Mindfulness Practice Made Simple for Occupational Therapy

History

  • Mindfulness is based on Eastern practices rooted from Buddhism.
  • Not a new practice, but has been practiced over 2500 years.
  • Adopted by Western psychotherapy and pioneered by Jon Kabat-Zinn.

Mindfulness Definition

There are many definitions and other terms for the concept and practice of mindfulness. Kabat-Zinn defined it as:

“The awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment to moment”.[1]Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10, 144–156.

Misconceptions

  • Mindfulness is more than just meditation. They are not synonymous terms.
  • Mindfulness is not about being mindless (having no thoughts or zoning out).
  • Being mindful all the time is not the goal – it is used when necessary or beneficial.
  • Mindfulness is not the same as resting and relaxing. [2]https://www.scientificamerican.com/article/the-5-biggest-myths-of-mindfulness/ Instead, it is intended to improve one’s self-awareness and therefore improve one’s ability to manage one’s life better. Relaxation is a by product.
  • Mindfulness is not a religious practice or a back door to religion (although it comes from Buddhism). Instead, its benefits have been distilled and derived from Buddhism. In fact, mindfulness can be practiced along with any religion.
  • Mindfulness is more than paying attention to one’s breath (although this is a type of mindfulness exercise). It’s really more about paying attention to one’s present inner world (mind and body) and environment.
  • Mindfulness does not help everyone and with everything. Some groups benefit from mindfulness more than others – this research is still in its infancy.[3]Roz Kings and Emma Wardropper, Case Study: Creating a mindful culture within financial services, in Mindfulness in the Workplace: An evidence-based approach to improving wellbeing and raising … Reference List

Themes of Mindfulness

  • Awareness
  • Thoughts
  • Attention
  • Noticing
  • Present Moment

Mindlessness Example

Mindfulness is the opposite of mindlessness.

An example of mindlessness is going through a typical day without actively thinking in the moment. An example of mindlessness is driving from point A to B and thinking about something else while driving. When you arrive, you don’t remember how you even got there.

Research

Mindfulness practices have been studied in the literature and more studies are emerging. While most of the mindfulness education and practices have been shown to be effective such as in adult populations, it is not a catch-all approach for everyone – just like anything in life.

  • Some studies have shown it to be less effective in schools over longer-term durations for adolescents.[4]Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., … & MYRIAD Team. (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training … Reference List
  • The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review – MBSR is an effective intervention which can help improve the psychological functioning of [health care professionals].[5]Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic … Reference List
  • A Systematic Review and Meta-Analysis of Workplace Mindfulness Training
    Randomized Controlled Trials – beneficial effects for mental health indicators and sleep, but no conclusions for burnout in work or work performance.[6]Bartlett, L., Martin, A., Neil, A. L., Memish, K., Otahal, P., Kilpatrick, M., & Sanderson, K. (2019). A systematic review and meta-analysis of workplace mindfulness training randomized … Reference List
  • Does your mindfulness benefit others? A systematic review and meta-analysis of the link between mindfulness and prosocial behaviour – We found a positive pooled effect between mindfulness and prosocial behaviour for both correlational and intervention studies.[7]Donald, J. N., Sahdra, B. K., Van Zanden, B., Duineveld, J. J., Atkins, P. W., Marshall, S. L., & Ciarrochi, J. (2019). Does your mindfulness benefit others? A systematic review and … Reference List
  • Effects of Brief Mindfulness-Based Interventions on Health-Related Outcomes: a Systematic Review – Despite heterogeneity of outcomes across studies, there is evidence that brief MBIs can impact numerous health-related outcomes, after only one session and with interventions as brief as 5 min.[8]Howarth, A., Smith, J. G., Perkins-Porras, L., & Ussher, M. (2019). Effects of brief mindfulness-based interventions on health-related outcomes: A systematic review. Mindfulness, 10(10), … Reference List
  • Mindfulness may be effective in improving the health and well-being of children and adolescents.[9]Semple, R. J., & Burke, C. (2019). State of the research: Physical and mental health benefits of mindfulness-based interventions for children and adolescents. OBM Integrative and Complementary … Reference List

Mechanism

  • Much is still unknown about why and how mindfulness works.
  • Researchers are using fMRI and looking at neural networks among other things.

