Each month the Elsevier Atlas Award recognizes research that could significantly impact people's lives around the world.
Larissa Horta Esper and Edilaine Cristina da Silva Gherardi-Donato
Archives of Psychiatric Nursing, Volume 33, February 2019, Pages 120-130
Many women around the world suffer from anxiety, depression, and post-traumatic stress disorder (PTSD) linked to past experiences with violence. Now, an Atlas Award-winning team of researchers has systematically gathered evidence to explore the potential of Mindfulness-based interventions to help women victims of violence feel better and move forward with their lives.
“The concept of mindfulness is to be in the present moment and accept the experience of here and now, and try not to be judgmental with this experience,” said Edilaine Cristina da Silva Gherardi-Donato of University of Sao Paulo at Ribeirao Preto College of Nursing in Sao Paulo, Brazil. “It’s a mental training.”
While Mindfulness-based practices have roots in contemplative and philosophical traditions such as Hinduism and Buddhism, their practice doesn’t require that one follow any particular philosophy or religion, explained Gherardi-Donato and co-author Larissa Horta Esper in their article published in Archives of Psychiatric Nursing. Mindfulness-based programs may include exercises such as attention on breathing, meditation, yoga, and other physical and cognitive techniques.
To explore what’s known about the potential of such techniques for helping victims of violence and particularly women, the researchers searched PubMed and other databases for any relevant articles. Their search turned up 879 studies for further analysis. Out of this large collection, the researchers focused their attention on ten clinical trials and one retrospective study published over the last decade that explored the use of Mindfulness-based interventions relative to Cognitive Behavioral Treatment or other approaches.
All but one of the ten studies showed benefits of Mindfulness-based interventions. The interventions led to a range of improvements including reductions in sexual difficulty, anxiety, depression, and post-traumatic stress. People became less likely to rely on strategies like avoidance and more able to pay attention. They also showed physical improvements, including reductions in inflammatory response.
While the findings are encouraging, the researchers say that more study is needed. Indeed, they are now engaged in clinical trials to explore the use of Mindfulness-based interventions for women victims of violence in Sao Paulo. They are also exploring its use for children who’ve experienced violence and for people experiencing stress at work, among other applications. Stay tuned for the results of those studies.
For Gherardi-Donato, one of the most promising aspects of Mindfulness-based interventions is the fact that, once a person has learned the practice, they can take it back and continue to use it in their own lives.
“Mindfulness isn’t something that you need a professional forever,” she said. “Once you learn how to practice, you will have these tools available. You can keep going and practicing and receiving the benefits of the practice. It’s all based on the experience of the person.”
Thais Vick (Elsevier), Edilaine Cristina da Silva Gherardi-Donato , Larissa Horta Esper, Christiane Fiorin (Elsevier)[from left to right]
A Conversation with Edilaine Cristina da Silva Gherardi-Donato
Atlas spoke with Edilaine Cristina da Silva Gherardi-Donato about mindfulness-based interventions and their potential to benefit women victims of interpersonal violence. Listen now
Atlas: How serious of an issue is interpersonal violence against women today and what inspired you to explore this area?
Edilaine Cristina da Silva Gherardi-Donato: We are always exploring all kinds of issues that can make mental health in a not good way. People are having many mental health problems and violence is one of the issues that are very common in the life of psychiatric patients. Some time ago, we started to work with early life stress—adults that were suffering from stress in childhood. Most of this early life stress was based on violence in the environment, the parents, and most patients were women. Unfortunately, many women have strong experience in violence. So, we consider the violence in the context of women. It’s very important to study and come up with possibilities to intervene in this population especially in Latin America. It’s an issue around the world for sure, but in Latin America there is a lot of violence against women.
We are working hard to identify and try to give some support to this population. We still don’t have a protocol to guarantee a better condition or improvement from trauma or problems that started to happen in the life of a woman after the violence. Because of that, we are very excited to start study in coming up with the best evidence to offer a better treatment, a better assistance and care for these women. We are conducting a study to test intervention of mindfulness with different groups, including women victims of violence and before we go to intervention and offer this kind of treatment, we needed to be sure of the information, the evidence, and experience from other researchers about this. We needed to make sure we aren’t reinventing the wheel and to make our clinical trial more efficient and to be successful. And that was the inspiration for this article.
Atlas: How is a mindfulness-based intervention defined? What does it look like?
Edilaine Cristina da Silva Gherardi-Donato: The concept of mindfulness is to be in the present moment and accept the experience of here and now and try to be not judgmental with this experience. It’s a mental training. You train yourself to stay more often in the natural state of mindfulness. You start training your mind to be more open to the experiences and not prescribing the moments, the situations, the emotions, and the body sensations based in your past or influenced by concerns about the future. You start training your mind to consider that everything is impermanent. Even your experience of emotion or physical sensation that is strong and unpleasant, you can help your mind to understand that the situation will pass. You are not your anxiety or your pain, you are a whole human being.
