Introduction
The work of LaRue and Herrman (2008) report that the level of stress in adolescents is often far underestimated by adults and others in the lives of the adolescent. Lau (2002) writes that teens “can experience a spectrum of stresses ranging from ordinary to severe” (p.238). (p.375) Lack of understanding as to the levels of stress experienced in the life of the teenager or adolescent is reported in the work of LaRue and Herrman to be in part linked to unawareness of that which causes stress in the life of the teen and the fact that sources of stress are changing in nature and evolve over time due to the complex nature of the life of the adolescent added to the fact that teen stress factors appear to be minimized by adults. (2008, paraphrased) Horowitz (2010) reports that mediation is “among the complementary and alternative medicine (CAM) therapies that is used by Americans…” (Horowitz, 2010) In addition Horowitz (2010) reports an increase in the use of mind-body medicine in the years between 2002 and 2007. (paraphrased)
Horowitz (2010) writes that meditation “refers to a group of techniques, most of which originated in Easter religious or spiritual traditions and are also practiced today for stress reduction and other health-related purposes.” Stated to be common elements of mediation are the following: (1) somewhere that has little in the way of distractions; (2) use of a position that is comfortable; (3) specific attention focus; and (4) an attitude of openness. (paraphrased)
Mindless meditation is derived from the Vedic tradition of India known as ‘Transcendental Meditation’, which has its roots in Buddhism. Meditation is reported to be “either practiced on its own or as a component of yoga t’ai chi, qigong, and other practices.” (Horowitz, 2010)
Other forms of meditation include (1) Vipassana (insight meditation); (2) Zen meditation; and (3) and breathing meditation. (Horowitz, 2010) All of these types of meditation have been studied in clinical trials with some of them being sponsored by the U.S. National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM). As of Spring, 2010, there were 58 open studies on meditation announced on the NIH website. (Horowitz, 2010, paraphrased)
The Mindfulness-Based Stress Reduction (MBSR) program was developed in 1979, by Jon Kabat-Zinn, Ph.D., who is now professor emeritus of medicine and founding direction of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School. The MBSR program lasts eight weeks and involves intensive training in mindfulness meditation.
Statement of the Problem
There is a general tendency for adults to fail to understand or recognize the sources of stress in the life of the adolescent or the nature of stressors over time that the adolescent must cope with as well as the increasing and ongoing complexities in the life of the adolescent that serves to produce various levels of stress.
Background and Significance of the Problem
Ferguson (2007) writes in the work entitled “Adolescent Stress, Stressors, and Coping”’ that stress is the’ adaptation of the human body in responding to “any demand or pressure” referred to as ‘stressors’. A stressor is defined by Ferguson as “…event” and coping is stated to be the action taken by the individual in the presence or due to the existence of the stressor. (paraphrased) Every individual copes with some level and degree of stress however, the adolescent is often very ill-equipped for coping with stressors and the resulting manifestations in their lives and relationships due to the stressors’ impact.’ (Ferguson, 2007, paraphrased) Behaviors that indicate stress in the individual are reported by Ferguson to include specific psychological changes in behavior including:
“…moodiness, irritability, inability to concentrate, crying, changes in eating patterns, changes in sleeping patterns, worrying, mood swings, frustration, nervousness, depression, exhibiting a negative attitude, low productivity, confusion, lack of creativity, lethargy, forgetfulness, and/or boredom may become more prevalent than usual for your adolescent. Socially increased stress levels…” [are often] “…exhibited through isolating his or her self from others, loneliness, decreased general communication skills, lashing out at others, nagging, or simply refusing to engage verbally.”
Ferguson, 2008, p.1
Stressors in the life of the adolescent include but are not limited to such as
- Demands of the school;
- Self negativism
- Body changes;
- Identity exploration;
- Peer group problems;
- Living environments that are unsafe;
- Parental separation and divorce;
- Illness that is chronic among members of the family;
- A loved one’s death;
- A move or change of school
- Too many extracurricular activities;
- Financial difficulties in the family.
