Rachel E. Myers

Soles of the Feet: A Mindfulness-Based Self-Control Intervention for Aggression by an Individual with Mild Mental Retardation and Mental Illness.

Uncontrolled low frequency, high intensity aggressive behavior is often a barrier to community living for individuals with developmental disabilities. Aggressive behaviors are typically treated with psychotropic medication, behavioral interventions or their combination; but often the behaviors persist at a level that is problematic for the individual as well as care providers. We developed a mindfulness-based, self-control strategy for an adult with mental retardation and mental illness whose aggression had precluded successful community placement. He was taught a simple meditation technique that required him to shift his attention and awareness from the anger-producing situation to a neutral point on his body, the soles of his feet. After practice he applied this technique fairly consistently in situations that would normally have elicited an aggressive response from him. The data show that he increased self-control over his aggressive behaviors, met the community providers requirement for 6 months of aggression-free behavior in the inpatient facility before being transitioned to the community, and then successfully lived in the community without readmission to a facility. No aggressive behavior was seen during the 1-year follow-up after his community placement. Mindfulness-based intervention may offer a viable alternative to traditional interventions currently being used to treat behavioral challenges in children and adults with mild mental retardation.

Effects of Role-Play and Mindfulness Training on Enhancing the Family Friendliness of the Admissions Treatment Team Process

This article describes two studies that evaluated training intended to improve the family friendliness of five components of the admissions treatment team process (Introduction, Meeting Management, Case Presentation and Discussion, Service Plans, and Tact and Technicalities) at an inpatient child and adolescent psychiatric hospital. In Study 1, we observed 18 case presentations and found that the ratings on family friendliness were low on Service Plans and Tact and Technicalities. Following three role-play training sessions, we found no statistically significant improvement. In Study 2, we used a multiple-baseline design across treatment team process components and enhanced the family friendliness of each component through mindfulness training. Follow-up observations at monthly intervals for 6 months showed continued high rates of family friendly services. Our study suggests that the mindful delivery of mental health services can produce long-term gains in the family friendliness of admissions treatment teams.

A Randomized Controlled Trial of a Mindfulness-Based Smoking Cessation Program for Individuals with Mild Intellectual Disability

Smoking is a risk factor for death and dying for individuals who smoke and for those who inhale second hand smoke. Smokers struggle to quit smoking because of the negative affect associated with nicotine withdrawal. We assessed the efficacy of a mindfulness-based intervention for smoking cessation in individuals with mild intellectual disabilities. In addition to the basic concentration meditation, the mindfulness-based smoking cessation program included daily intention, mindful observation of thoughts, and Meditation on the Soles of the Feet. In a two-group randomized controlled trial, 51 protocol-eligible participants were randomly assigned to either the experimental group (mindfulness-based intervention) or the control group (treatment as usual). Results showed a statistically significant reduction in smoking commensurate with mindfulness-based training when compared to the treatment as usual condition. This finding was evident regardless of whether the analysis included only those who completed the study or the total sample in an intent-to-treat analysis. Furthermore, those receiving the mindfulness-based intervention were significantly more successful in abstaining from smoking during a 1-year follow-up than the treatment as usual group. These results suggest mindfulness-based interventions may be effective treatments for smoking cessation in individuals with mild intellectual disabilities.

Caregiver Training in Mindfulness-Based Positive Behavior Supports (MBPBS): Effects on Caregivers and Adults with Intellectual and Developmental Disabilities

Caregivers often manage the aggressive behavior of individuals with intellectual and developmental disabilities that reside in community group homes. Sometimes this results in adverse outcomes for both the caregivers and the care recipients. We provided a 7-day intensive Mindfulness-Based Positive Behavior Support (MBPBS) training to caregivers from community group homes and assessed the outcomes in terms of caregiver variables, individuals’ behaviors, and an administrative outcome. When compared to pre-MBPBS training, the MBPBS training resulted in the caregivers using significantly less physical restraints, and staff stress and staff turnover were considerably reduced. The frequency of injury to caregivers and peers caused by the individuals was significantly reduced. A benefit-cost analysis showed substantial financial savings due to staff participation in the MBPBS program. This study provides further proof-of-concept for the effectiveness of MBPBS training for caregivers, and strengthens the call for training staff in mindfulness meditation.

A mindfulness-based intervention for self-management of verbal and physical aggression by adolescents with Prader–Willi syndrome

ABSTRACT Purpose: There is a dearth of clinical and research literature on the treatment of maladaptive behaviors in adolescents with Prader–Willi syndrome (PWS). The purpose of this study was to evaluate the effectiveness of a mindfulness-based intervention, Meditation on the Soles of the Feet (SoF), to facilitate self-management of verbal and physical aggression. Method: We utilized a multiple-baseline design across participants to test the intervention with three adolescents diagnosed with PWS. Results: Relative to baseline, verbal aggression decreased to minimal levels following mindfulness-based practice and physical aggression was nearly eliminated. Intervention effects were maintained at 12-month follow-up. Quantitative analytics confirmed statistically significant outcomes. Conclusions: The SoF mindfulness intervention was effective in reducing verbal and physical aggression in three adolescents with PWS. Future research should test the SoF intervention with this clinical population in a larger clinical trial, and the SoF intervention may be applicable to other pediatric populations.

Comparative Effectiveness of Caregiver Training in Mindfulness-Based Positive Behavior Support (MBPBS) and Positive Behavior Support (PBS) in a Randomized Controlled Trial

Caregivers of individuals with intellectual and developmental disabilities are often stressed due to the demands of the job, including the nature and severity of challenging behaviors of the clients, work conditions, degree of management support for the staff, and the demands of implementing some interventions under adverse conditions. Mindfulness-Based Positive Behavior Support (MBPBS) and PBS alone have been shown to be effective in assisting caregivers to better manage the challenging behaviors of clients with intellectual and developmental disabilities. The aim of the present study was to undertake a head-to-head assessment of the effectiveness of MBPBS and PBS alone in a 40-week randomized controlled trial. Of the 123 caregivers who met inclusion criteria, 60 were randomly assigned to MBPBS and 63 to PBS alone, with 59 completing the trial in the MBPBS condition and 57 in the PBS alone condition. Results showed both interventions to be effective, but the caregiver, client, and agency outcomes for MBPBS were uniformly superior to those of PBS alone condition. In addition, the MBPBS training was substantially more cost-effective than the PBS alone training. The present results add to the evidence base for the effectiveness of MBPBS and, if independently replicated, could provide an integrative health care approach in the field of intellectual and developmental disabilities.

Mental Health Nursing Services

This chapter describes the role and functions of psychiatric-mental health (PMH) nursing in inpatient psychiatric hospitals. The chapter begins with a brief description of various nursing roles, nursing’s relationship to the recovery model, and the therapeutic nurse–patient relationship. This is followed by a brief description of the inpatient psychiatric hospital setting and individuals typically served in this setting. Then there is a discussion of treatment planning and the nursing process, and the vital role of the PMH nurse as an interdisciplinary treatment team member. Next, there is a discussion of some of the services nurses provide, including assessments and interventions, with an emphasis on how nurses can incorporate recovery principles into the provision of these services. The chapter concludes with a discussion of some challenges the recovery model poses for nurses providing these services in inpatient psychiatric hospitals.