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The world today is cornered with an enormous challenge of exponentially rising mental health cases. In 2017, it was estimated that 792 million people suffered from at least one mental health illness (Ritchie & Roser, 2018). The population affected indicates that nearly one in ten people is a mental health disorder victim. Depression leads to the list of prevalent mental health disorders, affecting almost 264 million people worldwide (“Mental Disorders,’ 2016). Bipolar disorder and schizophrenia follow affecting 45 and 20 million people, respectively(Ritchie & Roser, 2018).
Ideally, the numbers could be significantly higher, since mental illnesses remain vastly unrecorded and unreported. Additionally, in day to day activities, people encounter challenges that affect their cognitive processes, such as job loss, grief, drug and substance addiction, among others. Critically, there is a vast population facing life-threatening illnesses (palliative care), and others in the final stages of terminal diseases (under hospice care), who require not only effective symptoms control but also psychosocial care, to alleviate their sufferings and pain. Their situation is even more peace threatening to caregivers, who are expected to be nonjudgmental, compassionate, and open-hearted. These cases present a greater need for practical therapeutic approaches to ensure persons affected live a happy, healthy, and fulfilling life.
Mindfulness meditation intervention is an approach that has been applied in addressing psychosocial issues, not only to patients but also to therapists. Mindfulness meditation allows clients to change from high-frequency waves of the brain to low-frequency waves, deactivating and activating specific areas of the brain, reducing stress, anxiety, or fear (Sharma, 2015). For instance, in-depth mindfulness meditation may reduce the neurological attachments to the medial prefrontal cortex, overcoming habits such as stress, anxiety, or fear. (Sharma, 2015). As a result, it has been applied in psychiatry, which is the basis of this review.
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Historical Antecedents
In the clinical environment, mindfulness meditation interventions are heavily founded on an approach initially developed in the Mindfulness-Based Stress Reduction (MBSR), established by Jon Kabat-Zim, and fellow psychologist in 1979 while at the medical school in the University of Massachusetts (Klatt, Buckworth, & Malarkey, 2008). The strategy emerged as a technique of alleviating stress in chronic pain ambulatory patients.
Later, Segal and fellow scholars increased the usefulness of mindfulness meditation into psychology by creating an integrated program between cognitive-behavioral therapy and mindfulness approaches, commonly called Mindfulness-Based Cognitive Therapy (MBCT), to prevent depression relapse (Groves, 2016). Since then, numerous interventions related to mindfulness meditation have been founded, with hundreds of studies and control trials been conducted to assess the effectiveness of these approaches.
Recently, the effectiveness of mindfulness on mental well-being using neuroimaging approaches, behavioral tests, and physiological interventions revealed that via meditation, an integral component of mindfulness, the brain could generate new gray matter (Hölzel, 2014). The evidence-based research proved that mindfulness is not vogue, but rather a scientific model that plays a critical role in restructuring the brain and increasing the well-being, as well as the quality of life (Hölzel, 2014). The results also supplement other studies that have elicited that meditation plays a vital role in improving a variety of symptoms, with the current focus being on the beneath mechanism that causes the change.
However, it is worth noting that the whole concept of mindfulness and meditation was founded in Buddhism, a contemplative religion founded on 400-500 B.C.E. by Gautama, commonly the Buddha (Chu, 2017). The religion emphasizes on meditation as the means for man to escape from the world’s suffering (Chu, 2017). Ideally, Buddha believed that the world is full of suffering because of man’s ignorance and desire for immortality, pleasure, and materiality inscribed in the four noble truths (Chu, 2017).
However, Buddha gave hope that men could escape the suffering of humanity through achieving Nirvana, a state of peace, and spiritual enlightenment (Chu, 2017). However, as Chu elicits, to attain Nirvana, one is guided by the Eightfold Path, which is inclusive of three themes: proper moral conduct, thought, and importantly, meditation and mental growth (Chu, 2017). Therefore, Buddha can be considered the author of mindfulness meditation, with the rest of the developers building on what he had already started.
Mindful Meditation Overview, Processes, Techniques, and Application
Mindfulness meditation has a renowned background in Eastern activities but has received significant public attention in recent years. Assuredly, the implementation of scientific mindfulness practices has increased over the years. Mindfulness meditation-based intervention aims at training persons to pay critical attention, in a specified way, impartially, and with a purpose, on the present activities, and constitute the practice into everyday life (Shapero et al., 2018). Notably, the interventions aim at the conceptualization of two objectives.
