The Effects of Mindfulness-Based Stress Reduction for Family Caregivers: Systematic Review

doi:10.1016/j.apnu.2015.08.014

Archives of Psychiatric Nursing

Volume 30, Issue 2, April 2016, Pages 292-299

https://doi.org/10.1016/j.apnu.2015.08.014 Get rights and content

Abstract

Caring for patients with various conditions is demanding and stressful and can have a negative impact on both physical and psychological health. This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of mindfulness-based stress reduction for the family caregivers of patients with various conditions. There were improvements in the self-rated psychological symptoms, such as stress, depression, anxiety and mindfulness. To conclude, mindfulness-based stress reduction, as a safe and transportable approach, has potential to improve the psychological symptoms in the caregivers of patients with various conditions.

Section snippets

Mindfulness-based stress reduction

Mindfulness is grounded in Buddhist philosophies and is defined as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (Kabat-Zinn, 1994, Siegel et al., 2009). That is to say, in mindfulness practice, individuals are encouraged to pay attention to what is happening in the moment, in a non-judgmental way, without relying on previously schemas. This approach may eventually help individuals change the way they think (Segal, Williams, & Teasdale, 2013).

Aim

The primary aim of this systematic review was to summarize and evaluate the evidence for the effectiveness of MBSR for caregivers of patients with various conditions.

Studies focusing individually on yoga and/or meditation, or including therapies like a non-MBSR intervention are not included in this review. The studies on Mindfulness-Based Cognitive Therapy (MBCT) for caregivers are included in this review. MBCT is grounded in MBSR and is designed to help individuals who suffer from depression

Protocol and Registration

The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009). The protocol was not registered prior to conducting the review.

Search Strategy

Nine databases (the Cochrane Library, PubMed, Medline, CINAHL, PsycINFO, Web of science and three Chinese databases, CNKI, Wanfang data and VIP) were searched (from inception to 1 Feb 2015) for original articles. The literature search was

Results

Fourteen studies, including 849 participants, met the eligibility criteria. No systematic reviews that related specially to the caregivers’ use of MBSR were found. Three published randomized controlled trials of MBSR (Dykens et al., 2014, Hou et al., 2014, Whitebird et al., 2012) and one randomized controlled trial of MBCT (Oken et al., 2010) were identified. There were seven published uncontrolled trials (Bazzano et al., 2015, Birnie et al., 2010, Epstein-Lubow et al., 2011, Haines et al., 2014

Discussion

MBSR is a well-structured, group-based, mindfulness intervention that focuses on empowerment, nonjudgmental interpretation of events and acceptance of the present situation (Kabat-Zinn et al., 1992). MBSR programs generally include mindfulness meditation, gentle stretching, group discussion, and integration of mindfulness into daily life to decrease physical and psychological symptoms (Bazzano et al., 2015). The pooled results of this review suggested that MBSR had a positive effect on the

Conclusion

Studies on MBSR for caregivers of patients with various conditions have focused on the psychological outcome measures (stress, depression and mood) and reported positive results. No side effects were reported in any of the included studies. Caregivers are a vital resource, and their needs for reducing stress and anxiety are substantial (Haines et al., 2014). MBSR, as a safe, simple, accessible and transportable approach, may enhance the psychological functions and facilitate the long-term

