Skip to main content

Advertisement

Log in

Evaluation of an Advanced Mindfulness Program Following a Mindfulness-Based Stress Reduction Program for Participants Suffering from Mental Fatigue After Acquired Brain Injury

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

Abstract

Mental fatigue is, for many, a very distressing and long-term problem after a traumatic brain injury (TBI) or stroke. This will make it more difficult for the individual to return to work and resume social activities, and it can take several years to find the right balance between rest and activity in daily life, to find strategies and to accept the new situation. The aim of this study was to evaluate the effect of an advanced mindfulness program following a MBSR program, designed for subjects suffering from long-term mental fatigue after a brain injury. The advanced program was based on The Brahma Viharas, meditative practices known for cultivating four mental states: compassion, metta, appreciative joy, and equanimity. Fourteen participants followed the 8-month advanced mindfulness program, with group visits once a month and a final all-day retreat. All the participants were suffering from mental fatigue at least 1 year after a brain injury following a stroke or a TBI. The assessments after the advanced program showed a significant and sustained positive effect on mental fatigue and on tests measuring information processing speed and attention. With mindfulness practice it was possible to improve wakefulness during meditation and, above all, improve the mental fatigue levels. We propose that mindfulness is a promising treatment for mental fatigue after a stroke or TBI.

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

Access this article

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

  • Ashman, T. A., Cantor, J. B., Gordon, W. A., Spielman, L., Egan, M., Ginsberg, A., et al. (2008). Objective measurement of fatigue following traumatic brain injury. The Journal of Head Trauma Rehabilitation, 23(1), 33–40.

    Article  PubMed  Google Scholar 

  • Azulay, J., Smart, C., Mott, T., & Cicerone, K. D. (2012). A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome. Journal of Head Trauma Rehabilitation, 28(4), 323–331.

    Article  Google Scholar 

  • Bedard, M., Felteau, M., Mazmanian, D., Fedyk, K., Klein, R., Richardson, J., et al. (2003). Pilot evaluation of a mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries. Disability and Rehabilitation, 25(13), 722–731.

    Article  PubMed  Google Scholar 

  • Bedard, M., Mazmanian, D., Felteau, M., Fedyk, K., Gibbons, C., Mack, G., & Klein, R. (2005). A mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries: one-year follow-Up. The Journal of Cognitive Rehabilitation, spring, 8–13

  • Belmont, A., Agar, N., Hugeron, C., Gallais, B., & Azouvi, P. (2006). Fatigue and traumatic brain injury. Annales de Réadaptation et de Médecine Physique, 49, 283–288.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., & Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12(4), 278–285.

    Article  PubMed  Google Scholar 

  • Chaudhuri, A., & Behan, P. O. (2000). Fatigue and basal ganglia. Journal of the Neurological Sciences, 179, 34–42.

    Article  PubMed  Google Scholar 

  • Cullen, M. (2011). Mindfulness-based interventions: an emerging phenomenon. Mindfulness, 2, 186–193.

    Article  Google Scholar 

  • Frencham, K. A. R., Fox, A. M., & Maybery, M. T. (2005). Neuropsychological studies of mild traumatic brain injury: a meta-analytical review of research since 1995. Journal of Clinical and Experimental Neuropsychology, 27(3), 334–351.

    Article  PubMed  Google Scholar 

  • Geary, C., & Rosenthal, S. L. (2011). Sustained impact of MBSR on stress, well-being, and daily spiritual experiences for 1 year in academic health care employees. Journal of Alternative and Complementary Medicine, 17(10), 939–944.

    Article  Google Scholar 

  • Grossman, P., Tiefenthaler-Gilmer, U., Raysz, A., & Kesper, U. (2007). Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics, 76(4), 226–233.

    Article  PubMed  Google Scholar 

  • Grossmana, P., Niemannb, L., Schmidtc, S., & Walachc, H. (2004). Mindfulness-based stress reduction and health benefits: a meta-analysis. Journal of Psychosomatic Research 57 (2004) 35–43, 57, 35–43.

  • Hanson, R. (2009). Buddha’s brain: the practical neuroscience of happiness. Love & Wisdom Oakland: New Harbinger Publications.

    Google Scholar 

  • Hartmann, M., Kopf, S., Kircher, C., Faude-Lang, V., Djuric, Z., Augstein, F., et al. (2012). Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients: design and first results of a randomized controlled trial (the Heidelberger Diabetes and Stress-study). Diabetes Care, 35(5), 945–947.

