Improve Mental Health in Older Adults with Mental Health Problems with Mindfulness
By John M. de Castro, Ph.D.
“You can think of emotional regulation like stopping a train—it works better if you can stop before the train (your emotions) starts rolling too fast. It also helps when your brakes work immediately, without interference. Mindfulness lets you know right away that you need to stop and keeps thoughts and emotions from interfering.” – University of Minnesotta
As we age, there are systematic progressive declines in every system in the body, the brain included. This includes our mental abilities and results in impairments in memory, attention, and problem-solving ability. Aging also results in changes in mental health. Depression is very common in the elderly. The elderly cope with increasing loss of friends and family, deteriorating health, as well as concerns regarding finances on fixed incomes. In addition, many elderly experience withdrawal and isolation from social interactions producing increased loneliness, worry and anxiety.
Mindfulness appears to be effective for an array of psychological issues that occur with aging. It has also been shown to be beneficial in slowing or delaying physical and mental decline with aging. and improve cognitive processes. It has also been shown to reduce anxiety, worry, and depression and improve overall mental health. But not everyone responds to mindfulness training with improvement. Identifying who will respond and who won’t is important in determining the best treatment option for each individual.
In today’s Research News article “Predictors of Improvements in Mental Health From Mindfulness Meditation in Stressed Older Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802968/ ), Oken and colleagues recruited generally healthy, meditation naïve, older individuals aged 50 to 85 years who reported high levels of perceived stress. They were randomly assigned to a wait-list control group or to receive a 6-week program of Mindfulness-Based Cognitive Therapy (MBCT) including home practice. MBCT training occurred once a week for 60 to 90 minutes and involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy That is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms.
The participants were measured before and after treatment and 2 months later for perceived stress, life experience stressors, neuroticism, positive and negative emotions, depression, health-related quality of life, sleep quality, fatigue, self-efficacy, and mindfulness. The researchers separated the participants by their response to the treatment with responders (half the participants) showing significant improvement in mental health.
They found that the responders had poorer mental health at the beginning (baseline) including greater levels of negative emotions, lower health related quality of life, and greater fatigue. One interpretive difficulty here is a phenomenon called regression to the mean. This occurs when extremes are selected. On retest they are almost always significantly better. It is possible that the observed effects were not due to the treatment but to people who were struggling getting spontaneously better.
These results, however, suggest that MBCT training is best suited to older individuals who have existing mental health issues and is little value to those who are relatively stable psychologically. This makes sense and implies that MBCT training is not particularly useful for psychologically healthy individuals but can help those with difficulties.
So, improve mental health in older adults with mental health problems with mindfulness.
“The research is strong for mindfulness’ positive impact in certain areas of mental health, including stress reduction, emotion and attention regulation, reduced rumination, for reducing mild to moderate depression and anxiety, and preventing depressive relapse.” – Kelle Walsh
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Oken, B. S., Goodrich, E., Klee, D., Memmott, T., & Proulx, J. (2018). Predictors of Improvements in Mental Health From Mindfulness Meditation in Stressed Older Adults. Alternative therapies in health and medicine, 24(1), 48-55.
Abstract
Context
The benefits of a mindfulness meditation (MM) intervention are most often evidenced by improvements in self-rated stress and mental health. Given the physiological complexity of the psychological stress system, it is likely that some people benefit significantly, while others do not. Clinicians and researchers could benefit from further exploration to determine which baseline factors can predict clinically significant improvements from MM.
Objectives
The study intended to determine: (1) if the baseline measures for participants who significantly benefitted from MM training were different from the baseline measures of participants who did not and (2) whether a classification analysis using a decision-tree, machine-learning approach could be useful in predicting which individuals would be most likely to improve.
Design
The research team performed a secondary analysis of a previously completed randomized, controlled clinical trial.
Setting
Oregon Health & Science University and participants’ homes.
Participants
Participants were 134 stressed, generally healthy adults from the metropolitan area of Portland, Oregon, who were 50 to 85 years old.
Intervention
Participants were randomly assigned either to a six-week MM intervention group or to a waitlist control group, who received the same MM intervention after the waitlist period.
Outcome Measures
Outcome measures were assessed at baseline and at two-month follow-up intervals. A responder was defined as someone who demonstrated a moderate, clinically significant improvement on the Mental Health Component (MHC) of the SF-36, Short Form Health-related Quality of Life (SF-36), ie, a change ≥4. The MHC had demonstrated the greatest effect size in the primary analysis of the above-mentioned randomized, controlled clinical trial. Potential predictors were demographic information and baseline measures related to stress and affect. Univariate statistical analyses were performed to compare the values of predictors in the responder and nonresponder groups. In addition, predictors were chosen for a classification analysis using a decision tree approach.
Results
Of the 134 original participants, 121 completed the MM intervention. As defined above, 61 were responders and 60 were nonresponders. Analyses of the baseline measures demonstrated significant differences between the 2 groups in several measures: (1) the Positive and Negative Affect Schedule negative sub-scale (PANAS-neg), (2) the SF-36 MHC, and (3) the SF-36 Energy/Fatigue, with clinically worse scores being associated with greater likelihood of being a responder. Disappointingly, the decision-tree analyses were unable to achieve a classification rate of better than 65%.
Conclusions
The differences in predictor variables between responders and nonresponders to an MM intervention suggested that those with worse mental health at baseline were more likely to improve. Decision-tree analysis was unable to usefully predict who would respond to the intervention.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802968/