It is reported in the work of Oman, et al (2008) and Shapiro, et al (2008) that previous studies have found that participation in meditation-based programs increases college students’ scores on mindfulness. Caldwell, et al (2010) reports a study that is stated to make provision of preliminary data is that “encouraging…to suggest that (a) a variety of movement courses can effectively increase mindfulness, and (b) increased mindfulness during the semester is associated with significant improvements in mood and perceived stress that, in turn, explains better sleep quality at semester’s end.” (p.441) The work of Pilcher and Ott (1998) and Pilcher, et al. (1997), as well as Moo-Estrella, et al (2005) report that poor sleep quality has been linked to mental and physical health difficulties with sleep difficulties rates among college students ranging from 31.6 to 64%
Statement of the Purpose
The purpose of this study is to examine the issue of coping with adolescent stress through the research and study of a specific technique and its effectiveness. That specific stress-coping technique is known as the ‘Mindfulness Meditation Intervention in Reducing Stress/Psychological Distress” in adolescents and teens.
Research Questions
What is the reported effect of mindfulness meditation on reducing stress in teen-age college students?
What is the overall effectiveness of the use of mindfulness meditation intervention in teen-age college students?
Philosophical Assumptions on which the Research is Based
Studies previously conducted have proposed mindfulness meditation as an innovative approach for reducing stress and in the treatment of certain psychiatric disorders. Mindfulness is reported to be a “type of meditative technique that emphasizes an observant and nonreactive stance toward one’s thoughts, emotions, and body states.” (Zylowska, 2008, p.738) In addition, mindfulness meditation further involves learning experientially through silent meditation or activities such as walking slow and purposefully focusing attention in daily activities. (Zylowska, 2008, paraphrased) The primary activity in this intervention is stated to be “a cognitive and intention-based process characterized by self-regulation of attention to the present moment with an open and accepting orientation toward one’s experiences.” (Zylowska, 2008, p.738)
Verbal instructions are utilized in assisting the individual to implement the technique in their lives however, the largest part of the training in this intervention is “experiential, consisting of intentional shifts of attention and perception. Incorporation of this technique with other methods, particularly cognitive-behavioral therapy has led to the development of a number of mindfulness-based treatments for stress, depression relapse, borderline personality disorder, anxiety disorders, and substance abuse.” (Zylowska, 2008, p.738)
Review of the Literature
The literature reviewed in this research proposal is of the nature that examines the effectiveness of mindfulness mediation intervention focused on the reduction of stress or psychological distress in adolescents and teens. First reviewed will be studies containing empirical research findings and secondly, examined will be literature relating to the theoretical basis of mindfulness mediation intervention which will serve to drive the research in this particular study.
Mindfulness-Based Meditation Intervention Studies
The work of McGonigal (2005) entitled “Your Brain on Mediation” states that meditation has a profound effect on the individual’s “experience of life” and that the sage Patanjali, “thousands of years ago…who compiled the Yoga Sutra, and the Buddha both promised that meditation could eliminate the suffering caused by an untamed mind.” (p.59) Each of these individuals are reported to have instructed their students on cultivating “focused attention, compassion and joy.” (McGonigal. 2005. p.59) It was the belief of both Patanjali and Buddha that the possibility exists to bring about a change in the mental powers as well as the emotional patterns of the individual through regular meditation. (McGonigal, 2005, paraphrased) Western science has focused on testing the statements of Patanjali and Buddha and today’s technology has served to enable the testing of the effect of meditation on the human brain. McGonigal reports that findings are critical and convincing and should motivate even those who resist meditation to pursue this course. In fact, it is indicated that even small amounts of meditation has the capacity to influence the individual’s life experience through somehow remolding some physical aspect of the human brain. (McGonigal, 2005, paraphrased)
