Mindfulness accepts some degree of suffering as part of the human condition. Mindfulness-based approaches have shown efficacy in depression, anxiety, and trauma. For bereaved patients with similar symptoms, could it also help them cope with their loss?
A study by Thieleman et al. done in 2014 examined such an approach in approximately 40 bereaved participants, mostly parents, who had self-referred for grief counseling at a mental health center. Clinicians at this center used the mindfulness-based ATTEND model: Attunement, Trust, therapeutic Touch, Egalitarianism, Nuance, and Death education. Attunement is the way we react to one another; in this case, it included clinician mindfulness. Trust is built by listening and validating the patient’s story, whereas therapeutic touch is gently incorporated where appropriate, if there is a trusting relationship between clinician and patient. The egalitarian approach is to palliate the power differential between the patient and clinician by regarding the patient as the expert of their life experiences. Nuanced care involves personalized care for the patient, their beliefs, and their culture. Death education is proactively used through psychoeducation by validating traumatic grief, as well as providing reading materials appropriate for the patient. Mindfulness practices, like meditation and emotional awareness, are incorporated throughout the therapy.
Participants self-reported their symptoms on two scales, the Impact of Event Scale-Revised and 25-item Hopkins Symptom Checklist. These scales measure symptoms of traumatic stress, anxiety, and depression. When comparing pre-intervention and post-intervention scores on the scales, there was a statistically significant decrease in the scores for both scales as well as for the subsets within each scale.
This suggests that a mindfulness-based approach could be helpful in alleviating symptoms of depression, anxiety, and trauma in bereaved patients. Mindfulness can help the individual have greater emotional awareness and increased tolerance towards the intense emotions experienced in bereavement. It can also decrease experiential avoidance – that is, avoiding uncomfortable thoughts, feelings, and memories. This type of therapy can also improve symptoms regardless of the amount of time which has passed since the death, as seen by patients who received treatment as much as 7 years after their loss. It might also help protect the clinicians from fatigue and burnout. As the loss of a loved one through death is a universal human experience, the benefits of mindfulness are worth noting not only for patient care, but also for self-care for medical students and doctors.
The biggest limitation of this study is its design, which was quasi-experimental. The study was based on a single group and did not include a control group. The patients were also self-referred for therapy, which does not represent the majority of people going through a bereavement. For these reasons, it’s impossible to say if the intervention itself was responsible for the changes in scores. Further research with an experimental design and a long-term follow-up is necessary.
References
(1) Thieleman, K., Cacciatore, J. & Hill, P.W. Traumatic Bereavement and Mindfulness: A Preliminary Study of Mental Health Outcomes Using the ATTEND Model. Clin Soc Work J 42, 260–268 (2014). https://doi.org/10.1007/s10615-014-0491-4
This article was written by Devangi Patel, a medical student at McGill University and member of the McGill Med Mindfulness Team.
The Mindful Medical Learner 