Part 3 in a weeklong series of blog posts written by undergraduate students from the 2017 spring-semester class, “Mindfulness & Compassion: Living Fully Personally and Professionally” at the University of Virginia.
Depression and anxiety are two of the most prevalent mental disorders in the United States (Anxiety and Depression Association of America, 2016). Depression is one of the world’s most urgent health problems, affecting an estimated 350 million people (World Health Organization; WHO). Moreover, depression is the leading cause of disability, and by the year 2030, depression is projected to be the number one cause of global disease burden (WHO).
Although never clinically diagnosed for either depression or anxiety, these are problems that have affected the lives of both authors. Han Ding has been affected primarily in her work as a nurse, while Nicole Miller has encountered these issues through her life as a college student. Due to these issues, we each determined that we would become involved in a mindfulness and compassion course at the University of Virginia in order to reduce anxiety and become more focused in our day-to-day experiences. While our experiences only represent a small portion of affected populations, we recognize that depression and anxiety are a much bigger problem and face a larger audience than that to which we have been exposed.
Depression and anxiety are affecting more and more people from various age groups, socio-economic statuses, and professional backgrounds. In order to meet the needs of various patient populations from various stages of the diseases, it is necessary for mental health professionals and those who working in healthcare fields to explore and examine full treatment options beyond traditional pharmacological and cognitive behavior treatments, as they may not be the ideal treatment for all. Among the various alternative treatments, studies on mindfulness-based therapy have yielded promising results and received increasing attention.
Jon Kabat-Zinn, founder of the modern movement of mindfulness as a therapeutic intervention, describes mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (as cited in Monteiro & Musten, 2013, p. xxii). Various exercises and programs have been designed cultivating this concept of mindfulness and acceptance. These exercises include awareness of breath meditations as well as exercises emphasizing detailed and non-evaluative attention to bodily sensations in rest or motion, such as body scans, yoga, or walking meditations. Vollestad, M.B. Nielsen and G.H. Nielsen (2012) provided a helpful overview of several specific mindfulness-based treatments that can be considered for patients suffering from depression or anxiety.
For example, a Mindfulness-Based Stress Reduction (MBSR) program is an 8-week, group-based psychoeducational program where participants practice a variety of mindfulness exercises in a secular format. MBSR has been shown to positively impact stress management, psychiatric symptoms, and quality of life for diverse patient groups as well as non-clinical populations. Mindfulness-Based Cognitive Therapy (MBCT) was developed to reduce the risk for relapse in previously depressed individuals. It incorporates exercises aimed specifically at enabling awareness of and disengagement from depressive cognitive processes.
Acceptance-based behavior therapy (ABBT) was developed specifically for the treatment of generalized anxiety disorder, and aims to decrease experiential avoidance through increased awareness and willingness to carry out valued actions in important life domains. All of these mindfulness-based therapies emphasize changing the individual’s relationship to experience, enabling a present-centered and non-evaluative stance that can help to decrease emotional reactivity and to facilitate the ability to instead respond with thoughtful action in the face of distress (Vollestad et al., 2012).
A recent study by Fuchs, Evans, Weisberg, Haradhvala, Nash, and Uebelacker (2016) followed patients with depression and anxiety in an urban family medicine clinic in the northeastern U.S. as they participated in 60-min acceptance and mindfulness-based groups twice a month. Over the course of 19 months, the 29 patients experienced a significant decrease in depression and anxiety symptoms in just the first four visits attended (d=-.26 and -.19, respectively).
In another study by Smith, Metzker, Waite and Gerrity (2015), 23 patients in an inner-city, racial/ethnic minority population attended a four-week long, group-based MBSR course at a federally qualified health center. A quasi-experimental design was used to assess the impact of participation on self-reported anxiety, stress, mindfulness, and quality of life. Among all the dependent variables, only anxiety showed a statistically significant decrease (as measured with the seven-item Generalized Anxiety Disorder Scale Score: 7.8-4.4; p=.005).
In 2015, 322 adults of another population, primarily made up of well-educated white women, enrolled in an eight-week, community-based MBSR program. Roughly half of the study participants had experienced symptoms of depression. The participants completed a secure online survey before and after the intervention, showing statistically significant (p<0.01) reductions in depressive symptoms regardless of affiliation with a religion, sense of spirituality, trait level of mindfulness before MBSR, sex, or age (Greeson, Smoski, Suarez, Brantley, Ekblad, Lynch, & Wolever, 2015).
In a quasi-experimental study of the effects of yoga exercise conducted in Spain by Roche, Barrachina, & Fernandez (2016), 16 participants in the yoga group showed a statistically significant increase in mindfulness and decrease in both anxiety and depression symptoms, as compared to 22 participants that had no significant change. The study was conducted based on Douglass’s (2009) finding that yoga practice has a positive effect on neurotransmitters associated with mood, increasing the levels of melatonin, dopamine, and serotonin that enhance positive mood and reducing the level of cortisol that is associated with reduction in experiencing stress (as cited in Roche et al., 2016).
College students are one of the populations that face high levels of stress and anxiety due to experiencing a transition adaptation process. The transition to college involves many adjustments, such as a lack of parental support, culture shock, or changes in lifestyle and thought. These adjustments can make students feel inadequate, leaving them prone to higher levels of stress, anxiety, and even depression (Falsafi, 2016). Falsafi explored the use of mindfulness-based interventions as an alternative treatment that could potentially be more appealing to college students, since it avoids the stigma associated with being diagnosed with a mental illness. Falsafi recruited 90 undergraduate students (both male and female) over age 18 who had a diagnosis of anxiety/or depression at the time of the study from a mid-sized university. The participants were randomly assigned to one of three groups: a mindfulness intervention group, a yoga-only intervention group, and a non-interventional group. After 8 weeks, symptoms of depression, anxiety, and stress decreased significantly (p<.01) from baseline to follow-up conditions in both the mindfulness and yoga intervention groups. No significant changes in the control group were demonstrated.