Eileen Luders, researcher at the University of California Los Angeles School of Medicine, Department of Neurology has been searching for evidence that the structure of the brain is in fact changed by meditation. Luder reports finding multiple differences between the brains of individuals who practice meditation and those who do not. Luders and colleagues report a study in which the brains of 22 individuals who meditate and 22 non-meditating individuals and state findings that those who meditated between 5 and 46 years “had more gray matter in regions of the brain that are important for attention, emotion regulation, and mental flexibility.” (McGonigal, 2005, p.61) This finding is important since “increased gray matter typically makes an area of the brain more efficient or powerful at processing information.” (McGonigal, 2005. p.60) McGonigal reports that meditation can assist individuals with anxiety disorders and specifically mindfulness meditation, reported to be practiced by Philippe Goldin, director the Clinically Applied Affective Neuroscience project at Stanford University’s Department of Psychology. McGonigal (2005) states that mindfulness meditation involves becoming “aware of the present moment – by paying attention to sounds, your breath, sensations in your body, or thoughts and feelings – and to observe without judgment and without trying to change what you notice.” (McGonigal, 2005, p. 62) Participants in Goldin’s studies are stated to be individuals coping with “all sorts of disturbances of the mind – worries, self-doubt, stress and even panic.” (McGonigal, 2005, p. 61) The difference is that individuals with anxiety disorders feel that they are not able to get away from these thoughts and emotions, which eventually overpower these individuals and their lives. (McGonigal, 2005, p.61)
The research reported by Goldin includes that mindfulness meditation provides individuals with anxiety disorders a method they can use in changing the response of their brain to thoughts that are negative. Goldin’s study involved individuals participating in a mindfulness-based course for reduction of stress for a period of eight weeks. The class met once per week and individuals practiced by themselves for one hour each day in activities such as “mindfulness meditation, walking meditation, gentle yoga and relaxation with body awareness as well as discussions about mindfulness in everyday life.” (McGonigal, 2005, p. 62) The brains of the participants are scanned both prior to and following the study in an fMRI, which measures the activity of the brain rather than the brain’s structure while simultaneously completing “self-referential processing” or according to Goldin “thinking about themselves”. (McGonigal, 2005, p. 63) The fMRI is reported to track the areas of the brain that consume the most energy during meditation. Goldin’s study reports that brain scans reveal patterns that are surprising following the mindfulness intervention in that “participants have greater activity in a brain network associated with processing information when they reflect on negative self-statements.” (McGonigal, 2005, p. 63) The participants in Goldin’s study report an improvement in self-esteem following mindfulness intervention. According to Goldin, the findings in this study show that mindfulness meditation instructs the individual on how to cope with thoughts that are stress-provoking and emotions in such a way as to avoid being overcome by these. (McGonigal, 2005, paraphrased) The process involves the individual becoming aware of their emotions and thoughts and without becoming bogged in those thoughts and emotions, processing them effectively. (McGonigal, 2005, paraphrased) McGonigal reports that research from other studies have shown that mindfulness meditation results in positive brain changes. (2005, paraphrased)
The work of Deckro, et al (nd) entitled “The Evaluation of a Mind/Body Intervention To Reduce Psychological Distress and Perceived in College Students” conducted a study examining the effect of a six-week mind/body intervention on college students’ psychological distress, anxiety and perception of stress. The study involved 1298 students randomly assigned to either an experimental or control group. The experimental group perceived 6 group training sessions lasting 90 minutes. Assessment was conducted using the Symptom Checklist-90-Revised, Spielberger State-Trait Anxiety Inventory, and the Perceived Stress Scale as well as the students’ psychological state before and after the intervention. The post assessment measure was completed by ninety students or seventy percent of the initial sample. Findings show “significantly greater reductions in psychological distress, state anxiety, and perceived stress were found in the experimental group.” (Deckro, et al, nd) It is reported that this mind/body training which is brief in nature may be effective in the prevention interventional therapy for college students. (Deckro, et al, nd, paraphrased)
The work of Zautra, et al (2008) entitled “Comparison of Cognitive Behavioral and Mindfulness Meditation Interventions on Adaptation to Rheumatoid Arthritis for Patients With and Without History of Recurrent Depression” reports a study that explored whether cognitive behavioral therapy and mindfulness interventions targeting chronic stress, pain, and depression responses serve to reduce the pain and improve the life quality of adults with rheumatoid arthritis. The study involved 144 participants with participants clustered into groups totaling 6 to 10 for each group and each group being assigned randomly to one of three treatments: (1) cognitive behavioral therapy for pain (P); (2) mindfulness meditation and emotion regulation therapy (M); and (3) education only (E). The study was conducted through a multi-method approach involved the use of daily diaries combined with laboratory assessment of pain and nitrogen-stimulated levels of interleukin-6. Self-reported pain control post-improvement was self-reported in the IL-6 group and both the P and M groups are stated to have shown a greater level of improvement in efficacy of coping than the E group. The study findings are stated to be of the nature that “offer qualified support for mindfulness mediation in addition to pain management skills training offered in standard methods of CBT for pain.” (Zautra, et al, 2008, p.420) This is stated to be the first “published randomized clinical trial that has compared a mindfulness-based intervention with an empirically supported psychological treatment for chronic pain.” (Zautra, et al, 2008, p.420)
