A Feasibility Study of a One-to-One Mindfulness-Based Intervention for Improving Mood in Stroke Survivors

Abstract

Objectives Mindfulness is an evidence-based treatment for depression but has never been rigorously tested with stroke survivors with depression. This feasibility study examined several issues relevant to a potential trial of a mindfulness-based intervention (MBI) for improving mood after stroke. Methods In 2017–2019 in New Zealand, we recruited 20 stroke survivors with low mood to undergo a 6-week, one-on-one MBI course delivered by an occupational therapist experienced in MBIs. Pre, post, and 4-week follow-up assessments were completed. Results Fifteen participants completed all six sessions and a 4-week “booster” or top-up session. The 1-hour session duration was considered appropriate by participants and all enjoyed the face-to-face individualized format. Mean Beck Depression Inventory-II scores improved by more than one standard deviation and this was maintained at follow-up. However, the baseline assessment package was too long for some participants due to the cognitive component. Three participants indicated feeling emotionally challenged by some of the practices. These effects were managed by the mindfulness facilitator by adjusting the practice, so participants maintained their sense of agency, well-being, and overall benefit from the program. Conclusions MBI training delivered individually over six weekly sessions was acceptable to stroke survivors with 14/15 participants reporting improved mood. Three participants reported feeling emotionally challenged by some of the practices and we recommend MBIs for stroke survivors be provided by practitioners experienced in mindfulness, working with stroke, and trauma-informed therapy. It is important now to conduct rigorous randomized controlled trials to test the effectiveness and efficacy of MBIs for stroke survivors.

Nursing Implications of Mindfulness-Informed Interventions for Stroke Survivors and Their Families

“…As a result, 13 out of 15 stroke survivors completed the full course and showed reduction in symptoms of depression and anxiety. 22 Although preliminary and descriptive, these findings suggest that the individualized approach to MBI can help manage poststroke recovery.…”

The use of mindfulness-based interventions in stroke rehabilitation: A scoping review.

“…Nine of the 16 studies used a face-to-face delivery mode (Baldo et al, 2021; Hofer et al, 2014; Jani et al, 2018; Johansson, Bjuhr, Karlsson, et al, 2015; Johansson, Bjuhr, & Rönnbäck, 2015; Moustgaard et al, 2007; X. Wang et al, 2020; Wrapson, Dorrestein, Wrapson, Theadom, Kayes, Snell, Rutherford, Roche, Babbage, & Siegert, 2021; Wrapson, Dorrestein, Wrapson, Theadom, Kayes, Snell, Rutherford, Roche, Babbage, Taylor, & Siegert, 2021), six used mixed delivery modes (face-to-face and home practice; Geneme et al, 2019; Johansson et al, 2012; Joo et al, 2010; Love et al, 2020; M. Wang et al, 2019; X.…”

“…The most common type of intervention was MBSR. Nine of the 16 studies involved MBSR as the core element in their practice (Baldo et al, 2021; Jani et al, 2018; Johansson et al, 2012; Johansson, Bjuhr, Karlsson, et al, 2015; Johansson, Bjuhr, & Rönnbäck, 2015; Joo et al, 2010; Wathugala et al, 2019; Wrapson, Dorrestein, Wrapson, Theadom, Kayes, Snell, Rutherford, Roche, Babbage, & Siegert, 2021; Wrapson, Dorrestein, Wrapson, Theadom, Kayes, Snell, Rutherford, Roche, Babbage, Taylor, & Siegert, 2021; see Table 2). Most of these studies involved formal practices, which typically consist of sitting meditation (emphasize the awareness of breathing while broadening the sensations of the body, feelings, states of mind, and thoughts), a body scan (emphasize bringing awareness and sensations to parts of the body region-by-region, from the feet to the head, without flexing or relaxing the muscles related to progressive relaxation), gentle yoga (emphasize mindful body awareness), and informal mindfulness practices of everyday activities (e.g., teeth brushing, communicating, eating, and doing chores; Baldo et al, 2021; Johansson et al, 2012; Johansson, Bjuhr, Karlsson, et al, 2015; Johansson, Bjuhr, & Rönnbäck, 2015; Joo et al, 2010).…”

“…Studies of the use of mindfulness in stroke patients have become more common in the last two decades. Some studies have explored whether MBIs may be tailored for the stroke population and they have confirmed their acceptance by and feasibility for individuals poststroke and their caregivers (Jani et al, 2018; Wrapson, Dorrestein, Wrapson, Theadom, Kayes, Snell, Rutherford, Roche, Babbage, Taylor, & Siegert, 2021). Specifically, MBSR intervention studies have demonstrated a reduction in mental fatigue in individuals with stroke or traumatic brain injury (Johansson et al, 2012).…”

Psychological interventions on the front lines: A roadmap for the development of a behavioral treatment program to mitigate the mental health burden faced by COVID-19 survivors.

“…A psychotherapy incorporating psychoeducation, behavioral activation, and adherence enhancement strategies, in collaboration with caregivers and providers, improves depression symptoms in poststroke depression (Alexopoulos et al, 2012). Mindfulness-based interventions improve physical comfort and quality of life and reduce anxiety, depression, and fatigue in stroke survivors undergoing rehabilitation (Lawrence et al, 2013;Ulrichsen et al, 2016;Wang et al, 2019Wang et al, , 2020Wrapson et al, 2021). Thus, we chose to implement focused skill-building interventions incorporating psychoeducation, mindfulness, and behavioral activation while incorporating the interdisciplinary medical team and caregivers as much as possible (Jaywant et al, 2021).…”