Mindfulness-Based Stress Reduction (MBSR) Delivered Live on the Internet to Individuals Suffering from Mental Fatigue After an Acquired Brain Injury

Abstract

An acquired brain injury often leads to long-lasting mental fatigue, which can have a considerable effect on work and social interactions. Fortunately, the Mindfulness-Based Stress Reduction (MBSR) program has been found to alleviate mental fatigue. The purpose of this feasibility study was to evaluate the success of an interactive MBSR program delivered live online to individuals who have experienced a traumatic brain injury or stroke. We included the following three groups in our study: an Internet group, a face-to-face MBSR group, and an active control group who took weekly walks in natural environments. Thirty-four participants completed the study, and all were suffering from long-lasting mental fatigue after either a traumatic brain injury (16 participants) or a stroke (18 participants). However, seven did not accept to attend an Internet MBSR, and Internet was the only choice for others. We found that, according to the Mental Fatigue Scale (MFS), the program leads to significantly reduced mental fatigue in the Internet group compared with the face-to-face and the control group. Individuals in the MBSR groups also exhibited an improved ability to process two temporally close targets (attentional blink task), while this was not detected in the control group. In conclusion, we believe that it is possible for individuals suffering from mental fatigue after an acquired brain injury to obtain positive results through enrollment in a live, interactive, online MBSR program. This is promising, as the Internet is accessible to many individuals, irrespective of where they live. Further randomized control studies comparing are warranted.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 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 

  2. Boettcher, J., Åström, V., Påhlsson, D., Schenström, O., Andersson, G., & Carlbring, P. (2014). Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial. Behavior Theraphy, 45, 241–253.

    Article  Google Scholar 

  3. Bushnik, T., Englander, J., & Wright, J. (2008). Patterns of fatigue and its correlates over the first 2 years after traumatic brain injury. The Journal of Head Trauma Rehabilitation, 23(1), 25–32.

    Article  PubMed  Google Scholar 

  4. 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 

  5. Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31(1), 23–33.

    Article  PubMed  Google Scholar 

  6. Davidson, R. J., Kabat-Zinn, J., Schmacher, J., Rosenkranz, M., Muller, D., Santorelli, S., & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564–570.

    Article  PubMed  Google Scholar 

  7. Detry, M. A., & Lewis, R. J. (2014). The intention-to-treat principle. How to assess the true effect of choosing a medical treatment. The Journal of the American Medical Association, 312(1), 85–86.

    Article  PubMed  Google Scholar 

  8. Dux, P. E., & Marois, R. (2009). The attentional blink: a review of data and theory. Attention, Perception, & Psychophysics, 71(8), 1683–1700.

    Article  Google Scholar 

  9. Glück, T. M., & Maercker, A. (2011). A randomized controlled pilot study of a brief web-based mindfulness training. BioMedCentral Psychiatry, 11(175), 1–12. doi:10.1186/1471-244X-11-175.

    Google Scholar 

  10. Hansson, E., & Rönnbäck, L. (2004). Altered neuronal-glial signaling in glutamatergic transmission as a unifying mechanism in chronic pain and mental fatigue. Neurochemical Research, 29, 989–996.

    Article  PubMed  Google Scholar 

  11. Johansson, B., & Rönnbäck, L. (2012). Mental Fatigue and Cognitive Impairment after an Almost Neurological Recovered Stroke. International Scholarly Research Network Psychiatry, 2012(Article ID 686425), 7 pages. doi: 10.5402/2012/686425

  12. Johansson, B., & Rönnbäck, L. (2014a). Evaluation of the mental fatigue scale and its relation to cognitive and emotional functioning after traumatic brain injury or stroke. International Journal of Physical Medicine & Rehabilitation, 2, 182. doi:10.4172/2329-9096.1000182.

    Google Scholar 

  13. Johansson, B., & Rönnbäck, L. (2014b). Long-lasting mental fatigue after traumatic brain injury – a major problem most often neglected diagnostic criteria, assessment, relation to emotional and cognitive problems, cellular background, and aspects on treatment. In F. Sadaka (Ed.), Traumatic brain injur. Rijeka, Croatia: INTECH.

    Google Scholar 

  14. 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 

  15. 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 

  16. Johansson, B., Bjuhr, H., & Rönnbäck, L. (2012). Mindfulness 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 

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

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

    Article  Google Scholar 

  19. Kohl, A. D., Wylie, G. R., Genova, H. M., Hillary, F., & Deluca, J. (2009). The neural correlates of cognitive fatigue in traumatic brain injury using functional MRI. Brain Injury, 23(5), 420–432.