The work of Caldwell, et al (nd) entitled “Developing Mindfulness in College Students Through Movement-Based Courses: Effects and Regulatory Self-Efficacy, Mood, Stress, and Sleep Quality” reports a study that sought to determine if mindfulness increased through participation in movement-based courses and whether changes in self-regulatory, self-efficacy, mood and perceived stress mediated the relationship between increased mindfulness and better sleep. The study involved 166 college students enrolled in the 2007-08 academic year in classes in Pilates Taiji quan lasting 15 weeks. It is reported that at all junctures of the semester that participants in the study had improved “…measures of mindfulness, self-regulatory self-efficacy, mood, perceived stress, and sleep quality.” (Caldwell, et al, nd) The study results show an overall increase in mindfulness scores and mindfulness subscales. Sleep quality was linked to the greater changes in mindfulness. It is also stated in the findings that “Tiredness, Negative Arousal, Relaxation, and Perceived Stress mediated the effect of increased mindfulness on improved sleep” (Caldwell, et al, nd) The study concludes that movement-based courses serve to bring about increases in the individual’s “mindfulness” In addition increased mindfulness results in changes in moods and perceived stress which assist in explaining at least in part the improvements in sleep quality. (Caldwell, et al, nd)
The work of Zeidan (2009) entitled “Effects of Brief and Sham Mindfulness Meditation on Mood and Cardiovascular Variables” reports a study conducted with 82 undergraduate student participants with no prior experience in meditation. The participants participated in three sessions involving training in (1) mindfulness; (2) meditation; or (3) sham mindfulness for the purpose of determining the changes in the individual’s heart rate, blood pressure, and psychologic variables both before and following the intervention. Findings from the study state as follows: “The meditation intervention was more effective at reducing negative mood, depression, fatigue, confusion, and heart rate, when compared to the sham and control groups.” (Zeidan, et al, 2009)
A report published September 1, 2010 reports that researchers from the University of Cambridge in an analysis of 155 boys from two UK independent schools states findings that the 14 and 15-year-old boys “were found to have increased well-being defined as the combination of feeling good (excluding positive emotions such as happiness, contentment, interest and affection) and functioning well.” (Science Daily, 2010) According to Professor Felecia Huppert of the Well-Being Institute at the University of Cambridge: “More and more we are realizing the importance of supporting the overall mental health of children. Our study demonstrates that this type of training improves well-being in adolescents and that the more they practice, the greater the benefits. Importantly, many of the students genuinely enjoyed the exercises and said they intended to continue them — a good sign that many children would be receptive to this type of intervention. Another significant aspect of this study is that adolescents who suffered from higher levels of anxiety were the ones who benefitted most from the training.” (Science Daily, 2010)
The work of Beauchemin, Hutchins, and Patterson (2008) reports that students with learning disabilities (LD defined by compromised academic performance) “often have higher levels of anxiety, school-related stress and social skills are that are not as optimal as those of their peers. The pilot study reported by Beauchemin, Hutchins, and Patterson (2008) used a pre-post no control design to examine the feasibility of attitudes toward and the outcomes of a five-week mindfulness meditation intervention. This intervention involved 34 adolescents diagnosed with learning disabilities. Post intervention survey responses are reported to have shown positive attitudes of the individuals involved in the program toward the program. There was significant improvement in all outcomes measures. (Beauchemin, Hutchins, and Patterson, 2008) Robert B. Wall reports a clinical project that used the combination of Tai Chi and mindfulness-based stress reduction as an educational program. The program lasted five weeks and involved school-aged boys and girls. Group selection was conducted by the school nurse and faculty and involved students with only minor behavioral issues. At the start of the group, there were stated goals and rules. Classes were provided on a voluntary basis. Students participating in the group are reported to have experienced “well-being, calmness, relaxation, improved sleep, less reactivity, increased self-care, self-awareness, and a sense to interconnection or interdependence with nature.” (Wall, 2008)
