Abstract
Prolonged exposure to ‘toxic stress’ caused by financial hardship and social exclusion can result in reduced well-being, increased risk of illness and impaired cognitive function and can negatively impact the physiological processes underlying ageing. Evidence suggests that mindfulness-based interventions (MBIs) may reduce stress and improve well-being in clinical and non-clinical populations, and recent studies indicate they may also help address well-being-related effects of poverty. This study aimed to evaluate the feasibility of delivering an adapted MBI training to adults living with the psychosocial stress caused by poverty and its effectiveness in improving participants’ well-being. In this mixed method, non-randomised waitlist-controlled feasibility pilot study, 40 adults (n = 20 in the training group) from regeneration areas in Scotland earning less than the Living Wage completed the adapted MBI. Delivery proved feasible, even though, as with previous studies on psychosocial interventions in socioeconomically deprived (SED) areas, the rate of participant attrition from recruitment (n = 107) to completion (n = 40) was high (58%). The results showed significant increases in well-being post training for the training group only (p < 0.001). No changes in mindfulness were found in either group. Further qualitative analyses suggested a possible shift in participants’ conceptualisation of well-being from being difficult to manageable or workable. These results indicate that MBI training can be feasibly delivered within SED communities and potentially improve the well-being of course participants. The practicalities of developing accessible MBIs for those living in areas of multiple deprivation are discussed.
Similar content being viewed by others
References
Abercrombie, P., Zamora, A., & Korn, A. P. (2007). Lessons learned providing a mindfulness-based stress reduction. Holistic Nursing Practice, 21(1), 26–34.
Adli, M. (2011). Urban Stress and Mental Health | Articles | LSE Cities. London. Retrieved from http://lsecities.net/media/objects/articles/urban-stress-and-mental-health/en-gb/
Ahern, J., Galea, S., Hubbard, A., Midanik, L., & Syme, S. L. (2008). “Culture of drinking” and individual problems with alcohol use. American Journal of Epidemiology, 167(9), 1041–1049. https://doi.org/10.1093/aje/kwn022.
Bartley, T. (2012). Mindfulness-Based Cognitive Therapy for Cancer, (1st ed., Vol. 16 Suppl 2). Chichester: Wiley-Blackwell.
Bech, P., Olsen, L. R., Kjoller, M., & Rasmussen, N. K. (2003). Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale. International Journal of Methods in Psychiatric Research, 12(2), 85–91. https://doi.org/10.1002/mpr.145.
Bermudez, D., Benjamin, M. T., Porter, S. E., Saunders, P. A., Anne, N., Myers, L., & Dutton, M. A. (2013). A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence. Complementary Therapies in Clinical Practice, 19(2), 104–108. https://doi.org/10.1016/j.ctcp.2013.02.004.
Black, D. S., Sussman, S., Johnson, C. A., & Milam, J. (2012). Psychometric assessment of the Mindful Attention Awareness Scale (MAAS) among Chinese adolescents. Assessment, 19(1), 42–52. https://doi.org/10.1177/1073191111415365.
Blacker, M., Meleo-meyer, F., Kabat-Zinn, J., & Santorelli, S. (2009). Mindfulness-Based Stress Reduction (MBSR) Curriculum Guide© 2009. Massachusetts: Center for Mindfulness in Medicine, Health Care & Society Department of Medicine.
Bowling, A. (2011). Do older and younger people differ in their reported well-being? A national survey of adults in Britain. Family Practice, 28(2), 145–155. https://doi.org/10.1093/fampra/cmq082.
Bramley, G., Hirsch, D., Littlewood, M., & Watkins, D. (2016). Counting the cost of UK poverty. York. Retrieved from https://www.jrf.org.uk/report/counting-cost-uk-poverty#jl_downloads_0
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa.
Brown, K. W., & Creswell, J. D. (2015). Handbook of Mindfulness:Thoery, Research, and Practice. New York London: Guildford Press.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. https://doi.org/10.1037/0022-3514.84.4.822.
Cabinet Office. (2006). Reaching Out: An Action Plan on Social Exclusion. London.
Carel, H. (2009). ‘I am well, apart from the fact that I have cancer’: explaining wellbeing within illness. In L. Bortolloti (Ed.), Philosophy and Happiness (First, pp. 82–99). Basingstoke: Palgrave Macmillan.
Carlson, L. E., & Brown, K. W. (2005). Validation of the Mindful Attention Awareness Scale in a cancer population. Journal of Psychosomatic Research, 58(1), 29–33. https://doi.org/10.1016/j.jpsychores.2004.04.366.
Carmody, J., & Baer, R. a. (2009). How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress. Journal of Clinical Psychology, 65(6), 627–638. https://doi.org/10.1002/jclp.20555.