    Article  PubMed  Google Scholar 

  20. Kornfield, J., & Goldstein, J. (2014). What makes us free? Shambhala Sun, 36-42.

  21. Krusche, A., Cyhlarova, E., King, S., & Williams, J. M. G. (2012). Mindfulness online: a preliminary evaluation of the feasibility of a web-based mindfulness course and the impact on stress. BioMedJournal Open. doi:10.1136/bmjopen-2011-000803.

    Google Scholar 

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

    Article  Google Scholar 

  23. Ljótsson, B., Falk, L., Wibron Vesterlund, A., Hedman, E., Lindfors, P., Rück, C., & Andersson, G. (2010). Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome—a randomized controlled trial. Behaviour Research and Therapy, 48(6), 531–539.

    Article  PubMed  Google Scholar 

  24. Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008). Attention regulation and monitoring in meditation. Trends in Cognitive Sciences, 12(4), 163–169.

    PubMed Central  Article  PubMed  Google Scholar 

  25. McCown, D., Reibel, D., & Micozzi, M. S. (2011). Teaching mindfulness. A practical guide for clinicians and educators. New York: Springer.

    Google Scholar 

  26. Montgomery, S. A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389.

    Article  PubMed  Google Scholar 

  27. Morledge, T. J., Allexandre, D., Fox, E., Fu, A. Z., Higashi, M. K., Kruzikas, D. T., & Reese, P. R. (2013). Feasibility of an online mindfulness program for stress management—a randomized controlled trial. Annals of Behavioral Medicine. doi:10.1007/s12160-013-9490-x.

    PubMed Central  PubMed  Google Scholar 

  28. Neff, K. D. (2003). The development and validation of scale to measure self-compassion. Self and Identity, 2, 223–250.

    Article  Google Scholar 

  29. Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology & Psychotherapy, 18(3), 250–255.

    Article  Google Scholar 

  30. Reitan, R. M., & Wolfson, D. (1999). The two faces of mild head injury. Archives of Clinical Neuropsychology, 14(2), 191–202.

    Article  PubMed  Google Scholar 

  31. Rödholm, M., Starmark, J.-E., Svensson, E., & von Essen, C. (2001). Asteno-emotional disorder after aneurysmal SAH: reliability, symptomatology and relation to outcome. Acta Neurologica Scandinavica, 103, 379–385.

    Article  PubMed  Google Scholar 

  32. Ronnback, L., & Hansson, E. (2004). On the potential role of glutamate transport in mental fatigue. Journal of Neuroinflammation, 1, 22.

    PubMed Central  Article  PubMed  Google Scholar 

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

    Google Scholar 

  34. Slagter, H. A., Lutz, A., Greischar, L. L., Francis, A. D., Nieuwenhuis, S., Davis, J. M., & Davidson, R. J. (2007). Mental training affects distribution of limited brain resources. Public Library of Science (PLOS) Biology, 5(6), e138. doi:10.1371/journal.pbio.0050138.

  35. Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., Welsh-Bohmer, K., & Sherwood, A. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosomatic Medicine, 72(3), 239–252.

    PubMed Central  Article  PubMed  Google Scholar 

  36. Snaith, R. P., Harrop, F. M., Newby, D. A., & Teale, C. (1986). Grade scores of the montgomery-asberg depression and the clinical anxiety scales. British Journal of Psychiatry, 148, 599–601.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  38. Surawy, C., Roberts, J., & Silver, A. (2005). The effect of mindfulness training on mood and measures of fatigue, activity, and quality of life in patients with chronic fatigue syndrome on a hospital waiting list: a series of exploratory studies. Behavioural and Cognitive Psychotherapy, 33(01), 103–109.

    Article  Google Scholar 

  39. Svanborg, P., & Åsberg, M. (1994). A new self-rating scale for depression and anxiety states based on the comprehensive psychopathological rating scale. Acta Psychiatrica Scandinavica, 89(1), 21–28.

    Article  PubMed  Google Scholar 

  40. Wechsler, D. (2003). Wechsler Adult Intelligence Scale—third edition, WAIS-III, Swedish version: Pearson Assessment. Stockholm: Pearson Education Ltd.

  41. Winward, C., Sackley, C., Metha, Z., & Rothwell, P. M. (2009). A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke. Stroke, 40, 757–761.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by grants from The Health & Medical Care Committee of the Västra Götaland Region, The Swedish Stroke Association, and The Swedish Association for Survivors of Accident and Injury.

Conflict of Interest

The authors have no conflict of interest to report.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Birgitta Johansson.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Johansson, B., Bjuhr, H., Karlsson, M. et al. Mindfulness-Based Stress Reduction (MBSR) Delivered Live on the Internet to Individuals Suffering from Mental Fatigue After an Acquired Brain Injury. Mindfulness 6, 1356–1365 (2015). https://doi.org/10.1007/s12671-015-0406-7

Download citation

Keywords

  • Mindfulness
  • Internet
  • Mental fatigue
  • Attention
  • TBI
  • Stroke