The work of Cohen-Katz et al entitled “The Effects of Mindfulness-Based Stress Reduction on Nurse Stress and Burnout” reports an 8-week mindfulness based stress reduction (MBSR) program based on the University of Massachusetts Medical Center Program created by Jon Kabat-Zinn which was proferred to nursing professionals and Lehigh Valley Hospital and Health Network (LVHHN). It was originally hypothesized that MBSR would be useful for the nurses since the majority of nursing staff were women and it was believed that a primary issue for the nurses was maintaining a work-life balance. Secondly, it was believed that these nurses would be especially vulnerable to burnout. Data from the study was reported to have supported this belief. Family stressors are reported to be the primary source of stress including such as illness, recent death of a family member and aging family members. Specifically stated in the study findings is the following:
“As the nurses acknowledged their needs and humanness, they began to develop greater self-kindness and reported a dramatic shift in their capacity to care for themselves. As teachers, a moving aspect of this work was observing this shift. The participants reported enjoying the simple pleasures around them, such as practicing meditation without guilt or even feeling the pleasure of a dog nuzzling them! For some, self-care included caring for their health: their skin, their need for exercise, and their desire for healthy eating. The program participants became more aware of their needs and more committed to communicating these needs to others.” (Cohen-Katz, nd) It is reported that the MBSR, in terms of its impact, was realized throughout the relationship network of each participant in the study. Participants are noted to have observed changes of a positive nature in their relationships with their spouses, colleagues and their children and report being “more fully present with others…paying more attention to their current patient…becoming less reactive and defensive in work and family relationships.” (Cohen-Katz, nd)
It is reported that one supervisor nurse developed an attitude that was fairer and to have become more consistent while another nurse who formerly was known for gossip and complaints became less so inclined. Furthermore, the self-awareness was raised and this is reported as being critical for the nurses as healers. Restlessness was reported by the nurses as being particularly challenging however, as the nurses progressed in the program they reported that their minds settled down and emotional issues that were previously unresolved surfaced including “an unrecognized abuse history, a long-suppressed sadness about an ended marriage, a troubling sense of guilt about a childhood event, and a pervasive sense of resentment…” (Cohen-Katz, nd)
The work of Gross, et al (2010) entitled “Mindfulness Based Stress Reduction for Solid Organ Transplant Recipients: A Randomized Controlled Trial” reports a study that assessed the efficacy of mindfulness-based stress reduction (MBSR) in reducing the symptoms of depression, anxiety and poor sleep in patients who had undergone transplants. The study reported was a controlled trial with two-staged randomization. Mindfulness meditation training was a program that lasted eight weeks with 2.5-hour classes including health education and peer-led active control. Primary outcome measures were those of: (1) anxiety; (2) depression; (3) and sleep quality. The study reports results being benefits of MBSR which were “above and beyond those afforded by the active control.” (Gross, et al, 2010) MBSR was effective in the reduction of anxiety and sleep symptoms with medium treatment effects at 1 year when compared to health education in intention-to-treat analyses. The MBSR group reported a decrease in depression, anxiety, and sleep problems, and an improvement in quality-of-life measures by eight weeks with all benefits being retained at one year following the study. The study concludes that MBSR is effective in reduction of depression, anxiety, and sleep problems and in improving the participant’s quality of life with a sustained benefit at one year following the study. (Gross, et al, 2010, paraphrased)
The work of Young and Baime (2010) entitled “Mindfulness-Based Stress Reduction: Effect on Emotional Distress in Older Adults” reports a study in which MBSR was used in a group-based intervention that provided instruction on techniques in mindfulness including meditation and mindful movement. The study included 27 hours of instruction over an eight-week period with homework including practice for 45 minutes daily in mindfulness exercises. THE POMS-SF of Profile of Mood States – Short Form was completed just before and immediately following MBSR training. The study reports improvements in the overall psychological distress and all mood subscales in both older males and older females after MBSR training and this is stated to potentially have clinical significance. The subset of participants, or those with clinically significant anxiety and depression, and based on POMS-SF scores, outpatient-based intervention that was nonpharmacological in nature was designed for improving skills in stress management and is reported to have made the provision of relief that was significant for most of the older patients. It is reported that very few of the participants had previously held beliefs that their participants would result in an improvement in mood, or that participants would serve to increase their vigor or improve their level of confusion therefore, it reported that “…making these observed psychological improvements less attributable to expectancy bias.” (Young and Baime, 2010) Mindfulness training is stated to have proven to be effective in alleviating psychological distress in diverse heterogeneous populations.