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. https://doi.org/10.1007/s10865-007-9130-7.
Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: an integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005.
Chen, S., & Ravallion, M. (2010). The developing world is poorer than we thought, but no less successful in the fight against poverty. The Quarterly Journal of Economics, 125(4), 1577–1625. https://doi.org/10.1162/qjec.2010.125.4.1577.
Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: are they all the same? Journal of Clinical Psychology, 67(4), 404–424. https://doi.org/10.1002/jclp.20776.
Conner, C. M., & White, S. W. (2014). Stress in mothers of children with autism: trait mindfulness as a protective factor. Research in Autism Spectrum Disorders, 8(6), 617–624. https://doi.org/10.1016/j.rasd.2014.02.001.
Curtis, S., Cave, B., & Coutts, A. (2002). Is urban regeneration good for health? Perceptions and theories of the health impacts of urban change. Environment and Planning C: Government and Policy, 20(4), 517–534. https://doi.org/10.1068/c02r.
Davidson, R. J., & McEwen, B. S. (2012). Social influences on neuroplasticity: stress and interventions to promote well-being. Nature Neuroscience, 15(5), 689–695. https://doi.org/10.1038/nn.3093.
Davis, A., Hirsch, D., & Padley, M. (2014). A Minimum Income Standard for the UK in 2014. York. Retrieved from www.jrf.org.uk
Diener, E. (2008). Happiness: Unlocking the Mysteries of Psychological Wealth. (online). Malden, Oxford.: Blackwell Publishing. Retrieved from doi: https://doi.org/10.1002/9781444305159
Doran, N. J. (2014). Experiencing wellness within illness: exploring a mindfulness-based approach to chronic back pain. Qualitative Health Research, 24(6), 749–760. https://doi.org/10.1177/1049732314529662.
Dupéré, V., Leventhal, T., & Lacourse, É. (2009). Neighborhood poverty and suicidal thoughts and attempts in late adolescence. Psychological Medicine, 39(08), 1295–1306. https://doi.org/10.1017/S003329170800456X.
Dutton, M. A., Bermudez, D., Matás, A., Majid, H., & Myers, N. L. (2013). Mindfulness-based stress reduction for low-income, predominantly African American women with PTSD and a history of intimate partner violence. Cognitive and Behavioral Practice, 20(1), 23–32. https://doi.org/10.1016/j.cbpra.2011.08.003.
Eames, C., Crane, R. S., Gold, E., Pratt, S., & Axford, N. (2015). Mindfulness-based wellbeing for socio-economically disadvantaged parents: a pre-post pilot study. Journal of Children’s Services, 10(1), 17–28. https://doi.org/10.1108/JCS-09-2014-0040.
Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation: a meta-analysis. Mindfulness, 3(3), 174–189. https://doi.org/10.1007/s12671-012-0101-x.
Egan, M., Tannahill, C., Petticrew, M., & Thomas, S. (2008). Psychosocial risk factors in home and community settings and their associations with population health and health inequalities: a systematic meta-review. BMC Public Health, 8(1), 239. https://doi.org/10.1186/1471-2458-8-239.
Eisenberger, N. I. (2012). The pain of social disconnection: examining the shared neural underpinnings of physical and social pain. Nature Reviews. Neuroscience, 13(6), 421–434. https://doi.org/10.1038/nrn3231.
Fox, K. C. R., Nijeboer, S., Dixon, M. L., Floman, J. L., Ellamil, M., Rumak, S. P., et al. (2014). Is meditation associated with altered brain structure ? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners author ’ s personal copy. Neuroscience and Biobehavioral Reviews, 43, 48–73. https://doi.org/10.1016/j.neubiorev.2014.03.016.
Fresco, D. M., Segal, Z. V., Buis, T., & Kennedy, S. (2007). Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression. Journal of Consulting and Clinical Psychology, 75(3), 447–455. https://doi.org/10.1037/0022-006X.75.3.447.
Galea, S., Uddin, M., & Koenen, K. (2011). The urban environment and mental disorders: epigenetic links. Epigenetics, 6(4), 400–404. https://doi.org/10.4161/epi.6.4.14944.
Goyal, M., Singh, S., Sibinga, E., Gould, N., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 29(6), 997–1003. https://doi.org/10.1016/j.biotechadv.2011.08.021.Secreted.
Grossman, P. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re)invention of mindfulness: Comment on Brown et al. (2011). Psychological Assessment, 53(9), 1034–1040. https://doi.org/10.1037/a0022713.
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.
