Report: Mindfulness Intervention and Occupational Health Strategies

This report delves into the significance of mindfulness interventions within occupational therapy, emphasizing its role in enhancing healthcare strategies and patient wellbeing. It highlights the benefits of mindfulness in improving cognitive, affective, and interpersonal outcomes, particularly in managing pain, stress, and anxiety. The report discusses various mindfulness interventions like Mindfulness-Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (ACT), and their application in treating conditions such as chronic pain, musculoskeletal disorders, and work-related injuries. It outlines evaluation methods for assessing the effectiveness of these interventions, including both general and specific evaluations, along with recommended practices and future research directions. The report also stresses the importance of integrating mindfulness with traditional occupational therapy for holistic patient care, supported by empirical research and practical guidelines. It provides a detailed overview of mindfulness techniques, their application, and the expected outcomes in occupational therapy settings, providing valuable insights for healthcare professionals and students alike. The document concludes by suggesting further research, including a call for more validation, integration of mindfulness protocols with occupational rehabilitation, and the need for high-quality, evidence-based occupational therapies.

Occupational Health & Wellbeing
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Importance of practice:
Mindful intervention is useful in providing greater attention to healthcare strategies and
increasing awareness of the ongoing healthcare strategies. Mindful intervention has several
benefits including improving quality and vibrancy of the current medical practice. Abundant
scientific reports are available for the usefulness of mindfulness in improving mental and
physical health. Mindfulness interventions are useful in improving cognitive, affective, and
interpersonal outcomes. Mindfulness intervention is helpful in reducing pain, stress and
anxiety in the patients. It is also helpful in providing wellness and quality-of -life of the
patient. Mindfulness interventions incorporate nonjudgmental experience of the current
knowledge which provides positive outcome for mental and physical health. Mindfulness
intervention based on the theory that most of the people give attention to future and think
about the past. Both these aspects give stress to the individual. In such scenario, mindfulness
intervention is helpful in reducing pain and anxiety and improving well-being. Mindful
intervention has significant application in the occupational therapy like physical rehabilitation
from pain. Mindful intervention has critical role in the occupation intervention because there
should be integration of mind and body in the occupational therapy. Mindful intervention
improves occupational engagement and it is related to the state of timelessness within the
ideal expertise or experience of the activity engagement1. Mindfulness itself is an occupation
and it is useful in improving experiences of the occupational practice. Thinking about the
experiences of the illness in pain, would be helpful in understanding importance of
mindfulness in pain management. In chronic illness like musculoskeletal pain, there would be
loss of control, uncertainty and frequent change in the physical and psychological aspects of
the patient. Mindfulness intervention is helpful in stabilizing all these aspects. Chromic pain
is always accompanied with negative emotional aspects of the patient and family members.
Mindfulness intervention is helpful in stabilizing emotional instability. In patients with
chronic pain, there may be sleeplessness, weakness, discomfort, loss of functional abilities
and inability to carry out activities of daily living. However, all these disabilities can not be
treated by occupational rehabilitation. In such scenario, mindfulness intervention would be
helpful for providing holistic care to the patient. Mindfulness can be applicable to different
circumstances. Mindfulness intervention is useful in controlling emotions and sensations2.
1 Jackman, M. M. (2014). Mindful occupational engagement. In N. N. Singh (Ed.), Psychology of meditation (pp.
241–277). New York: Nova Science.
2 American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and
process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48.
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Theoretical background:
Mindfulness intervention is mainly applied to nonjudgemental current-focused awareness to
the complete experience in a stepwise manner. Mindfulness is a self-centred practice,
however it exhibits presence in the world. In actual mindfulness practice, focus should be
towards breath, body sensations, feelings and thoughts. Along with focusing on awareness of
current moment, mindfulness intervention focuses on the attitude for giving attention,
patience, sincerity, inquisitiveness and compassion. Discussion and inquiry in the process of
mindfulness intervention are helpful in self-discovery and personal growth. Application of
mindfulness interventions are gaining importance in the healthcare with the development of
newer protocols, applicability of the mindfulness to varied populations and varied symptoms.
There is abundant evidence available for the occupational health workers working in the
areas of mental and physical health. It is well established that mindfulness is beneficial for
the mental health people in improving quality of their life. Mindfulness techniques are
directed towards the needs of individual patients. Goals of mindfulness in occupational
therapy should be occupational engagement, reduced anxiety and alertness of physical
sensations. Mindfulness intervention is similar to the generally accepted awareness-based
interventions. Mindfulness intervention helps to tolerate unpleasant symptoms and it would
be helpful in the liberation from the painful condition. Basically, mindfulness intervention not
only gives training to relieve pain but also incorporates practice to relieve pain. Mindfulness
practice gives patient new attitude and perspective to look towards illness and eliminate fear
and distress due to illness. Mindfulness intervention deals with the decrease in the physical
symptoms of the disease and increase in the broad psychological positive outcomes3,4.