The work of Roberts and Danoff-Burg (2010) reports a study in which relations between mindfulness and health behaviors in college students and the role of stress in the mediation of these effects. Participants in the study included 553 undergraduates that were recruited from a northeastern United States university. Participants in the study completed questionnaires that assessed mindfulness, perceived health, health behaviors, and health-related activity restriction and stress. Roberts and Danoff-Burg (2010) state that mindfulness is a concept known to have emerged in Buddhist meditation practices thousands of years ago only recently becoming known to the Western world. Mindfulness is stated to be a way of “paying attention – a ‘moment-to-moment’, non-judgmental awareness that involves purposely focusing on the experiences of the present moment.” It is suggested by Eastern spiritual tradition that it is possible to cultivate mindfulness through regular meditation practices described as “the measure of our thoughts, our emotions, our body sensations, and embracing all that in awareness.” (Kabat-Zinn, 2005 in: Roberts and Danoff-Burg, 2010)
It is further reported that Zvolensky et al examined the role of mindfulness-based attention in the prediction of perceived health status and functioning and found that in a community sample, measured by the Mindfulness Attention Awareness Scale that greater levels of mindfulness-based attention were linked to perceptions of both the physical and psychological functioning improvement in young adults. (Roberts and Danoff-Burg, 2010, paraphrased) In another study findings report that in excess of 1/3 of college students who were surveyed had sleep problems and that mindfulness meditation assists in the reduction of sleep disturbances that are stress-related. (Roberts and Danoff-Burg, 2010, paraphrased) It has also been indicated that mindfulness meditation assists in smoking cessation. The most common of all eating disorders or that of binge eating was also found to be responsive to mindfulness meditation. (Roberts and Danoff-Burg, 2010, paraphrased) The study reported a link between mindfulness and health perceptions and behaviors in college students and findings are stated to indicate that mindfulness is directly related to decreases in stress and contributes to the increases in health perceptions and behaviors. (Roberts and Danoff-Burg, 2010, paraphrased)
The work of Kvillemo and Branstrom (2011) entitled “Experiences of a Mindfulness-Based Stress-Reduction Intervention among Patients with Cancer” relates a study that was conducted with the objective of observing the results of mindfulness stress reduction therapy for cancer patients. The study is reported to be based upon the data analyzed, which was collected in semistructured interviews so the participants after a mindfulness-medication training program was completed. (Kvillemo and Branstrom, 2011, paraphrased) The intervention reported is an eight-week mindfulness training program. Results reported in the study include that the majority of participants stated various perceived positive effects from their participation in the mindfulness program which include: (1) they were calmer; (2) they slept better; (3) their energy was enhanced; (5) they did not hurt as much; and (5) their well-being was increased. (Kvillemo and Branstrom, 2011, paraphrased)
Reported as a significant source of stress is caring for a child with a chronic disability or illness and as well children with special needs demand care that is unique in association with their health condition. This increased demand is reported to “often result in adverse repercussions in terms of family functioning, and may result in high levels of stress for both the child and caregiver.” (Kvillemo and Branstrom, 2011, paraphrased) The study reported was based “on the high levels of need in this population, and the success of Mindfulness-Based Stress Reduction (MBSR) in other highly distressed groups and was focused on determining the use of a pre-post intervention design” and the changes that are likely to occur in a group of caregivers due to participation in MBSR. (Kvillemo and Branstrom, 2011, paraphrased) It is reported that clinical treatment and wellness programs that have MBSR as their basis have grown and that there are presently more than 250 programs in the U.S. alone. (Kvillemo and Branstrom, 2011, paraphrased) The study reported involved a convenience sampling used for enrolling parents and caregivers in the study. It is reported that the newly developed MBSR program was advertised throughout a large urban children’s medical center and specifically Alberta Children’s Hospital and for both patients and their caregivers. Program information was presented to various professional teams in the hospital setting as well as being advertised on the hospital’s website and throughout the hospital. The study findings are stated to be striking in two ways: (1) due to the high levels of stress, symptoms, and mood disturbance reported by caregivers prior to participation in the intervention. The pre-intervention scores on both the SOSI and POMS are similar to those reported in a group of cancer patients, many of whom had late-stage disease and were undergoing treatment. In addition, the scores were also reported much higher in the area of mood disturbance than in a group of cancer patient family members; and (2) due to the significant amount of improvement over the course of this eight-week intervention. (Kvillemo and Branstrom, 2011, paraphrased)
The Five Facet Mindfulness Questionnaire (FFMQ) is a 39-item instrument that uses a 5-point Likert-type scale.. The five factors representing elements of mindfulness include (1) observation or attention to sensations, perceptions, thoughts, and feelings; (2) description of these internal experiences with words; (3) acting with awareness rather than on ‘automatic pilot’ to inner experiences; and (5) non-reactive to inner experience.” (Zeidan, et al, 2009) The Total Mindfulness score is reported to have been calculated by adding scores on each of the 5 scales with greater levels of mindfulness being those with higher scores. (Zeidan, et al, 2009) The study further utilized the Pittsburg Sleep Quality Index (PSQI), which consists of 19 self-rated questions regarding normal sleeping habits. With scores ranging from 0 to 21, the higher PSQI scores indicated greater levels of sleep disturbance and poorer quality of sleep.