    Article  PubMed Central  PubMed  Google Scholar 

  • Johansson, B., & Rönnbäck, L. (2012). Mental fatigue and cognitive impairment after an almost neurological recovered stroke. ISRN Psychiatry(vol. 2012, Article ID 686425, 7 pages, doi:10.5402/2012/686425), 7pages

  • Johansson, B., Berglund, P., & Rönnbäck, L. (2009). Mental fatigue and impaired information processing after mild and moderate traumatic brain injury. Brain Injury, 23(13–14), 1027–1040.

    Article  PubMed  Google Scholar 

  • Johansson, B., Starmark, A., Berglund, P., Rödholm, M., & Rönnbäck, L. (2010). A self-assessment questionnaire for mental fatigue and related symptoms after neurological disorders and injuries. Brain Injury, 24(1), 2–12.

    Article  PubMed  Google Scholar 

  • Johansson, B., Bjuhr, H., & Rönnbäck, L. (2012b). Mindfullness based stress reduction improves long-term mental fatigue after stroke or traumatic brain injury. Brain Injury, 26(13–14), 1621–1628.

    Article  PubMed  Google Scholar 

  • Joo, H. M., Lee, S. J., Chung, Y. G., & Shin, Y. (2010). Effects of mindfulness based stress reduction program on depression, anxiety and stress in patients with aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgery Social, 47(5), 345–351.

    Article  Google Scholar 

  • Kabat-Zinn, J. (2001). Full catastrophe living: how to cope with stress, pain and illness using mindfulness meditation (15th ed.). London: Piatkus Books.

    Google Scholar 

  • Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8(2), 163–190.

    Article  PubMed  Google Scholar 

  • Kilpatrick, L. A., Suyenobu, B. Y., Smith, S. R., Bueller, J. A., Goodman, T., Creswell, J. D., et al. (2011). Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. NeuroImage, 1(56), 290–298.

    Article  Google Scholar 

  • Kramer, G., Meleo Meyer, F., & Turner, M. L. (2008). Cultivating mindfulness in relationship: insight dialogue and the interpersonal mindfulness program In S. F. Hick & T. Bien (Eds.), Mindfulness and the therapeutic relationship (pp. 176–194). New York: The Guilford Press.

    Google Scholar 

  • Lindqvist, G., & Malmgren, H. (1993). Organic mental disorders as hypothetical pathogenetic processes. Acta Psychiatrica Scandinavica, 88(suppl 373), 5–17.

    Article  Google Scholar 

  • Madigan, N. K., DeLuca, J., Diamond, B. J., Tramontano, G., & Averill, A. (2000). Speed of information processing in traumatic brain injury: modality-specific factors. The Journal of Head Trauma Rehabilitation, 15(3), 943–956.

    Article  PubMed  Google Scholar 

  • McMillan, T., Robertson, I., Brock, D., & Chorlton, L. (2002). Brief mindfulness training for attentional problems after traumatic brain injury: a randomised control treatment trial. Neuropsychological Rehabilitation, 12(2), 117–125.

    Article  Google Scholar 

  • Miller, J. J., Fletcher, K., & Kabat-Zinn, J. (1995). Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. General Hospital Psychiatry, 17(3), 192–200.

    Article  PubMed  Google Scholar 

  • Moore, A., & Malinowski, P. (2009). Meditation, mindfulness and cognitive flexibility. Consciousness and Cognition, 18, 176–186.

    Article  PubMed  Google Scholar 

  • Peacock, J. (2008). Opening talk for the metta retreat—loving kindness and compassion as a path to awakening Winchester: Dharma Hardcopy

  • Reibel, D. K., Greeson, J. M., Brainard, G. C., & Rosenzweig, S. (2001). Mindfulness-based stress reduction and health-related quality of life in a heterogeneous patient population. General Hospital Psychiatry, 23(3), 183–192.

    Article  PubMed  Google Scholar 

  • Reitan, R. M., & Wolfson, D. (1985). The Halstead-Reitan neuropsychological test battery. Theory and clinical interpretation. Tucson: Neuropsychology Press.

    Google Scholar 

  • Rönnbäck, L., & Johansson, B. (2012). Long-lasting mental fatigue after traumatic brain injury or stroke—e new perspective Saarbrucken: LAP Lambert Academic Publishing

  • Slagter, H. A., Lutz, A., Greischar, L. L., Francis, A. D., Nieuwenhuis, S., Davis, J. M., et al. (2007). Mental training affects distribution of limited brain resources. PLoS Biology, 5(6), 1228–1235.

    Article  Google Scholar 

  • Smith, B. W., Shelley, B. M., Dalen, J., Wiggins, K., Tooley, E., & Bernard, J. S. (2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. Journal of Alternative and Complementary Medicine, 14(3), 251–258.

