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

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.

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Acknowledgment

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

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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.

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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

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Keywords

  • Mindfulness
  • Mental fatigue
  • TBI
  • Stroke
  • Cognition