The Self-Regulatory Self-Efficacy Scale (SRE) is a four-item Likert-type instrument with a design focused on measurement of self-regulatory and self-efficacy The scores range from 4 to 28 and the measures is stated to have been found to be correlated with perceived performance and activity-specific self-efficacy.
The Four-Dimensional Mood Scale (FDMS) is reported to be based on “a circumplex model of dispositional mood measuring Positive Energy, Tiredness, Negative Arousal and Relaxation.” (Zeidan, et al, 2009) This test is comprised by a 20-item adjective checklist and to use a 5-point Likert scale. Scores on each scale are stated to be the “mean response to items on the scale.” (Zeidan, et al, 2009) The Perceived Stress Scale – 4 (PSS4) is a four-item Liker-type scale which has as its design the measurement of “the degree to which situations in one’s life are appraised as stressful.” (Zeidan, et al, 2009)
The work of Birnie, Garland, and Carlson (2010) entitled: “Psychological Benefits for Cancer Patients and their Partners Participating in Mindfulness-based Stress Reduction (MBSR) reports a study that examined the impact of a Mindfulness-based Stress Reduction program for the duration of eight weeks for 21 individuals with cancer and their spouse. Findings from the study state that there were “significant reductions for both patients and partners in mood disturbance.”
Methodology
- Research Design
The research in this proposed study will be a Quantitative research study in a Quasi-experimental research design. The research will involve the intervention of Mindfulness Meditation and will include a Pretest prior to the intervention and a post-test following the intervention. This study will include assessment of blood pressure and other vital signs. - Sampling
The sample in this study will include a group of adolescents. - Conceptual Framework of the Study
The conceptual framework of this study is as follows:
- Pre-test and Post-test
As shown in the figure above the participants will be observed in a pretest study for psychological and emotional distress and the blood pressure and vital signs of participants will be taken. Mindfulness meditation intervention will be provided and a posttest study will observe psychological and emotional distress levels in participants and the blood pressure and vital signs of the participants will be taken. The pre-test and post-test findings will be compared to assess the effectiveness of the mindfulness mediation intervention in this study. - Quasi-Experimental Evaluation
The Quasi-experimental evaluation while unable to prove that a program is the cause of the change in outcomes in valuable through the provision of the following: (1) Descriptive information about the population served; (2) Information that suggests whether anticipated changes are occurring; (3) Data that suggest the magnitude of change that is occurring over time; (4) Information on whether anticipated changes are occurring in some subgroups and not others; and (5) Information on whether some outcomes are changing while others are not. (Moore, 2008)
The Quasi-experimental study is appropriate for use when random assignment is not feasible or is unethical and when random assignment in not affordable. This type of study is also appropriate when the “pool of potential participants is too small to fill both a treatment and a control group.” (Moore, 2008) Furthermore, the Quasi-experimental design is appropriate when a program has a desire to “establish ongoing, internal evaluation capacity.” (Moore, 2008) - Limitations of the Study
The limitations of the Quasi-experimental research design are inclusive of the potential risk of selecting a comparison population that is not similar to the population being served. However, in this study, the target population is a group of adolescents and it is this group that the program is focused on in this study and in the mindfulness meditation intervention. - Data Analysis
Data will be analyzed through conducting a comparison of the assessments of pre-test and post-test observation of psychological and emotional distress levels of participants and through comparison of blood pressure and vital sign readings of the participants in this study.
References
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