Conditions

Includes but is not limited to:

  • Fibromyalgia
  • Mixed cancers
  • Depression
  • Chronic pain
  • Anxiety
  • Obesity and binge eating disorders
  • Psychiatric problems
  • Prisoners
  • Populations seeking help to cope with stress [10]Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits: a meta-analysis. 2004. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed … Reference List

Clinical Benefits

  • Stress
  • Anxiety
  • Concentration
  • Memory
  • Rumination
  • Emotional reactivity
  • Cognitive (Psychological) flexibility
  • Depression
  • PTSD
  • Blood pressure
  • Cortisol levels
  • Other physiologic markers of stress[11]Behan, C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Irish journal of psychological medicine, 37(4), 256-258.

Mindfulness for Patients

  • Mindfulness can be taught to patients to help them manage their mental and physical health while participating in their meaningful occupations while living with various health conditions.[12]Asuero AM, Queralto JM, Pujol, et al. Effectiveness
    of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. J Contin Educ Health Prof. 2014;34:4–12.
    [13]Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57:35–43.
  • Occupations have been defined as not just ‘doing’ but also ‘being’ and ‘becoming’, which aligns with mindfulness practice.[14]Wilcock AA. Reflections on doing, being and becoming. Can J Occup Ther. 1998;65:248–256.
  • Still, mindfulness in relation to human occupation is not well-studied.
  • Being mindful while engaging in occupations ‘occupational mindfulness’ can allow for deeper understanding of the occupational process itself.[15]Elliot ML. Being mindful about mindfulness: an invitation to extend occupational engagement into the growing mindfulness discourse. J Occup Sci. 2011;18:366–376.

Occupational Mindfulness Examples

An example that came to mind that is universal to the human experience is the ADL of sexual activity. A rhetorical question is: is mindfulness beneficial while participating in sexual activity? Most would say yes. But what about non-consensual sex for the individual? This example highlights how mindfulness may be beneficial for an occupation, but is not always the case.

Work rehabilitation and reintegration – How about for employees? Studies have shown that employees that view their job positively have overall better outcomes in terms of mental health, physical health, and less time missed from work such as from injuries and sick leave. This may perhaps be why many organizations have instituted mindfulness for their employees in broad programs. Of course, this may not work for everyone, such as the employee who is burned out and already made up their mind.

How about for mundane tasks such as ADLs like toileting, brushing our teeth or IADLs like folding laundry? I think this is individualistic and depends on the individual, but mindfulness can have benefits across many occupations from the meaningful to the necessary and functional. For example, would you get better satisfaction while folding laundry while noticing the moment or while listening to a podcast that you like? One mindfulness exercise is the raisin activity where you keep a raisin in your mouth without swallowing it immediately, you focus on the raisin while it is in your mouth.

Mindful eating and walking definitely have their benefits as we all have experienced this ourselves compared to shoving food down our mouths or walking while focusing on something else like our listening to our music.

How about patients in pain or who are suffering? While counterintuitive, focusing on one’s pain may be beneficial in some ways. For example, one may benefit from noticeingthat they may have pain in only one part of their body, e.g., lower back, while the rest of their body is pain-free. Or applying mindfulness in our moments when we are pain-free (which is likely to be more often than being in pain), can help patients to appreciate and treasure their moments…hopefully motivate them to engage in meaningful occupations that they value.

Outcome Measures

While I haven’t extensively researched the screens and outcome measures for mindfulness specifically in OT (there probably are none at the moment), many other typical tools can be used to measure this data such as for data points like stress, anxiety, pain scores, in relation to occupations such as the COPM.

Commonly used mindfulness outcome measures include:

  • The Mindful Attention Awareness Scale [MAAS] (Brown & Ryan, 2003) is a Likert scale from 1 (almost always) to 6 (almost never). Interestingly, the MAAS mentions two occupations in its questionnaire regarding ADLs (eating) and IADLs!
    • “I drive places on ‘automatic pilot’ and then wonder why I went
      there.”
    • “I snack without being aware that I’m eating.”
    • One potential issue I see with this version is that it’s not client-centered and driving is an IADL, not an ADL. Not everyone drives so it may not be relevant to them.
    • Does this mean if specific occupations are mentioned in a mindfulness outcome measure scale, that it can be somehow tailored to that individual? Similar to the COPM has broad categories of self care, productivity and leisure?
  • Perceived Stress Scale (Cohen & Williamson, 1988)
  • Rumination and Reflection Questionnaire (Trapnell & Campbell, 1999)
  • Forgiveness of Others Scale (Thompson & Snyder, 2003)

