Mindfulness – a way of paying attention that can help individuals cope with everyday life or tough times (ReachOut.com, n.d.)- is increasingly recognised as an effective way to reduce stress and improve wellbeing. You may have noticed that mindfulness has recently attracted attention in the mainstream media. In February 2014, ‘The Mindful Revolution’ appeared on the cover of Time magazine and 2014 was deemed ‘The Year of Mindfulness’ in the New Republic.
However, mindfulness is more than mere pop-science: Mindfulness-Based Stress Reduction (MBSR) was founded by Jon Kabat-Zinn in 1979 and has since been used to address stress in women with breast cancer, men with prostate cancer, prison inmates and staff, and in multicultural settings (see Baer, 2003 and Ludwig and Kabat-Zinn, 2008 for interesting overviews of the research).
Authors of this study (Dykens et al 2014) took note of the potential benefits of MBSR and positive psychology interventions aiming to increase happiness and wellbeing (see for example, this useful Australian podcast ) for mothers of children with autism or other developmental disabilities. These mothers often experience high distress, particularly anxiety and depression – which can in turn affect their parenting and other life experiences.
In this study, the authors test whether MBSR and a positive psychology practice called Positive Adult Development reduces stress among mothers of children with autism and other disabilities.
The authors recruited 243 mothers from a community in the US, and placed them randomly into a Mindful practice group or a Positive Adult Development. These mothers were on average aged around 41 years, and most (73%) were married. Their children were, on average, around 11 years old and more (65%) experienced autism spectrum disorders than other developmental disabilities (14.4%).
Other mothers (deemed “peer mentors”) who had already been trained and were closely supervised in the delivery of face-to-face group treatment led six weeks of 1.5 hour sessions each week.
Distress among mothers was assessed six times (using markers such as, for example, life satisfaction, sleep quality, depression and anxiety) before, during and after the treatments. The authors used sophisticated statistics to measure changes across each assessment.
Before treatment, the vast majority (85%) of mothers experienced significantly elevated stress, and almost half reported (48%) clinical depression and (41%) anxiety disorders as measured by standardised outcome measurements that are used often in research such as this.
The authors found that after both MBRI and Positive Adult Development treatments, mothers experienced less stress, depression, anxiety, had more sleep and better life satisfaction. MBRI was more effective in reducing anxiety, depression and improving sleep and wellbeing. However, those mothers of children with ASD improved less in anxiety.
The authors concluded that interventions such as MBRI can ‘significantly reduce stress in of children with disabilities.
Well-trained peer-mentors are effective interventionists.
Adult-oriented services are needed for these mothers to improve their mental health and sustain their caregiving over the long-term’.
Importantly, the authors note that even though children transition into adulthood and continue to reside with ageing parents, we know very little about how to support these parents in relation to their own physical and mental health needs. More research investigating how best to promote the wellbeing and long-term caregiving efforts of parents is needed.
Strengths and limitations
This is a well-run study with a good number of parents recruited from a community sample, which means that we can be more certain that it is applicable in different contexts and environments. However, the sample of mothers recruited were, on average, older, very well educated and from higher socioeconomic backgrounds so caution must be exercised if applying these programmes to mothers from different backgrounds.
The authors did not include fathers in this study – given that most mothers were married, it would be interesting to test whether couples who attend the sessions are better able to support each other compared with those where only one caregiver attends. Certainly, it cannot be assumed that it is only mothers who are affected by the stress of parenting.
Critically, the authors did not compare outcomes of the two interventions with a non-treatment group so it is impossible to know empirically whether the outcomes were better than no treatment. The authors make a good case for this design – arguing that evidence suggests mothers do not become less distressed with time – and it is positive to see researchers making rational decisions to target their work to real-world, high-risk groups.
Also important to note is that the authors did not investigate the impact of the programme on outcomes among the children themselves. Therefore, it remains unknown whether the reduced maternal distress led to improved experiences for children with ASD.
It is critical that high risk groups are provided with more help to access health promotion programmes that we know work. The recent focus on mindfulness should not be limited to the general population or a privileged few. Making such programmes accessible and relevant to parents of children with disability is a small step to addressing the vast inequities experienced by this group. Another important step is including access to children themselves, where safe and appropriate.
If you would like to take a look at this programme and are comfortable with the limitations of this particular trial, check out the website that allows for licensing of their MBRI programme at psip.vueinnovations.com. The programme costs around $200 and can be administered by those with clinical skills such as psychologists, social workers and counsellors. We feel that on the basis of this trial, whilst this programme appears to deliver positive results, it would not be possible to make an evidence-based recommendation at this time.
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]
Baer R (2003) Mindfulness Training as Clinical Intervention: A Conceptual and Emperical Review. American Psychological Association. 10(2): 125-143 [abstract]
Ludwig, DS, Kabat-Zinn, J. (2008) Mindfulness in Medicine. JAMA. 300(11): 1350-2.
New Republic. 2014. The Year of Mindfulness. Accessed on 30 December 2014.
ReachOut.com. What is Mindfulness? The Inspire Foundation. Accessed on 30 December 2014.
Time Magazine. 2014. The Mindful Revolution. Accessed on 30 December 2014.