Skip to main content

Advertisement

SpringerLink
Log in

A Pilot Randomized Controlled Trial of a Mindfulness-Based Intervention for Caregivers of Veterans

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Objectives

Informal caregivers of veterans are providing care for a population whose specialized care needs require increased investments on the part of caregivers and for longer durations. Empirical evidence shows negative mental health effects on these caregivers at rates that outpace those seen in caregivers in the general population. With a growing need and limited resources, effective interventions are needed to improve mental health outcomes in this special population of caregivers.

Methods

This pilot, randomized control trial tested the effectiveness of a mindfulness-based intervention at improving perceived stress, depressive symptoms, anxiety, and worry compared to waitlist controls in a sample of 23 caregivers of veterans.

Results

The Mann-Whitney U tests used to determine whether groups differed in change scores (post minus pre) indicated that there were significant differences between the mindfulness and waitlist control group in perceived stress (U = 21.5, p = .006, r = .57), anxiety (U = 24.0, p = .009, r = .54), and worry (U = 29.5, p = .024, r = .47). Results from the Wilcoxon signed-rank tests indicated that caregivers in the mindfulness group reported a significant reduction in perceived stress (Z = − 2.50, p = .013, r = .75) and anxiety (Z = − 2.81, p = .005, r = .85), whereas the waitlist control group reported higher mean symptoms at the end of the intervention period.

Conclusions

Given these promising results, policymakers, health practitioners, and veteran-related programs should increase efforts to provide caregivers of veterans with mindfulness-based interventions to improve mental health outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Baer, R. A. (2003). Mindfulness training as a clinical intervention: a conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. https://doi.org/10.1093/clipsy.bpg015.

    Article  Google Scholar 

  • Bass, D. M., Judge, K. S., Snow, A. L., Wilson, N. L., Looman, W. J., McCarthy, C., et al. (2012). Negative caregiving effects among caregivers of veterans with dementia. The American Journal of Geriatric Psychiatry, 20(3), 239–247.

    Article  PubMed  Google Scholar 

  • Beck, J. G., Stanley, M. A., & Zebb, B. J. (1995). Psychometric properties of the Penn State Worry Questionnaire in older adults. Journal of Clinical Geropsychology, 1(1), 33–42.

    Google Scholar 

  • Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behaviour Research and Therapy, 30(1), 33–37.

    Article  PubMed  Google Scholar 

  • Carlozzi, N. E., Kratz, A. L., Sander, A. M., Chiaravalloti, N. D., Brickell, T. A., Lange, R. T., et al. (2015). Health-related quality of life in caregivers of individuals with traumatic brain injury: development of a conceptual model. Archives of Physical Medicine and Rehabilitation, 96(1), 105–113. https://doi.org/10.1016/j.apmr.2014.08.021.

    Article  PubMed  Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396.

    Article  PubMed  Google Scholar 

  • Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.

    Article  PubMed  Google Scholar 

  • Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

    Article  PubMed  Google Scholar 

  • Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: the development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29(3), 177.

    Article  Google Scholar 

  • Fischer, E. P., Sherman, M. D., Han, X., & Owen, R. R., Jr. (2013). Outcomes of participation in the REACH multifamily group program for veterans with PTSD and their families. Professional Psychology: Research and Practice, 44(3), 127.

    Article  Google Scholar 

  • Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011). Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatrica Scandinavica, 124(2), 102–119. https://doi.org/10.1111/j.1600-0447.2011.01704.x.

    Article  PubMed  Google Scholar 

  • Fortune, D. G., Richards, H. L., Griffiths, C. E., & Main, C. J. (2005). Worry and pathological worry in patients with psoriasis: cross sectional and longitudinal analyses of the Penn State Worry Questionnaire (PSWQ) in four samples of patients. Journal of Clinical Psychology in Medical Settings, 12(2), 143–152.

    Article  Google Scholar 

  • George, L. K., & Gwyther, L. P. (1986). Caregiver well-being: a multidimensional examination of family caregivers of demented adults. The Gerontologist, 26(3), 253–259.

    Article  PubMed  Google Scholar 

  • Ghasemi, A., & Zahediasl, S. (2012). Normality tests for statistical analysis: a guide for non-statisticians. International Journal of Endocrinology and Metabolism, 10(2), 486.