In a few moments, the next second, next day, things will be different. Nothing is permanent. When a woman suffers violence, they may experience thoughts about the situation. She may replay the memories of that situation and they may come up and she starts to feel all the emotions and all of her physiological and psychological responses. It’s like she’s experiencing the trauma all over again and the reactions are the same. It’s like being in the violent situation all the time. With the training on mindfulness, we are reprogramming the brain, the areas of the brain that are excited by experience of the trauma and try to redirect the brain. Some [other] therapies ask for details of the situation, asking the person to describe again what happened, to relive the trauma. In mindfulness, we try to avoid this confronting or re-experience of the violence and the rumination of the brain to allow a woman to keep going and open up to new experiences. It is an attitude of simply becoming aware of fear and anger, among other feelings, with kindness and care for yourself.
Atlas: In the paper, you looked at existing evidence for the benefits of mindfulness. What did you conclude about what’s already known about its potential?
Larissa Horta Esper (translated): One of the most important outcomes we found was about the emotional symptoms. Because we work with psychiatric patients after trauma, two conditions are very frequent: depression and anxiety. In this review, we found good outcomes including a decrease in depression and anxiety as well as post-traumatic stress. The articles we analyzed show a good outcome for these symptoms with mindfulness training. Another area of potential relates to women’s sexuality. This is very important because most assistance doesn’t include this dimension of a woman’s life. We want women not to just avoid mental health problems, but to also integrate her sexuality in her life in a healthy way.
We are also working here with some biomarkers of mental problems. In this review, we found some studies showing outcomes about immunological response after intervention, especially inflammatory cytokines. That’s important because it’s not just psychological but the body is physically responding to the trauma. It is important for our next study to consider measurement of biomarkers and follow women in their physiological performance to give more evidence for the effectiveness of mindfulness.
In this work, it’s important to consider the population we are working with. In the case of women, some practices can increase anxiety instead of decrease it. It’s related to the kind of trauma or violence women suffered. For example, when a person has experienced physical or sexual assault, it’s important to consider the practice of body scanning and other practices that are often included in Mindfulness-based interventions could be more anxiety provoking than breathing practices and others not focused on the body. So, we should make the program in a sequence that starts with practices that can improve tranquility, calm, emotional stability first, in the first weeks, and then we can start with body scanning and other practices once a woman is more prepared to deal with sensations in the body without confronting the trauma and violence.
Atlas: Is there more you can say about the studies you are working on to test this in practice?
Edilaine Cristina da Silva Gherardi-Donato: Yes, we are conducting clinical trials in different groups, including women in treatment in a service for women and children victims of violence. We already finished two groups of women and are doing the statistical analysis. We were successful in finding many benefits after the mindfulness intervention. This is something we were not necessarily expecting because, in our sample in this study, most women came from very difficult social conditions. Some can’t read and write. They didn’t have time in school. We were worried before we started if they could follow the program. We made arrangements to make vocabulary simple and try to work with their experience and we were surprised.They could follow it. They gave us deep feedback.
Some women were mothers and grandmothers and they talked about the children they were caring for. We could also collect data from this relationship between these women caring for a child. Both were in the same context, suffering from violence and the cycle of violence. So, in the end of intervention, we could point to how the program, this work with mindfulness, could help not just the woman but help to stop the cycle of violence and make a better life for the children living with her.
We are also working with chronic pain cases, psychiatric patients in a mental health hospital and university workers that are suffering high levels of work-related stress. We just started a project with crack cocaine users that are trying to stay away from drugs who are in treatment to quit using drugs. We are also working with diabetes and hypertension patients, trying to teach mindfulness to help them to change their lifestyles and decrease stress and improve the prognosis for those patients.
Larissa reminds me that we are collaborating with the justice system in our city. We will receive children that suffered violence, especially sexual violence, and we are reviewing a mindfulness protocol to listen to these children. Usually police and lawyers question the children and they are asking questions that could make the situation worse for the children. We are trying to build in this protocol based on mindfulness to make a better environment and support to listen to the children in a way that could ease their anxiety. It is collaborative work with the University and the Justice System.
Atlas: If women and others can learn this, this is something they might take back and practice on their own. Is that something you are thinking about?
Edilaine Cristina da Silva Gherardi-Donato: Yes, thanks for this question. It makes me shine in this moment. Mindfulness is a way to make an intervention that is not something that you need a professional forever. Once you learn how to practice and will have these tools available. You can keep going and practicing and receiving the benefits of the practice. It’s all based on the experience of the person. It’s not based on the insights of a professional. We are all the time motivating and creating surroundings to make a person come up with their own insights. They can produce and make conclusions about their own lives. We are trying to make a better environment for them to reach their own conclusions.
There’s something about mindfulness that’s very interesting. After the training, women are capable to carry on with the practice and have this tool to help themselves. They can practice a breathing exercise anywhere. We don’t use music or any other stuff. We always teach them to use their own body. Their breathing, their sensations of the air, to train their mind so they can practice everywhere, every time, where ever they need this practice. It’s something that makes mindfulness very useful.
- Global and Regional Estimates of Violence Against Women (World Health Organization)
- Center for Health Minds (University of Wisconsin-Madison)
- Mindfulness (Mental Health Foundation, U.K.)
- Global Online Meditation Community (UMass Medical School, Center for Mindfulness in Medicine, Health Care and Society)
About Archives of Psychiatric Nursing
Archives of Psychiatric Nursing disseminates original, peer-reviewed research that is of interest to psychiatric and mental health care nurses. The field is considered in its broadest perspective, including theory, practice and research applications related to all ages, special populations, settings, and interdisciplinary collaborations in both the public and private sectors.