As a college student, I [Nicole] can relate to the tough transition upon entering college. Assignments consistently pile up with quickly approaching deadlines, social endeavors become more daunting, and success relies on the ability to manage time effectively. Each task individually adds extra stress to my life, despite the seeming simplicity. Similar to the students in the study conducted by Falsafi, I have been involved in a MBSR-style course. Since the start of my formal practice, I have noticed that I can focus on my assignments with a greater attentiveness than before. The awareness of breath meditation has been particularly significant in my college life as it takes my focus and pushes it inward, allowing me to calm myself and refocus my attention when I find my busy thoughts taking over. The class has also taught me how to view myself and my shortcomings with compassion instead of guilt. I find this important because the workload and expectations set on college students can cause them to mentally shut down and blame themselves for not meeting expectations. Based on my experience, I believe that having the ability to reframe those negative experiences through mindfulness can help mitigate issues of depression and anxiety. While I speak to the college student population, there are plenty of other groups that face similar problems of depression and anxiety.
Nurses are another population that received much attention due to work-related stress, which is estimated to be the biggest occupational health problem after musculoskeletal disorders. (Guillaumie, Boiral, & Champagne, 2016). A mixed-methods systematic review of the effects of mindfulness on work-related stress among nurses was conducted by Guillaumie et al. in Canada: a total of 32 studies, including 17 controlled designs, 11 pre-post designs and 4 qualitative designs were reviewed. The most frequent intervention components were group meetings for relaxation, meditation, and the MBSR program. Meta-analyses suggest that mindfulness-based interventions may be effective in reducing state anxiety and depression at posttreatment with uncontrolled studies. A significant decrease was observed in state anxiety and trait anxiety in random controlled trials at follow-up. Qualitative studies showed improvements in the well-being of nurses (e.g. inner state of calmness, awareness and enthusiasm) and improved performance at work through better communication with colleagues and patients, higher sensitivity to patients’ experiences, clearer analysis of complex situations, and emotional regulation in stressful contexts.
As a nurse who works in an acute care setting, I [Han] experience significant levels of stress and anxiety during work, especially when I am doing something for one patient and my mind is wandering to thoughts and concerns about another patient. This multi-task thinking habit causes a lot of anxiety during work, including a lack of feeling focused and peaceful, and instead feeling very tense at work. After participating in a semester-long mindfulness course, I have gained skills through my mindfulness practice to notice when I am distracted and tense, and to then remind myself to pay attention to my breath. This consistently helps to increase my sense of relaxation and calmness. I have also noticed myself being less reactive to stressful situations. When a patient who had an unpleasant experience in the hospital lashed out at me personally with sarcastic and cruel comments, I consciously reminded myself that he was actually angry with his overall treatments and hospital experiences, and that any nurse caring for him on that day would have been the scapegoat of his anger and frustration. Before my experience with mindfulness, I would have taken his comments more personally, and often I would be upset by such an experience for a long time to come. To my surprise, however, in this instance the hurtful feeling passed pretty quickly.
Although limited in our scope of population, we have certainly experienced our own form of non-clinical depression or anxiety. I [Han] have struggled with the pressure of the work environment, and I [Nicole] with the stress of the college environment. Our mindfulness-based course and practices have helped us to deal with daily stresses and anxieties and enabled us to more easily return to the states of peace and harmony. Our personal positive experiences from mindfulness-based practice are consistent with the findings among various populations in the above studies: clinical patients, community population, college students, and nurses. In summary, mindfulness-based practices have proved to be helpful in promoting mental well-being, especially by reducing the symptoms of depression and anxiety in various populations. For people with medicine noncompliance issues or people unwilling to start formal psychotherapy, mindfulness-based therapies could be a beneficial alternative to consider.
Falsafi, N. (2016). A randomized controlled trial of mindfulness versus yoga: Effects on depression and/or anxiety in college students. Journal of the American Psychiatric Nurses Association, 22(6), 483-497.
Fuchs, C. H., Haradhvala, N., Evans, D. R., Nash, J. M., Weisberg, R. B., & Uebelacker, L. A. (2016). Implementation of an acceptance-and mindfulness-based group for depression and anxiety in primary care: Initial outcomes. Families, Systems, & Health, 34(4), 386.
Greeson, J. M., Smoski, M. J., Suarez, E. C., Brantley, J. G., Ekblad, A. G., Lynch, T. R., & Wolever, R. Q. (2015). Decreased symptoms of depression after mindfulness-based stress reduction: potential moderating effects of religiosity, spirituality, trait mindfulness, sex, and age. The Journal of Alternative and Complementary Medicine, 21(3), 166-174.
Guillaumie, L., Boiral, O., & Champagne, J. (2016). A mixed-methods systematic review of the effects of mindfulness on nurses. Journal of advanced nursing.
Monteiro, L. & Musten, F. (2013). Mindfulness Starts Here: An Eight-week Guide to Skillful Living. Canada: FriesenPress.
Roche, L. T., Barrachina, M. T. M., & Fernández, I. I. (2016). Effect of ‘Exercise Without Movement’ yoga method on mindfulness, anxiety and depression. Complementary Therapies in Clinical Practice, 25, 136-141.
Smith, B., Metzker, K., Waite, R., & Gerrity, P. (2015). Short-form mindfulness-based stress reduction reduces anxiety and improves health-related quality of life in an inner-city population. Holistic Nursing Practice. 70-76.
Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta‐analysis. British Journal of Clinical Psychology, 51(3), 239-260.