Mindfulness has evolved from its Buddhist inspired meditation techniques to its recognition by the National Institute for Health and Clinical Excellence as a recommended intervention for people with borderline personality disorder (as part of dialectical behaviour therapy) and as a relapse prevention intervention in depression (NICE 2009/2011)
The evidence base is continuing to grow for a wide range of mental health problems. Benefits have also been reported for reducing the stress of family and carers of people with learning disabilities (Dykens et al 2014). However, few studies looked directly at the effects of offering mindfulness-based interventions to people with learning disabilities, and the methodological quality of these studies is often poor (Harper et al 2013).
The inpatient assessment and treatment unit where the authors work has been offering mindfulness groups for 1.5 years and it is part of the unit’s routine practice. Through interviews they sought to explore people with learning disabilities’ understanding of mindfulness, the benefits they experienced and the challenges they encountered.
Six people with mild to moderate learning disabilities and at least one additional diagnosed mental health problem were interviewed. All were adults and had previously attended between 2 and 23 mindfulness sessions.
Individual interviews took place at the inpatient unit and were led by one of the facilitators of the mindfulness group. Interviews were semi-structured, comprised open and closed questions, and asked people to recall group activities and reflect on their experiences and satisfaction with these. Session materials were provided to serve as visual and tactile reminders of the different mindfulness exercises.
Group members reported that the mindfulness exercises taught them how to focus on one particular thing and had improved a range of, mainly physical, skills. Improvements in mood and the ability to stay calm were also identified and labeled by the authors as intrapersonal benefits.
From an interpersonal perspective, people talked about how they had more attention for their relationships with others and reported that the group sparked their desire to help others grasp these new mindfulness exercises.
By contrast, some people were not convinced of their own ability to learn the mindfulness techniques and described it as ‘a bit too late to teach old dog new tricks’.
People with learning disabilities formed an understanding of mindfulness more related to their own experiences than to how the mindfulness exercises were explained to them. The findings suggest that mindfulness groups may be effective in enabling people to distance themselves from upsetting experiences through improved focusing and relaxation skills.
Strengths and limitations
The study has a number of limitations, most notably in the recruitment of participants. It is not clear whether participants had attended the group at the same time, and if all group members were invited for the study or if invitation was at the authors’ discretion.
The potential recruitment bias may reflect on the reported outcomes with participants who attended the group together being more likely to share similar experiences. It can also be expected that two sessions may not be sufficient for people to report on the potential benefits and challenges associated with mindfulness.
Interviews were conducted in line with the ‘Guidelines for Researchers when Interviewing People with an Intellectual Disability’ (D’Eath, M. 2005 ) and paid particular attention to reduce response bias and enhancing communication.
While the authors recognise that having one of the group’s facilitators conducting the interviews might induce bias in people’s responses, it also points towards a significant strength of the study. It highlights the necessity for process and outcome evaluations to be implemented in all therapeutic interventions, which is in essence what this study has done.
It also reflects common practice in that the person responsible for providing the intervention often conducts the evaluations.
The existence of the group prior to the study adds to the ecological validity of the findings. It can be expected that the group facilitators were well familiarized with its procedures and that both former and future group members would report similar benefits and challenges.
This study, although small in sample size, supports the delivery of mindfulness groups to people with learning disabilities in inpatient units and reports a range of potential benefits.
It is not yet clear to what extent the reported benefits are associated with mindfulness techniques that practice focusing skills or with exercises that lead to physical relaxation. Although both may result in stress reduction, the latter would provide more support for relaxation programmes than for mindfulness interventions.
It would be interesting to examine if and how people’s understanding of mindfulness changes depending on the number of sessions attended. Likewise, further research should investigate to what extent the identified benefits and the theme ‘Helping people’ are related to a group-based format.
Yildiran, H., & Holt, R.R. (2014). Thematic analysis of the effectiveness of an inpatient mindfulness group for adults with intellectual disabilities. British Journal of Learning Disabilities, 43, 49-54 [abstract]
Common mental health disorders: Identification and pathways to care, NICE guidelines [CG123] 2011
Borderline personality disorder: Treatment and management NICE guidelines [CG78] 2009
Dykens, EM, Fisher, MH, Lounds Taylor, J, Lambert W, Miodrag N. (2014) Reducing distress in mothers of children with autism and other disabilities: A randomised trial. Pediatrics. 134: e454 [abstract]
Harper S et al., (2013) The effectiveness of mindfulness-based interventions for supporting people with intellectual disabilities: a narrative review, in Behaviour Modification, 37, 3, 431-453 [abstract]