Gucht, K. Van Der, Takano, K., Broeck, N. Van, & Raes, F. (2014). A mindfulness-based intervention for economically disadvantaged people : effects on symptoms of stress, anxiety, and depression and on cognitive reactivity and overgeneralization. Mindfulness, 11. doi https://doi.org/10.1007/s12671-014-0353-8.
Henkel, V., Mergl, R., Kohnen, R., Maier, W., Möller, H., & Hegerl, U. (2003). Identifying depression in primary care: a comparison of different methods in a prospective cohort study. Bmj, 326(7382), 200–201. https://doi.org/10.1136/bmj.326.7382.200.
Hick, S. F., & Furlotte, C. (2010). An exploratory study of radical mindfulness training with severely economically disadvantaged people: findings of a Canadian study. Australian Social Work, 63(3), 281–298. https://doi.org/10.1080/0312407X.2010.496865.
Hoge, E. A., Bui, E., Elizabeth, G., Robinaugh, D. J., Ojserkis Rebecca, A., Fresco, D. M., & Simon, N. M. (2015). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2), 228–235. https://doi.org/10.1016/j.coviro.2015.09.001.Human.
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.00. Armonk, NY.: IBM Corp. Retrieved from http://www-01.ibm.com/support/docview.wss?uid=swg21476197
Kabat-Zinn, J. (1982). An outpatient program in behavioural medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4, 33–47.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain and illness: The program of the stress reduction clinic at the University of Massachusetts Medical Center. New York: Delacorte Press
Kabat-Zinn, J. (2004). Full Catastrophe Living. How to Cope with Stress, Pain and Illness Using Mindfulness Meditation. New York: Bantam Dell.
Kenealy, D. D. (2015). Elitest Scotland. Edinburgh. Retrieved from www.gov.uk/smcpc
Kenway, P., & Bushe, S. (2015). Monitoring Poverty and Social exclusion in Scotland 2015. York. Retrieved from www.jrf.org.uk
Kim, P., Evans, G. W., Angstadt, M., Ho, S. S., Sripada, C. S., Swain, J. E., … Phan, K. L. (2013). Effects of childhood poverty and chronic stress on emotion regulatory brain function in adulthood. Proceedings of the National Academy of Sciences, 110(46), 18442–18447. doi https://doi.org/10.1073/pnas.1308240110.
Kuyken, W., Crane, R. S., & Williams, J. M. G. (2012). Mindfulness-Based Cognitive Therapy (MBCT) Implementation Resources. Exeter, Bangor and Oxford: Exeter, Bangor and Oxford Universities.
MacKillop, J., & Anderson, E. J. (2007). Further psychometric validation of the mindful attention awareness scale (MAAS). Journal of Psychopathology and Behavioral Assessment, 29(4), 289–293. https://doi.org/10.1007/s10862-007-9045-1.
Malpass, A., Carel, H., Ridd, M., Shaw, A., Kessler, D., Sharp, D., et al. (2012). Transforming the perceptual situation: a meta-ethnography of qualitative work reporting patients’ experiences of mindfulness-based approaches. Mindfulness, 3(1), 60–75. https://doi.org/10.1007/s12671-011-0081-2.
Mani, A., Mullainathan, S., Shafir, E., & Zhao, J. (2013). Poverty impedes cognitive function. Science (New York, N.Y.)., 341(6149), 976–980. https://doi.org/10.1126/science.1238041.
McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131(1–2), 63–69. https://doi.org/10.1016/j.pain.2006.12.013.
Mcknight, A. (2015). Downward Mobility, Opportunity Hoarding and the “Glass Floor” (No. 1) (Vol. 1). London. Retrieved from www.gov.uk/smcpc
Mindfulness All-party Parliamentary Group. (2015). Mindful nation uk. London. Retrieved from www.themindfulnessinitiative.org.uk
Noble, K. G., Houston, S. M., Kan, E., & Sowell, E. R. (2012). Neural correlates of socioeconomic status in the developing human brain. Developmental Science, 15(4), 516–527. https://doi.org/10.1111/j.1467-7687.2012.01147.x.
Nyklíček, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(331–340), 10. https://doi.org/10.1007/s12160-008-9030-2.
Palmer, G. (2015). Key facts—the poverty site. Retrieved December 4, 2015, from http://www.poverty.org.uk
Palta, P., Page, G., Piferi, R. L., Gill, J. M., Hayat, M. J., Connolly, A. B., & Szanton, S. L. (2012). Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income African-American older adults. Journal of Urban Health, 89(2), 308–316. https://doi.org/10.1007/s11524-011-9654-6.
Rechavi, O., Houri-Ze’Evi, L., Anava, S., Goh, W. S. S., Kerk, S. Y., Hannon, G. J., & Hobert, O. (2014). Starvation-induced transgenerational inheritance of small RNAs in C. elegans. Cell, 158(2), 277–287. https://doi.org/10.1016/j.cell.2014.06.020.