    Article  PubMed  PubMed Central  Google Scholar 

  • Griffin, J. M., Lee, M. K., Bangerter, L. R., Van Houtven, C. H., Friedemann-Sanchez, G., Phelan, S. M., et al. (2017). Burden and mental health among caregivers of veterans with traumatic brain injury/polytrauma. American Journal of Orthopsychiatry, 87(2), 139–148. https://doi.org/10.1037/ort0000207.

    Article  PubMed  Google Scholar 

  • Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004). Mindfulness-based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research, 57(1), 35–43. https://doi.org/10.1016/s0022-3999(03)00573-7.

    Article  PubMed  Google Scholar 

  • Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006.

    Article  PubMed  Google Scholar 

  • Guillen-Riquelme, A., & Buela-Casal, G. (2014). Meta-analysis of group comparison and meta-analysis of reliability generalization of the State-Trait Anxiety Inventory Questionnaire (STAI). Revista Española de Salud Pública, 88(1), 101–112.

    Article  PubMed  Google Scholar 

  • Hayes, J., Wakefield, B., Andresen, E. M., Scherrer, J., Traylor, L., Wiegmann, P., et al. (2010). Identification of domains and measures for assessment battery to examine well-being of spouses of OIF/OEF veterans with PTSD. Journal of Rehabilitation Research and Development, 47(9), 825–840.

    Article  PubMed  Google Scholar 

  • Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. https://doi.org/10.1177/1745691611419671.

    Article  PubMed  Google Scholar 

  • IBM_Corp. (2015). IBM SPSS statistics for Windows (version 23). Armonk: IBM Corp.

    Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12.

    Article  PubMed  Google Scholar 

  • Jaffray, L., Bridgman, H., Stephens, M., & Skinner, T. (2016). Evaluating the effects of mindfulness-based interventions for informal palliative caregivers: a systematic literature review. Palliative Medicine, 30(2), 117–131.

    Article  PubMed  Google Scholar 

  • Julian, L. J. (2011). Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care & Research, 63(S11), S467–S472.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1), 33–47.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156.

    Google Scholar 

  • Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., et al. (2013). Mindfulness-based therapy: a comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771.

    Article  PubMed  Google Scholar 

  • Knight, R. G., McMahon, J., Skeaff, C. M., & Green, T. J. (2008). Normative data for persons over 65 on the Penn State Worry Questionnaire. New Zealand Journal of Psychology, 37(1), 4–9.

    Google Scholar 

  • Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1), 163–173.

    Article  PubMed  Google Scholar 

  • Ladebue, A. C., Helfrich, C. D., Gerdes, Z. T., Fihn, S. D., Nelson, K. M., & Sayre, G. G. (2016). The experience of patient aligned care team (PACT) members. Health Care Management Review, 41(1), 2–10.

    Article  PubMed  Google Scholar 

  • Levine, C., Halper, D., Peist, A., & Gould, D. A. (2010). Bridging troubled waters: family caregivers, transitions, and long-term care. Health Affairs, 29(1), 116–124. https://doi.org/10.1377/hlthaff.2009.0520.

    Article  PubMed  Google Scholar 

  • Liu, Z., Chen, Q. L., & Sun, Y. Y. (2017). Mindfulness training for psychological stress in family caregivers of persons with dementia: a systematic review and meta-analysis of randomized controlled trials. Clinical Interventions in Aging, 12, 1521–1529. https://doi.org/10.2147/cia.s146213.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lorig, K., Thompson-Gallagher, D., Traylor, L., Ritter, P. L., Laurent, D. D., Plant, K., et al. (2012). Building better caregivers: a pilot online support workshop for family caregivers of cognitively impaired adults. Journal of Applied Gerontology, 31(3), 423–437. https://doi.org/10.1177/0733464810389806.

    Article  Google Scholar 

  • Lynn, J. (2014). Strategies to ease the burden of family caregivers. Journal of the American Medical Association, 311(10), 1021–1022. https://doi.org/10.1001/jama.2014.1769.

    Article  PubMed  Google Scholar 

  • Matthey, S. (2004). Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders, 78(3), 269–272.