One, to self-regulate attention and focus on the happenings of the current moment (Shapero et al., 2018). Secondly, it aims at openness and embracing of the incidents (Shapero et al., 2018). As a result, the mindfulness meditation approach emphasizes mindfulness abilities to promote deliberate focus, and create a different connection with thoughts and feelings, and implement diverse procedures to distorted thoughts and feelings in an impartial way (Shapero et al., 2018). Through constant exposure, exercises, and experience, engaged persons can disconnect or step back from the inceptive feelings and thoughts through the creation of a meta-cognition, which, in place, overcomes distorted thoughts as well as increasing the flexibility of the mind (Shapero et al., 2018).
Strategies for mindfulness meditation follows a typical guideline. It is most commonly performed on seats, with participants seated in an upright posture that is suitable to maintain stability throughout the session. Nonetheless, in other techniques such as the body scan, the participants lie on their backs, while in other cases, it can be practiced while in slow motion, performing a simple task such as washing utensils, or in yoga position (Sharman, 2015). During the sessions, the participants begin with a central focus of meditation, often breathing sensations.
With that, they then attend step by step to the object in an impartial and nonjudgmental approach, while also keeping a composed vigilance for interruptions and distractions (Creswell, 2017). While distractions are inevitable, practitioners are encouraged to shift back to the object. With continued mindfulness meditation, the practitioners experience an emotional, energetic release, which is the end goal of mindfulness meditation (Creswell, 2017).
Mindfulness Meditation Techniques
Body Scan Meditation
This approach seeks to establish where unaware holding patterns are, and in turn, release them with self-awareness. The participants lay down or sit comfortably in a suitable position and finds a serene and stable breath (Colgan et al., 2015). What follows is the self-awareness of body sensations, where the client makes a few slow breaths on each point of focus, starting with left toes, foot, thigh, up to the left hip. In case of realization of an area of tension, the client breaths into it while relaxing during breathing out (Colgan et al., 2015). The pattern follows for the right side, the pelvic area, abdomen, wrists, forehead, all the way to the head. This approach has been significantly useful in lowering sleep problems, fatigue, depression, and anxiety.
Mindful Breathing Meditation
This technique creates a consciousness of the present time, dissociating the participants from stressful and ruminating past experiences. In this technique, breath is considered as the object of meditation, with deep concentration on the sensation and the rhythm of life’s primary force (Sharman, 2015). In practice, the practitioner sits suitably with a broad, straight spine, and finds a steady breath. The step is followed by counting of inhales and exhales between one and ten, and then counting in a reverse manner to one. After the counting, the practitioner continues to breathe calmly and at a steady pace for three minutes, while imagining the breath transcend down the respiratory tracts and appreciating the body relationship (Colgan et al., 2015). This approach is useful in treating bipolar disorder, pain, fear, severe fatigue, anxiety, and depression.
Relaxation Breathing
This phenomenon is the most straightforward exercise which aims at activating the parasympathetic part of the nervous system, commonly the relaxation system, reducing the heart attack and blood pressure significantly (Khols et al., 2019). The practitioners close the eyes, followed by a deep breath and then exhalation. During the process, the stress, pain, fear, or anxiety floats away.
Mindfulness-Based Therapy
The approach combines both mindfulness strategies with cognitive-behavioral techniques to help participants control their thoughts and emotions. The participants are made to interrupt the uncontrolled thoughts leading to depression, anxiety, bipolar disorder, or any other disorder, and consequently separate themselves from such distorted thoughts, inducing healing (Creswell, 2017).
Mindfulness Meditation in Patients under Hospice and Palliative Care
Since the 1990s, the U.S. population has experienced a considerable number of patients under palliative and hospice care, which has attracted a lot of attention towards addressing their psychosocial and physical needs Wielgosz et al. (2019). Notably, while the clients are at the end of life, they are not too sick to participate in mindfulness meditation techniques. While they are under heavy medication to control their already weak body system, adoption of the physical mechanism that improves their body condition is the most preferred, which makes mindfulness meditation techniques useful Wielgosz et al. (2019).