Reeves, R. V, & Howard, K. (2013). Richard V. Reeves and Kimberly Howard sticky at both ends. Affluence and poverty are both partially inherited. Policy and research has focused on upward mobility, especially from the bottom. But relative intergenerational upward mobility is only poss. Washington, DC. Retrieved from https://www.brookings.edu/research/the-glass-floor-education-downward-mobility-and-opportunity-hoarding/
Richardson, T., Elliott, P., & Roberts, R. (2013). The relationship between personal unsecured debt and mental and physical health: a systematic review and meta-analysis. Clinical Psychology Review, 33(8), 1148–1162. https://doi.org/10.1016/j.cpr.2013.08.009.
Rockville, M. D. (1994). The Buddy System. In Disaster Response and Recovery: a Handbook for Mental Health Professionals (p. 2). Atlanta: Center for Mental Health Services.
Roth, B., & Creaser, T. (1997). Mindfulness meditation-based stress reduction: experience with a bilingual inner-city program. The Nurse Practitioner, 22(3), 150–175.
Roth, B., & Robbins, D. (2004). Mindfulness-based stress reduction and health-related quality of life: findings from a bilingual inner-City population. Psychosomatic Medicine, 66(1), 113–123. https://doi.org/10.1097/01.PSY.0000097337.00754.09.
Santorelli, S. F., & Kabat-Zinn, J. (2014). Mindfulness-Based Stress Reduction (MBSR): Standards of Practice. Massachusetts: Center for Mindfulness in Medicine, Health Care & Society Department of Medicine.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Health Care, 62(3), 373–386.
Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663.
Sibinga, E. M. S., Webb, L., Ghazarian, S. R., & Ellen, J. M. (2016). School-based mindfulness instruction: an RCT. Pediatrics, 137(1), 10. https://doi.org/10.1542/peds.2015-2532.
Szanton, S. L., Wenzel, J., Connolly, A. B., & Piferi, R. L. (2011). Examining mindfulness-based stress reduction: perceptions from minority older adults residing in a low-income housing facility. BMC Complementary and Alternative Medicine, 11(1), 44. https://doi.org/10.1186/1472-6882-11-44.
Taggart, F., & Stewart-Brown, S. (2015). A review of questionnaires designed to measure mental wellbeing. London: Royal Society of Public Health.
Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 well-being index: a systematic review of the literature. Psychotherapy and Psychosomatics, 84(3), 167–176. https://doi.org/10.1159/000376585.
Vallejo, Z., & Amaro, H. (2009). Adaptation of mindfulness-based stress reduction program for addiction relapse prevention. The Humanistic Psychologist, 37(2), 192–206. https://doi.org/10.1080/08873260902892287.
Van Dam, N. T., Earleywine, M., & Borders, A. (2010). Measuring mindfulness? An item response theory analysis of the mindful attention awareness scale. Personality and Individual Differences, 49(7), 805–810. https://doi.org/10.1016/j.paid.2010.07.020.
Wenzel, M., von Versen, C., Hirschmüller, S., & Kubiak, T. (2015). Curb your neuroticism—mindfulness mediates the link between neuroticism and subjective well-being. Personality and Individual Differences, 80, 68–75.
Williams, M., Teasdale, J., & Segal, Z. (2007). The mindful way through depression. New York: The Guilford Press.
Wu, S.-F. V. (2014). Rapid screening of psychological well-being of patients with chronic illness: reliability and validity test on WHO-5 and PHQ-9 scales. Depression Research and Treatment, 2014(2007), 1–9. https://doi.org/10.1155/2014/239490.
Author information
Authors and Affiliations
Contributions
KJ designed and executed the study, conducted initial quantitative data analyses, conducted the qualitative analyses, and wrote the manuscript. RJK conducted and wrote the final quantitative data analyses and edited the manuscript. DD collaborated on the design and writing of the study, guided the data analyses, and edited the manuscript.
Corresponding author
Ethics declarations
Ethics Statement
The Ethics Committee in the School of Psychology at Bangor University granted ethical and governance approval for the study, and informed consent was obtained from all participants prior to their inclusion in the study. Permission was granted to hold the study in a Dundee City Council integrated health and welfare facility, with full disabled access, facilities, security and logistical support by a Communities Officer.
Conflict of Interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Jiga, K., Kaunhoven, R.J. & Dorjee, D. Feasibility and Efficacy of an Adapted Mindfulness-Based Intervention (MBI) in Areas of Socioeconomic Deprivation (SED). Mindfulness 10, 325–338 (2019). https://doi.org/10.1007/s12671-018-0977-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-018-0977-1