Practical Applications for OTs

Before you provide mindfulness education and interventions, I think it’s important to get the patient’s buy-in. They may come with many misconceptions or myths about mindfulness from popular culture. The key to getting one’s buy-in is tailoring the education, metaphors, and exercises to the individual and their own personal contexts, culture, interests, and values. A short experiential exercise such as eating (as used in the MAAS scale) may open their mind and interest to mindfulness towards other rehabilitation and interventions for other symptoms or ideally, their occupations.

OT Mindfulness Intervention Ideas

  1. Mindful breathing, deep breathing, diaphragmatic breathing
  2. Attending to the 5 senses: vision, hearing, smell, touch, taste, e.g.,  IHA/Aromatherapy with various essential oils or fragrances
  3. Mindful walk with the patient, e.g., outside
  4. Mindful laundry folding
  5. “I spy” with my eye…
  6. Mindful gardening (inside or out)
  7. Any patient-identified meaningful occupation that can be practiced in different environments

Closing Thoughts

OTs should ‘practice what they preach and practice mindfulness themselves to provide any insights they have learned to their patients.

While OT practitioners may notice immediate short-term benefits from mindfulness such as self-reports, the challenge comes with if the patient can persist in the practice over the long term on their own.

More research is needed regarding mindfulness + occupational therapy.

References

References
1 Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10, 144–156.
2 https://www.scientificamerican.com/article/the-5-biggest-myths-of-mindfulness/
3 Roz Kings and Emma Wardropper, Case Study: Creating a mindful culture within financial services, in Mindfulness in the Workplace: An evidence-based approach to improving wellbeing and raising performance, London: Kogan Page (2016)
4 Kuyken, W., Ball, S., Crane, C., Ganguli, P., Jones, B., Montero-Marin, J., … & MYRIAD Team. (2022). Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Evidence-based mental health, 25(3), 99-109.
5 Kriakous, S. A., Elliott, K. A., Lamers, C., & Owen, R. (2021). The effectiveness of mindfulness-based stress reduction on the psychological functioning of healthcare professionals: A systematic review. Mindfulness, 12(1), 1-28.
6 Bartlett, L., Martin, A., Neil, A. L., Memish, K., Otahal, P., Kilpatrick, M., & Sanderson, K. (2019). A systematic review and meta-analysis of workplace mindfulness training randomized controlled trials. Journal of occupational health psychology, 24(1), 108.
7 Donald, J. N., Sahdra, B. K., Van Zanden, B., Duineveld, J. J., Atkins, P. W., Marshall, S. L., & Ciarrochi, J. (2019). Does your mindfulness benefit others? A systematic review and meta‐analysis of the link between mindfulness and prosocial behaviour. British Journal of Psychology, 110(1), 101-125.
8 Howarth, A., Smith, J. G., Perkins-Porras, L., & Ussher, M. (2019). Effects of brief mindfulness-based interventions on health-related outcomes: A systematic review. Mindfulness, 10(10), 1957-1968.
9 Semple, R. J., & Burke, C. (2019). State of the research: Physical and mental health benefits of mindfulness-based interventions for children and adolescents. OBM Integrative and Complementary Medicine, 4(1), 1-1.
10 Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits: a meta-analysis. 2004. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK70854/
11 Behan, C. (2020). The benefits of meditation and mindfulness practices during times of crisis such as COVID-19. Irish journal of psychological medicine, 37(4), 256-258.
12 Asuero AM, Queralto JM, Pujol, et al. Effectiveness
of a mindfulness education program in primary health care professionals: a pragmatic controlled trial. J Contin Educ Health Prof. 2014;34:4–12.
13 Grossman P, Niemann L, Schmidt S, et al. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004;57:35–43.
14 Wilcock AA. Reflections on doing, being and becoming. Can J Occup Ther. 1998;65:248–256.
15 Elliot ML. Being mindful about mindfulness: an invitation to extend occupational engagement into the growing mindfulness discourse. J Occup Sci. 2011;18:366–376.
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.