s attention to experiences occurring in the present moment, which can be developed through the practice of meditation and other training” (“Mindfulness-based stress reduction”, n.d., para. 1). The program of Mindfulness-Based Stress Reduction or MBSR incorporates mindfulness as a way to help people with chronic pain, illnesses, or life issues that may not be treated in a medical setting. MBSR was developed in the 1970s by Professor Jon Kabat-Zinn, while at the University of Massachusetts Medical Center and is an eight-week workshop program that includes weekly group meetings, a one-day retreat, instruction in three techniques: mindfulness meditation, body scanning and yoga, along with daily practice.

Professor Kabat-Zinn describes MBSR as “moment by moment, non judgemental awareness” (“Mindfulness-based stress reduction”, n.d.)

In the study reviewed, adolescents with functional; somatic syndromes such as chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, unexplained chronic pain or symptoms attributed to Lyme disease were the subjects.

After questioning and evaluating the possible subjects, 15 adolescents between the ages of 10-18 years were selected (Ali et al.

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, 2017). Written informed concent was obtained from each subject and a parent and each subject received $200 for participating. Subjects attended weekly 1 1/2 hour group sessions for 8 weeks, one 4-hour session and were given specific 15-20 minute assignments to practice at home on a daily basis. Additionally each subject received a test daily to remind them to do the daily home practice. All sessions and assignments were led by experienced MBSR instructors and the homework assignments were step by step audio recordings from the instructors (Ali et al., 2017).

Three primary assessments were used to measure the outcomes and subjects were assessed at the beginning to form a baseline, after 8 weeks and again after 12 weeks. The three assessments used were all self reported by the subjects and included:

1. FDI – Functional Disability Inventory to score physical and functional impairment in adolescents with chronic pain.

2. FIQR – Fibromyalgia Impact Questionnaire-Revised for subjects meeting the diagnostic criteria for fibromyalgia.

3. SIQR – Symptom Impact Questionnaire-Revised for subjects that did not meet the criteria for fibromyalgia (Ali et al., 2017).

Also used to assess the subjects, but of less importance to the study were:

1. PedsQL – Pediatric Quality of Life Inventory – health related quality of life

2. Child and Adolescent Mindfulness Measure – assessing mindfulness skills

3. PSS – Perceived Stress Scale – assesses perceived stress of life situations

4. MASC2 – Multidimensional Anxiety Scale or Children, Second Edition – assesses anxiety across the following domains: physical symptoms, social anxiety, harm avoidance, separation anxiety/phobia, generalized anxiety and obsessive compulsive symptoms (Ali et al., 2017). Parents were also asked to complete the parent versions of the MASC2 and PedsQL as a baseline, at 8 weeks and again at 12 weeks.

In the discussion of the study, the group believes that they showed that MBSR may be effective in improving the symptoms, functionality and lessening anxiety of the subjects. The researchers also concluded that having parents involved in the MBSR program gave parents a better understanding of what their children are dealing with and gave the parents tools to help their children with their chronic pain, depression and anxiety. The researchers cite several other studies that also support or parallel their findings. In Sibinga et al. (2011) the urban youth studied showed perceived improvements in school achievement, physical health, reduced stress and interpersonal relationships at the end of the MBSR program. Another study cited in the study demonstrated that mindfulness meditation produces more pain relief than other cognitive training techniques and that MBSR is a valid adjunct therapy (Zeidan et al., 2015).

In considering the type or approach the researchers used for this study I would agree that it was a good decision. The study measured physical, emotional and psychological aspects of the subjects and self-reporting was the only way to get the data. During the study some interviewing was done by trained interviewers. One thought might be to have the same interviewer go over the reporting tools with each subject to verify their score and make sure each subject fully understands the scoring tool being used. A couple of internal threats noticed in reviewing the study were self reporting and the home practice. It was noted in the study that one subject reported not doing the home practice at all, and others admitted to missing days or even a week or more.

While the lack of commitment to practice daily was a threat, it did show that those that did the home practice more consistently showed more improvement. The home practice aspect of the study required a personal commitment from each adolescent and the motivation to keep the commitment. Another possible problem would be with the self-reporting, did the subject report truthfully about the amount of time and days of practice and was the practice done correctly? One possible solution would be to monitor the home practice or have the daily practice done as a group with the MBSR instructors. Another possibility to insure the daily practice would be completed might be to incorporate the daily practice into a class at school.

External threats that were noticed included: small sample size, the subjects were mostly white and from middle class, different home environments which might have influenced the home practice, parental involvement and support or lack of. Interaction and personality traits of the subjects and instructors may also cause issues in motivation, commitment and outcomes.

While there were several internal and external threats to this study, it still demonstrates that MBSR as a feasible treatment for children, adolescents and adults in the treatment of chronic pain, depression, stress, anxiety and other functionality. Further research in this area may show even more possibilities for those suffering with chronic illness, pain and other debilitating conditions. One of these is reducing the effects of childhood stress and trauma. With my interest in ACEs, Theraplay and working with children in trauma, the article by Ortiz, R. & Sibinga, E. M. (2017) was informative.

The authors cite studies using MBSR with female adults exposed to trauma as children showed a decrease in the effects of the trauma exposure such as depression, anxiety, emotional deregulation and posttraumatic stress symptoms. In the same article, a study of youth in foster care showed gains in social interaction skills and coping with stress after participating in an MBSR program. One of the concerns that was brought out in this article was the lack of regulated training and offshoots of mindfulness programs. This is not to say that these programs may not be quality programs with trained instructors, it is just a cautionary note to be aware. Some Mindfulness programs have been implemented in school and teachers are reporting positive outcomes (Ortiz, R. & Sibinga, E. M., 2017).

As stated earlier this is still a fairly new and open field of study with the potential for many similar and varied studies possible. As the connection between body and mind becomes more understood, it is possible that the medical field will be more ready to incorporate non-medicinal therapies as an option. Patients may begin to acknowledge their responsibility is making sure that their health is at its best and be open to different possibilities such as Mindfulness-Based Stress Reduction.

References

Ali, A., Weiss, T. R., Dutton, A., McKee, D., Jones, K. D., Kashikar-Zuck, S., … Shapiro, E. D. (2017). Mindfulness-based stress reduction for adolescents with functional somatic syndromes: A pilot cohort study. The Journal of Pediatrics, 183, 184–190. http://dx.doi.org/10.1016/j.jpeds.2016.12.053
Mindfulness-based stress reduction. (n.d.). Retrieved from https://en.wikipedia.org/wiki/Mindfulness-based_stress_reduction
Ortiz, R. & Sibinga, E. M. (2017). The role of mindfullness in reducing the adverse effects of childhood stress and trauma. Children, 4(3), 16. http://dx.doi.org/10.3390/children4030015
Sibinga, E. M. S., Kerrigan, D., Stewart, M., Johnson, K., Magyari, T., & Ellen, J. M. (2011). Mindfulness-based stress reduction for urban youth. The Journal of Alternative and Complementary Medicine, 17, 213–218. http://dx.doi.org/10.1089/acm.2009.0605
Zeidan, F., Emerson, N. M., Farris, S. R., Ray, J. N., Jung, Y., McHaffie, J. G., & Coghill, R. C. (2015). Mindfulness meditation-based pain relief employs different neural mechanisms than placebo and sham mindfulness meditation-induced analgesia. The Journal of Neuroscience, 35, 15307–15325. http://dx.doi.org/10.1523/JNEUROSCI.2542-15.2015