Beneficial Effects of Mindfulness Based Interventions Used with Spinal Cord Injury Patients; Integrative Literature Review

Beneficial Effects of Mindfulness Based Interventions Used with Spinal Cord Injury Patients An Integrated Review of Literature

Sharif Rahim

Background and Significance: The major psychiatric complication of 20 to 45% after the injury is related to depression (North, 1999). This population has 4 to 5 times of higher rates of suicide which is the leading cause of death. Seventy-five percent of suicides occur within the first 5 years of the injury. High levels of pain and lack of support further increases their status of being at high risk. This population faces a difficult transition filled with stress from the trauma of physical injuries, healing, rehabilitation, and an acceptance of a life filled with many forms of physical dependency depending on their level in the spine of injury from paraplegic to quadriplegic. The mode of stress reduction should be where the physically challenged SCI individual can positively cope utilizing their minds deliberately despite their physical limitations. Mindfulness based stress reduction (MBSR) interventions may play a key role during the recovery and rehabilitation process. However, this stress reduction modality requires further exploration of a review of literature since the present research is unknown regarding medical/psychiatric conditions for the SCI population.

Objectives: The purpose of this literature review is to explore, analyze, and identify mindfulness-based interventions that may have the possibility of allowing a person with SCI to have a more effective recovery and quality of life.

Methods: The research design includes an integrative literature review conducted to analyze the benefits of mindfulness interventions in people living with spinal cord injuries. According to Torraco (2005), an integrative literature review is a distinctive form of research that generates new knowledge about the topic reviewed

Results: A total of 6 research article studies were reviewed and analyzed. The articles were grouped into four prevalent themes. The first theme was in relation to yoga as a SCI mindfulness modality. The case study found yoga to be effective by increasing balance, flexibility, and decreased physical pain of a high fall risk incomplete C3-C6 SCI subject. The same subject had a lower quality of life due to disappointment in abilities to perform tasks were not in the same way prior to injury. The second theme was in relation to biological and immunological outcomes. This theme was explored whether mindfulness meditation as a stress reduction modality had an effect on decreasing biological and immunological markers for patients with generalized anxiety disorder. Acetylcholine, tumor necrosis factor and Interleukin-6 all decreased post-intervention signaling that mindfulness mediation had a significant effect on these 3 markers, but cortisol had no significant response. Cortisol did not respond according to researchers due to a slower half-life. The third theme was exploratory on resilience which was found be a strong possible component of mindfulness for SCI population. Mental strength was verbalized as in the perseverance to live by adapting and/or finding meaning from traumatic events. SCI subjects with more resilient thoughts had also higher self-efficacy. The fourth theme was in exploring benefits of mindfulness meditation for reduction of anxiety and coping. One study on emotional control testing found that cardiovascular subjects in mindfulness program indicated improvement for expressing negative feelings from pre to post-intervention. This may have potential for SCI population to increase their skill in outwardly expressing feelings during transition of healing/recovery. SCI subjects may have a period of uncertainty and anxiety from the initial injury to rehabilitation. If uncertainty can be tolerated with decrease levels of anxiety and increased levels of mindfulness perhaps post-traumatic growth may be facilitated.

Conclusion: Return to the literature verified the lack of articles on mindfulness with SCI patients regarding bowel and bladder dysfunction was found. There is promise that mindfulness can be utilize as a treatment modality for bladder dysfunction since there is recent research that bladder incontinence can be improved. Evidence-based practice for optimal outcomes for the SCI patient in support of their mental and physical well-being though their journey of recovery is lacking in nursing literature. To address the limitations of findings of this IRL: 1) more SCI patients of different ethnicities, males, and larger sample sizes would assist in population representativeness and generalization. 2) Longitudinal counseling interventional studies along with mental health assessments utilizing established tools would reflect more of the process of recovery for both mental and physical health. 3) Need for a theoretical/conceptual model to guide the researchers who will be incorporating mindfulness interventions. 4) Caregivers and social support in the communities of SCI patient was lacking and is needed to be focused on.

Key words: “spinal cord injury”, “mindfulness”, “MBSR”, “stress”, “quality of life”, “meditation”, “biopsychosocial”, “anxiety”, “yoga therapy