They lower the blood pressure, reduce stress, overcome gastrointestinal challenges, as well as treating cardiovascular diseases. Additionally, according to Wielgosz et al. (2019), practicing mindfulness can lower pain in hospice and palliative patients by up to 57%, even to patients who are not active mediators, with up to 90% for perfect mediators. Therefore, the techniques increase the quality of life while extending their lives significantly.
Cultural Perspective
The influence of culture on mindful medication cannot be underestimated. Ideally, mindfulness meditation interventions are founded on meditative traditions, which are integral parts of the Buddhist contemplative religion. Mindfulness meditation principles adopted in psychotherapy can find their origin in Buddhist teachings, which aimed at equipping a vast number of laypeople on basic meditation, with minimal exposure to Buddhism beliefs (Kirmayer, 2015). The lessons aimed at instructing the audience to insightfully meditate with attention on breathing, while giving an observation on thoughts, emotions, or feelings that arise (Kirmayer, 2015).
Upon the teachings, Kabat-Zinn adopted a similar approach and the same lessons to develop MBSR, an intervention that would be effective and acceptable in the mainstream psychological community, without emphasis on Buddhist origin. The scenario presents a compelling instance of cross-cultural borrowing, which is a perfect example of the modern world. Ideally, the mindfulness practices bear significant effectiveness because of the considerable connection between the universal nature of the human brain functioning and the cultural context.
On the contrary, the secure connection between mindful interventions and the Buddhism practices bears significant barriers to its effectiveness. Needless to say, it can be considered as an indigenous psychological approach of Buddhism in secular practice to transform a victim’s experience. While Asians may strongly recommend the procedure since it incorporates their most famous religion, to others of the diverse religion and beliefs, it is inapplicable (Wielgosz et al., 2019). They view it as Buddhist psychotherapy and irrelevant to them, pushing away persons who could have benefitted immensely it.
Moreover, in the Buddhist culture where it originated, mindful meditation is only a constituent of a broader Buddhist tradition with firm morals and ethics (Kirmayer, 2015). Ideally, changing several concepts of the mindfulness approach from the sociocultural context in which it originates may reverse its effect on practice on the Buddhist people. This phenomenon could undermine the approach effectiveness on people with whom the intervention arises.
Research Implication
The research has borne significant results in relation to the application of mindfulness meditation in clinical practice. The study vividly depicts that mindfulness meditation is effective in stress reduction. The inference receives experimental backing from Song et al. (2015), who conducted 39 studies meta-analyses. The research sought to elicit the effectiveness of mindful meditation techniques in cognitive processes, negative thoughts, depression, and stress Song et al. (2015). revealed that patients who were subjected to meditation techniques experienced a significant reduction in stress levels, as well as reduced stress and anxiety. Secondly, the research has well indicated the efficiency of the methods in promoting health well-being.
As Tan et al. (2017) depict in a review of mindfulness health benefits, mindfulness meditation interventions cause a significant decrease in psychological distress, reduced fatigue, pain, lowering blood pressure, and treatment of heart diseases. This scenario, in addition to addressing critical mental processes, explains the broad application of the techniques in patients under palliative and hospice care. Lastly, the review has significantly elicited that mindful meditation increases cognitive flexibility. The finding is backed by a study conducted by McConville et al. (2017), which postulated that persons who engage in mindfulness meditation potentially incept the trait of self-observation that neurologically interrupts their unconscious pathways generated prior to the intervention.
Implication for Social Work Practice
One of the goals of social work practice is adequate care for improved quality and longevity of life. Mindfulness meditation interventions contribute significantly to the aim by not only addressing critical clients’ concerns but also through enhancing the quality of caregivers. According to Ho et al. (2019), professional social workers working in palliative and hospice care are exposed continuously to immense stress from the emotional connection with dying clients and the deceased families. Continuous exposure to grief and death can result in severe burnout and fatigue.
These adverse effects do not only affect the caregivers but also trickles down to the type of care they offer to their patients. If not properly managed, the effects can present threats to patients, colleagues, and friends’ access to safe and quality patient care. On the contrary, mindfulness meditation provides useful techniques for caregivers to manage stress, overcome fatigue, and have the emotionality to deal with death and grief.
