Evaluation of a meditation based stress reduction program during acquired brain injury rehabilitation in an inpatient setting: a pilot study

INTERVENTION: Those participants allocated to the Intervention Group will attend twice weekly mindfulness meditation based stress reduction (MBSR) sessions run for a small group of 6‐8 people for 4 weeks. Each session will last for 60 minutes. A senior Occupational Therapist (OT), who is accreditated in meditation instruction, will provide the intervention. Participants will also be supported to undertake individual meditation practice each day for approximately 15 minutes in between the formal sessions. Their compliance will be monitored by the senior OT. They will be provided with an audiotape of meditation exercises developed by the senior OT. As participants will be admitted and discharged at different times, the make‐up of the group is likely to change for individuals. CONDITION: Acquired Brain Injury PRIMARY OUTCOME: ‐ Goal Attainment Scaling (GAS). This individualised measurement specifies a range of criterion referenced goals using a 5 point ordinal scale: (+2) indicates the most favourable outcome to (‐2) which indicates the least favourable outcome. This outcome measure provides a collaborative and individualised approach to goal‐setting and treatment and has been found to be useful in measuring goals that fall outside standardised outcome measurement instruments, and is consistent with client and family centred intervention (McLaren and Rodger 2003). ‐Generalized Anxiety Disorder Scale 7 items (GAD‐7). This scale demonstrated high sensitivity for detecting anxiety as a response to generalised anxiety disorder and panic disorder. Although not tested for validity and reliability in an inpatient brain injury population this outcome measure was selected as it is short with clear questions that are easy to use with clients who have marked impairments of cognition and communication. Also, the 2 item GAD (ie using the first 2 questions of the scale only) has shown high sensitivity and specificity for detecting generalised anxiety disorder in a primary care setting (Kroenke, Spitzer et al. 2007). ‐Satisfaction with Life Scale. This scale inquires about participants overall assessment of their lives by comparing their current status and their self‐defined expectations of what they would like their lives to be. Good validity, reliability and sensitivity have been demonstrated (Pavot and Diener 1993). SECONDARY OUTCOME: ‐ Likert scale to measure fatigue. Participants will be asked to rate their levels of fatigue mid morning and mid afternoon and this data will be averaged. This method will be used as it is a simple and quick way of ascribing quantitative value to qualitative data, to make it amenable to statistical analysis for a group of individuals with cognitive and communication difficulties. Cognitive performance measures. The battery of three computerised cognitive performance tests are designed to evaluate selective attention, working memory, and psychomotor speed. ; ‐The selective attention task is based on the task described by Posner (Posner 1980) and also Hodgins & Adair (Hodgins and Adair 2010). Hodgins & Adair (2010) reported that meditators demonstrated higher performance than non‐meditators. ; ‐Working memory will be assessed using the n‐back task where participants are asked to identify if a current letter is the same as that presented 1 or 2 letters previously. McAllister et al. (2004) have reported on working memory deficits after TBI using the n‐back task (McAllister, Flashman et al. 2004). INCLUSION CRITERIA: Be an inpatient in the Brain Injury Rehabilitation Unit (BIRU) at Hampstead Rehabilitation Centre, Royal Adelaide Hospital Be expected to be an inpatient for at least 6 weeks to be able to complete the baseline evaluation, intervention and follow‐up evaluation. ; ‐Psychomotor speed will be assessed using a choice reaction time (CRT) task where participants have to press a corresponding key to the onset of an associated visual stimulus when there is one, two or four potential responses to choose from. Sosnoff et al. (2008) have demonstrated increased CRT latencies after TBI (Sosnoff, Broglio et al. 2008) Participants' perspective of their level of mindfulness, anxiety, and satisfaction with life by guided interview.