    Article  Google Scholar 

  • Staub, F., & Bogousslavsky, J. (2001). Fatigue after stroke: a major but neglected issue. Cerebrovascular Diseases, 12, 75–81.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (2003). Wechsler adult intelligence scale—third edition, WAIS-III. Pearson Assessment: Swedish version.

    Google Scholar 

  • Yee, R. (1998). Living yoga—back care yoga for beginners [video]

  • Young, S. (2005). Break through pain: a step-by-step mindfulness meditation program for transforming chronic and acute pain. Louisville: Sounds True, Inc.

    Google Scholar 

  • Ziino, C., & Ponsford, J. (2006). Selective attention deficits and subjective fatigue following traumatic brain injury. Neuropsychology, 20, 383–390.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was supported by grants from AFA Insurance and The Local Research and Development Board for Gothenburg and Södra Bohuslän.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Birgitta Johansson.

Appendix A

Appendix A

The curriculum of the advanced program

Session one:

  • Helping people to present themselves succinctly.

  • Presentation of the curriculum: to enhance a more in-depth and sustained awareness of the meditative and mindful skills achieved during MBSR and to further explore the four Brahma Viharas of compassion, metta, appreciative joy, and equanimity.

  • Short meditation sessions; mindfulness mediation on the present moment and the breath, as a formal sitting meditation repetition followed by a 15-min metta meditation; actively cultivating positive emotional states towards others, as well as towards ourselves, including a contemplation on remembering, acknowledging and visualizing people and important circumstances to enable the participation in the MBSR program as well as this advanced program.

  • Short dialogue training.

  • Group reflection and discussion on common difficulties due to mental fatigue.

Session two:

  • The session begins with a meditation on the breath followed by being mindful with the tiredness and the fatigue; cultivation of compassion towards oneself in the tired state.

  • Friendly yoga session, exploring simple movements with care and curiosity.

  • Exploring fatigue. Meditation inspired by Shinzen Youngs approach to pain (Young 2005). Discovering the difference between constructs and reality.

  • Short dialogue training.

  • Group reflection.

Session three:

  • The session continues with the following elements: further exploration of tiredness and fatigue.

  • Exploring further; meditation on fatigue.

  • Yoga on a chair (Yee 1998).

  • Didactic teaching on Mindfulness meditation not only being a way to concentration, but just as much a way to cultivate friendliness towards oneself and others.

  • Exploring the role of metta through meditation.

  • Formal metta meditation and home assignments; “your own metta meditation”.

  • Dialogue training.

  • Group reflection.

Session four:

  • Metta meditation and acceptance: making friends with oneself and being with what is.

  • Introducing appreciative joy meditation on “taking in the good”; noticing pleasant, unpleasant, and neutral parts of the body and mind; which parts of the body and mind are affected by the fatigue and which are not. Knowing the mind and the importance of being able to choose what to attend to.

  • Dialogue training.

  • Group reflection.

Session five:

  • Appreciative joy meditation on “taking in the good”; in the body and in the mind and the world. Zooming in on small things—the capacity to choose what to attend to.

  • Walking meditation.

  • Working with joy while walking.

  • More formal instructions on dialogue training.

  • Group reflection.

Session six:

  • Exploring the theme of appreciative joy and further instructions on insight dialogue training. Bringing mindfulness into communication and relationships. Exploring deep listening and wise speech. Allowing oneself to slow down. Asking for what is needed; a slower communicative pace.

  • Mediation “taking in the good”, through sensations arising with sounds, breath, body, and mind.

  • Group reflection.

Session seven:

  • Theme: equanimity.

  • More insight dialogue training and working with finding a balance in levels of energy in relationships and communications.

  • Equanimity meditation with mountain meditation (Kabat-Zinn 2001).

  • Group reflection.

Session eight:

  • Meditation on balance—being peaceful with what is. Safe and neutral places—equanimity and body sensations. Paying attention to that which the person feels at peace with.

  • Group dialogue training; what about the future? How to keep on practicing.

  • Group reflection.

  • Ending with writing a letter to oneself; a reminder on insights, what has been learnt etc., and mediation on gratefulness.

All-day retreat: This is mostly a repetition of the all-day retreat from the MBSR program.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Johansson, B., Bjuhr, H. & Rönnbäck, L. Evaluation of an Advanced Mindfulness Program Following a Mindfulness-Based Stress Reduction Program for Participants Suffering from Mental Fatigue After Acquired Brain Injury. Mindfulness 6, 227–233 (2015). https://doi.org/10.1007/s12671-013-0249-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-013-0249-z

Keywords

Navigation