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Yoga is a type of practice with numerous benefits for health. This systematic review aimed to synthesize evidence on yoga therapy and determine its effects on caregiver stress and mental health among those who provide care for people with dementia.
The Cochrane methodological guidelines were adopted and reported using the PRISMA statement. MEDLINE, Cochrane Central, CINAHL, EMBASE, PROQUEST, Scopus, and Web of Science were among the seven online databases searched between January 2010 and October 2021 for randomized controlled trials. The risk of bias in the trials was evaluated using the Cochrane risk of bias tool. Meta-analysis was done using Revman software 5.4 version.
Thirteen randomized controlled trials consisting of 522 research participants assessed the impact of yoga on caregiver stress, burden, mental health, and depression. A random effects model on the effect of yoga revealed that yoga is beneficial in caregiver stress reduction and enhancing the psychological well-being of caregivers of people with dementia with statistical significance (95%CI: 0.64–0.89, p < 0.05). It was statistically significant that caregiver stress was reduced among the caregivers of people living with dementia.
The practice of yoga decreases caregiver stress with a positive impact on caregiver mental health. Additionally, yoga plays a vital role in bringing down caregiver burden and depression. However, considering the heterogeneity among the included studies, additional research with larger sample size and rigorous randomized controlled trials must be conducted to generate a higher quality of evidence.
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Accordingly, for this study, we hypothesized that training in mindfulness could enhance the CG's shift from a resistance to uncertainty to an acceptance of uncertainty as a natural part of life. Additionally, the proposed focus on improving family conflict should affect perceived social support, another mediator of health outcomes, thereby leading to greater self-efficacy and positive emotions [38]. Moreover, since mindfulness training programs have been successfully adapted to distance-based formats, including use of the internet, smart-phone and telephone-delivered mindfulness training formats, we hypothesized that a distance-based training format would be feasible and acceptable [45–48].
There have been few interventions targeted for rural African American (AA) caregivers of persons with dementia despite their unique cultural, geographic, health-related and socio-economic needs, including relatively less access to—and willingness to engage with—formal supports and resources. One effective intervention, Mindfulness-based stress reduction (MBSR), has been found to be culturally acceptable in AA populations; however, no studies have assessed feasibility, acceptability and impact of an adapted mindfulness intervention targeting rural AA dementia caregivers.
The purpose of this study is to 1) determine the feasibility and acceptability of a telephone-delivered mindfulness training intervention in decreasing caregiver burden among rural, AA, informal caregiving teams of people with dementia; 2) to explore the effects of the training on caregiver burden and relevant secondary outcomes for both caregiving team members, including emotional regulation, tolerance of uncertainty, emotional and physical health, family conflict within the informal caregiving team, and self-efficacy; and 3) to explore comfort with and willingness to adopt technologies to access mindfulness practices and existing caregiving educational resources.
Our study utilizes a single-group, uncontrolled design to assess the feasibility and acceptability of telephone-delivered mindfulness training designed to alleviate burden for rural caregivers of AA individuals with moderate to severe dementia. A care partner—the person who provides additional help —is included in the intervention. The primary outcome is feasibility of the telephone-delivered mindfulness intervention as assessed by an 85% retention rate with completion of at least 6 of the intervention sessions. Pre- and post-participation interviews assess acceptability.
Facing epistemic and complex uncertainty in serious illness: The role of mindfulness and shared mind
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Third, mindfulness is linked to empathy and compassion [80], including in health professionals [66] In situations of high threat and emotional valence, mindfulness can promote compassion and self-compassion in both patients and clinicians, increasing social connectivity while reducing anxiety. Finally, among health care professionals and family caregivers, mindfulness reduces reactivity to stress and symptoms of burnout, and improves well-being [65,70,81–84], presumably through greater attentiveness to inner states and lowering reactivity to stress. Burnout takes a cognitive and emotional toll, and reduction in burnout may promote better problem solving as well as emotional availability.
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Epistemic uncertainty is common, and encompasses uncertainty about the nature of the illness, whom to entrust with one’s care, and one’s ability to adapt and cope. Communication about the “unknowable unknown” occurs infrequently and ineffectively, and there is little research on improving communication in the face of epistemic and complex uncertainty. Terror Management Theory (TMT) predicts that in encountering serious illness, people engage in “worldview defense” – suppressing death-related thoughts, affiliating with like-minded others, and developing cognitive rigidity and intolerance of information that challenges their worldview. Mindfulness is associated with diminished defensive worldview reactions and cognitive rigidity, and greater tolerance of ambiguity. Shared mind encompasses shared understanding and affective attunement.
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For example, increased mindfulness is linked to lower stress and depression, greater cognitive flexibility, and lower blood pressure [27-28]. The documented benefits of increased mindfulness pertain to many of the difficulties that caregivers commonly report [29]. Interventions utilizing mindfulness techniques with caregivers correspond with their health-related improvements [30-31].
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Mindfulness-based stress reduction is a structured psychoeducational and skills-based program that uses contemplative mindfulness meditation practices to facilitate better emotional coping (Kabat-Zinn, 1990; Kabat-Zinn, 2003). First developed in the late 1970s for people experiencing chronic pain, it has since been adapted and has shown some efficacy in reducing stress, depression, and anxiety in family carers of various conditions (Guichen et al., 2016), and in reducing stress for carers of people with dementia (Kor et al., 2018). While drawing on Buddhist philosophy, mindfulness-based stress reduction is delivered as a secular, group-based intervention, involving 2.5 h weekly sessions over eight weeks, a 7-h silent retreat, and 45-min daily homework.
To provide an overview of the current use of mindfulness- and compassion-based interventions with family carers of older adults, to aid primary healthcare practitioners in their decision-making around referral to wider healthcare services. The study was guided by four research questions: what interventions are currently used; whom they are used with; why they are used; and their evidence-base in terms of acceptability and effectiveness.
A scoping study using the methodological frameworks of Arksey and O'Malley and Levac et al.
Searches of electronic databases (MEDLINE, CINHAL, PsycINFO), reference lists of relevant articles, and journal websites were conducted in June 2019. Search terms were developed via an iterative process, and included medical subject headings and keywords relating to mindfulness and compassion, interventions, and family carers.
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From 2005 unique records, 32 primary studies were included. Seven types of mindfulness- or compassion-based interventions were broadly described within studies, including: mindfulness-based stress reduction (n = 13), mindfulness-based cognitive therapy (n = 3), meditation interventions (n = 9), acceptance and commitment therapy (n = 1), dialectical behaviour therapy (n = 1), compassion-focused therapy (n = 1), and study-specific interventions involving a combination of mindfulness and/or compassion (n = 4). Studies sampled a total of n = 991 participants and targeted six family carer sub-groups: dementia (n = 23), cancer (n = 5), amyotrophic lateral sclerosis (n = 1), chronic conditions (n = 1), cirrhosis (n = 1), and Parkinson's disease (n = 1). A variety of health outcomes were assessed across interventions, with the most common being depression (n = 26), anxiety (n = 15), burden (n = 15), quality of life (n = 14), and stress (n = 11). The evidence-base for each intervention was insufficient and too heterogeneous to make clear statements regarding effectiveness. However, based on these findings, interventions show some potential utility in supporting family carers in their role and, given a collective rate of attrition (18%), may do so in a way that is acceptable to carers.
This scoping study highlighted the nascent use of mindfulness- and compassion-based interventions with family carers of older adults, and provided important substantive detail about what each intervention entails. Based on current evidence, a number of implications for research and practice are presented.
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La maladie d’Alzheimer affecte près de trois millions de Français et exige la formation des professionnels de santé et des aidants. Notre étude souligne l’intérêt de soutenir un programme adapté reposant sur la méditation pleine conscience, afin de diminuer l’anxiété et le stress du patient et de son aidant.
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: Conflict of interest statement: The authors declare that they have no conflicts of interest.