    Article  PubMed  Google Scholar 

  • McBee, L. (2003). Mindfulness practice with the frail elderly and their caregivers: changing the practitioner-patient relationship. Topics in Geriatric Rehabilitation, 19(4), 257–264.

    Article  Google Scholar 

  • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6.

    Article  PubMed  Google Scholar 

  • National Alliance for Caregiving (2010). Caregivers of veterans—serving on the homefront: report of study findings. Bethesda: Author.

  • Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29(6), 798–803.

    Article  PubMed  Google Scholar 

  • Oken, B. S., Fonareva, I., Haas, M., Wahbeh, H., Lane, J. B., Zajdel, D., & Amen, A. (2010). Pilot controlled trial of mindfulness meditation and education for dementia caregivers. Journal of Alternative and Complementary Medicine, 16(10), 1031–1038. https://doi.org/10.1089/acm.2009.0733.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pagnini, F., Phillips, D., Bosma, C. M., Reece, A., & Langer, E. (2016). Mindfulness as a protective factor for the burden of caregivers of amyotrophic lateral sclerosis patients. Journal of Clinical Psychology, 72(1), 101–111. https://doi.org/10.1002/jclp.22235.

    Article  PubMed  Google Scholar 

  • Palmeira, L., Pinto-Gouveia, J., & Cunha, M. (2017). Exploring the efficacy of an acceptance, mindfulness & compassionate-based group intervention for women struggling with their weight (Kg-Free): a randomized controlled trial. Appetite, 112, 107–116. https://doi.org/10.1016/j.appet.2017.01.027.

    Article  PubMed  Google Scholar 

  • Patel, B. R. (2015). Caregivers of veterans with "invisible" injuries: what we know and implications for social work practice. Social Work, 60(1), 9–17.

    Article  PubMed  Google Scholar 

  • Phillipot, P., & Segal, Z. (2009). Mindfulness based psychological interventions: developing emotional awareness for better being. Journal of Consciousness Studies, 16(10–1), 285–306.

    Google Scholar 

  • Piersol, C. V., Canton, K., Connor, S. E., Giller, I., Lipman, S., & Sager, S. (2017). Effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders: a systematic review. American Journal of Occupational Therapy, 71(5), 7105180020p7105180021–7105180020p7105180010.

    Article  Google Scholar 

  • Ramchand, R., Tanielian, T., Fisher, M. P., Vaughan, C. A., Trail, T. E., Epley, C., et al. (2014). Hidden heroes: America's military caregivers. Santa Monica, CA: Rand Corporation.

    Book  Google Scholar 

  • Ryum, T., Kennair, L. E. O., Hjemdal, O., Hagen, R., Halvorsen, J. O., & Solem, S. (2017). Worry and metacognitions as predictors of anxiety symptoms: a prospective study. Frontiers in Psychology, 8, 924. https://doi.org/10.3389/fpsyg.2017.00924.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schwarz, K. A., & Dunphy, G. (2003). An examination of perceived stress in family caregivers of older adults with heart failure. Experimental Aging Research, 29(2), 221–235. https://doi.org/10.1080/03610730390176077.

    Article  PubMed  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression (2nd ed.). New York: Guilford Press.

    Google Scholar 

  • Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality (complete samples). Biometrika, 52(3/4), 591–611.

    Article  Google Scholar 

  • Sheets, C., & Mahoney-Gleason, H. (2010). Caregiver support in the Veterans Health Administration: caring for those who care. Generations, 34(2), 92–98.

    Google Scholar 

  • Spadaro, K. C. (2017). Effect of mindfulness meditation on short-term weight loss and eating behaviors in overweight and obese adults: a randomized controlled trial. Journal of Complementary and Integrative Medicine, 15(2). https://doi.org/10.1515/jcim-2016-0048.

  • Spielberg, C., Gorsuch, R., Lushene, R., Vagg, P., & Jacobs, G. (1970). Manual for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists Press.

    Google Scholar 

  • Tanielian, T., Bouskill, K. E., Ramchand, R., Friedman, E. M., Trail, T. E., & Clague, A. (2017). Improving support for America's hidden heroes: a research blueprint. Santa Monica: RAND Corporation.