: Sources of funding: None.

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The Effects of Mindfulness-Based Stress Reduction for Family Caregivers: Systematic Review

Abstract

Section snippets

Mindfulness-based stress reduction

Aim

Protocol and Registration

Search Strategy

Results

Discussion

Conclusion

American Journal of Geriatric Psychiatry

Journal of Neuroimmunology

Archives of Gerontology and Geriatrics

Alzheimer's & Dementia

Journal of Psychosomatic Research

General Hospital Psychiatry

European journal of oncology nursing : the official journal of European Oncology Nursing Society

General Hospital Psychiatry

American Journal of Geriatric Psychiatry

Lancet Neurology

Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity

Gerontologist

Mindfulness training as a clinical intervention: a conceptual and empirical review

Clinical Psychology: Science and Practice

Stress-reduction and improved well-being following a pilot community-based participatory mindfulness-based stress-reduction (MBSR) program for parents/caregivers of children with developmental disabilities

Disability and Health Journal

Mindfulness based stress reduction (MBSR) for parents and caregivers of individuals with developmental disabilities: A community-based approach

Journal of Child and Family Studies

Alzheimer's and related disorders: Loneliness, depression, and social support of spousal caregivers

Journal of Gerontological Nursing

Psychological benefits for cancer patients and their partners participating in mindfulness-based stress reduction (MBSR)

Psycho-Oncology

A spiritually based caregiver intervention with telephone delivery for family caregivers of veterans with dementia

Family & Community Health

A brief behavioral sleep intervention for family caregivers of persons with cancer

Cancer Nursing

Meditative therapies for reducing anxiety: A systematic review and meta-analysis of randomized controlled trials

Depression and Anxiety

A systematic review of neurobiological and clinical features of mindfulness meditations

Psychological Medicine

Predicting caregiver burden and depression in Alzheimer's disease

The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences

Mindfulness-based stress reduction for breast cancer-a systematic review and meta-analysis

Current Oncology

Integrative oncology: Complementary therapies for pain, anxiety, and mood disturbance

CA: a Cancer Journal for Clinicians

Reducing distress in mothers of children with autism and other disabilities: a randomized trial

Pediatrics

Persisting burden predicts depressive symptoms in dementia caregivers unhappiness

Journal of Geriatric Psychiatry and Neurology

A pilot investigation of mindfulness-based stress reduction for caregivers of frail elderly

Mindfulness

Prevalence of stress, anxiety and depression in with Alzheimer caregivers

Health and Quality of Life Outcomes

Caregiver well-being: A multidimensional examination of family caregivers of demented adults

Gerontologist

Reducing stress and anxiety in caregivers of lung transplant patients: Benefits of mindfulness meditation

International Journal of Organ Transplantation Medicine

Health promotion during childhood chronic illness: A paradox facing society

Holistic Nursing Practice

Impact of caregiving on health and quality of life: a comparative population-based study of caregivers for elderly persons and noncaregivers

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences

The effects of brief mindfulness training on caregivers' well-being

Activities, Adaptation, & Aging

The effects of mindfulness-based stress reduction program on the mental health of family caregivers: a randomized controlled trial

Psychotherapy and Psychosomatics

Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders

Psychological Medicine

Metabolic control in a state of decreased activation: Modulation of red cell metabolism

The American Journal of Physiology

Wherever you go, there you are

Mindfulness-based intervention in context: past, present and future

Clinical Psychology: Science and Practice