    Book  Google Scholar 

  • Tanielian, T., Ramchand, R., Fisher, M. P., Sims, C. S., Harris, R. S., & Harrell, M. C. (2013). Military caregivers: cornerstones of support for our nation's wounded, ill, and injured veterans. Rand Health Quarterly, 3(1), 3.

    PubMed  PubMed Central  Google Scholar 

  • Teasdale, J. D., Williams, J. M. G., & Segal, Z. V. (2014). The mindful way workbook: an 8-week program to free yourself from depression and emotional distress. New York: The Guilford Press.

    Google Scholar 

  • Thorpe, J. M., Sleath, B. L., Thorpe, C. T., Van Houtven, C. H., Blalock, S. J., Landerman, L. R., et al. (2006). Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia. Medical Care, 44(8), 713–721. https://doi.org/10.1097/01.mlr.0000215905.36968.76.

    Article  PubMed  Google Scholar 

  • U.S. Bureau of the Census. (2012). Statistical abstract of the United States: 2012 (131st ed.). Washington: U.S. Bureau of the Census.

    Google Scholar 

  • Uphold, C. R., Jordan, M., & Freytes, M. (2014). Family caregivers of veterans: a critical review of the empirical literature and recommendations for future research. Annual Review of Nursing Research, 32(1), 155–202.

    Article  PubMed  Google Scholar 

  • Van Houtven, C. H., Friedemann-Sánchez, G., Clothier, B., Levison, D., Taylor, B. C., Jensen, A. C., . . . Griffin, J. M. (2012). Is policy well-targeted to remedy financial strain among caregivers of severely injured US service members? INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 49(4), 339–351.

    Article  PubMed  Google Scholar 

  • Zou, L., Yeung, A., Quan, X., Boyden, S. D., & Wang, H. (2018). A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases. International Journal of Environmental Research and Public Health, 15(2), 206.

    Article  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the participants for their time, effort, and commitment. The authors also thank veterans and their caregivers for their service abroad and at home. The authors also wish to thank Ellen Ritter for her assistance implementing the intervention, Dr. Sa Shen for her statistical support during revisions, and the Danville Area Community College and Chez Center for Wounded Veterans in Higher Education for providing space to conduct the mindfulness trainings.

Funding

This project was funded by the Chez Center for Wounded Veterans in Higher Education at the University of Illinois at Urbana-Champaign. The funder was not involved in the development or execution of the project, including data collection and data analysis.

Author information

Authors and Affiliations

  1. College of Applied Health Sciences, Department of Kinesiology and Community Health, 1206 S. Fourth Street, Champaign, IL, USA

    Sandraluz Lara-Cinisomo & Ryan L. Santens

  2. Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, Urbana, IL, USA

    Elinor M. Fujimoto

Authors
  1. Sandraluz Lara-Cinisomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan L. Santens
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elinor M. Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sandraluz Lara-Cinisomo was the study’s Principal Investigator. She conceptualized the study, secured funding, developed the study protocol, supervised and trained the research team, conducted the data analysis, wrote the methods and results, and edited the entire manuscript. Ryan L. Santens implemented the intervention, wrote the introduction, contributed to the methods, assisted with data management, and reviewed the entire manuscript. Elinor M. Fujimoto collected and entered the data, assisted with coordination of the study, wrote the discussion, contributed to the introduction, and reviewed the entire manuscript.

Corresponding author

Correspondence to Sandraluz Lara-Cinisomo.

Ethics declarations

Conflict of Interest

The authors do not have any conflicts of interest to disclose.

Ethics Statement

All study procedures involving human participants were in accordance with the ethical standards of the University of Illinois at Urbana-Champaign Institutional Review Board and with the 1964 Helsinki declaration and amendments or comparable ethical standards. All participants involved in the study provided written informed consent.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lara-Cinisomo, S., Santens, R.L. & Fujimoto, E.M. A Pilot Randomized Controlled Trial of a Mindfulness-Based Intervention for Caregivers of Veterans. Mindfulness 10, 1855–1869 (2019). https://doi.org/10.1007/s12671-019-01131-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-019-01131-9

Keywords

Search

Navigation