Some recommended best practices:
Mindfulness-Based Stress Reduction (MSBR) involves the meditation for 2 hours a week for
8 weeks. MSBR proved useful in the improving characteristic based mindfulness of the
participants. Activities covered under MSBR include body scans, mindful yoga, mindful
meditation and awareness of the stress management and health. MSBR is beneficial in giving
attention to different parts of the body and current sensations. MSBR studies established that
mindful practices learned by the patients can also be applied in the daily lives. Thus,
3 Williams, J. M. G., & Kabat-Zinn, J. (2011). Mindfulness: Diverse perspectives on its meaning, origins, and
multiple applications at the intersection of science and Dharma. Contemporary Buddhism, 12.
http://dx.doi.org/10.1080/ 14639947.2011.564811.
4 Stroh-Gingrich, B. (2012). Occupational therapy and mindfulness meditation: An intervention for persistent
pain. Occupational Therapy Now, 14, 21–22
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mindfulness can emerge as a new occupation for the participants. Studies conducted on the
occupational therapy for mindfulness varied in terms of duration of treatment and frequency
of sessions of treatment5,6. Acceptance and Commitment Therapy (ACT) is another therapy
which deals with the psychological interventiosns of clinical behavioural analysis and
mindfulness procedures. Main goals of these ACT studies are to improve psychological
flexibility and involvement in therapy by accepting painful condition and other psychological
experiences7.
Empirical research:
Different occupational therapies were conducted for targeting musculoskeletal and pain
disorders using mindfulness interventions. These studies include chronic pain, work related
musculoskeletal injury and knee injury. Out of these studies in three studies, significant
reduction in the pain was observed in mindfulness intervention group as compared to the
control group8. In one study, reduction in pain was observed over time however this reduction
in pain was not significant as compared to the control group9. In one study, mobile phone
application was used for mindful intervention. Though, in this study number of participants
were less, it was concluded that mindfulness interventions are useful in reducing pain. Along
with the usefulness of these mindfulness interventions in primary outcome like pain
reduction, these mindfulness interventions are also useful in the secondary outcomes. These
secondary outcomes include, augmented acceptance of pain, ease of functioning with pain
and reduced distress and anxiety due to pain10. Study was also conducted on people with
work related musculoskeletal disorders. In this study, outcomes were based on the trait-level
5 Azulay, J., Smart, C. M., Mott, T., & Cicerone, K. D. (2013). A pilot study examining the effect of
mindfulnessbased stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive
syndrome. Journal of Head Trauma Rehabilitation, 28, 323–331.
6 Bedard, M., Felteau, M., Gibbons, C., Klein, R., Mazmanian, D., Fedyk, K., & Mack, G. (2005). A mindfulness-
based intervention to improve quality of life among individuals who sustained traumatic brain injuries: One-
year followup. Journal of Cognitive Rehabilitation, 23, 8–13.
7 Mahoney, J., & Hanrahan, S. J. (2011). A brief educational intervention using acceptance and commitment
therapy: Four injured athletes’ experiences. Journal of Clinical Sport Psychology, 5, 252–273.
8 McCracken, L. M., & Gutie ´rrez-Martı ´nez, O. (2011). Processes of change in psychological flexibility in an
interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy.
Behaviour Research and Therapy, 49, 267–274.
9 Zangi, H. A., Mowinckel, P., Finset, A., Eriksson, L. R., Høystad, T. O., Lunde, A. K., & Hagen, K. B. (2012). A
mindfulness-based group intervention to reduce psychological distress and fatigue in patients with
inflammatory rheumatic joint diseases: A randomised controlled trial. Annals of the Rheumatic Diseases, 71,
911–917.
10 Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., van Dulmen, S., Wigers, S. H., & Eide, H. (2011). Written
online situational feedback via mobile phone to support self-management of chronic widespread pain: A
usability study of a web-based intervention. BMC Musculoskeletal Disorders, 12, 51.
http://dx.doi.org/10.1186/1471-247412-51.
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mindfulness of patients. In this study, improvement in the quality of life of the patients with
work related musculoskeletal disorders was observed. This outcome was used in the
prediction of time until return to work for all the patients11. Combination of the traditional
rehabilitation therapy and mindfulness intervention proved helpful in the improving
rehabilitation process and augmented engagement in the therapy. Integration of mindfulness
intervention and physical rehabilitation are proved clinically useful and well accepted by the
patients. Integration of mindfulness and physical rehabilitation are helpful reducing pain and
maintaining normal functioning despite pain12.
Evaluation of practice:
Evaluation of the outcome of pain intervention should be done in general and specific way. In
general evaluation, temperature and general appearance should be evaluated. For evaluating
origin of pain, patients should undergo spinal and neurological examination. If there is no
pain of spinal and neurological origin, patient should be assessed for localized or referred
pain. In spinal examination, inspection of back and neck should be done for deformity and
erythema. Spine and paravertebral muscles should be assessed by palpation for tenderness
and muscle spasm. Gross motion of the patient with pain should be evaluated. Acceptance of
the pain for performing routine activities should be performed by observing motion in pain
and asking questions about acceptance of pain. Shoulder and hip examination should be
performed in patients with neck and lower back pain respectively. Neurological examination
should be performed for sensation and reflexes. In mindfulness intervention of
musculoskeletal pain, outcome should be evaluated in both physical and psychological
aspects. Psychological aspects include assessment of pain unpleasantness score, acceptance
of pain, psychological flexibility, self-compassion and mental score for stress reduction. Pain
unpleasantness scores should be assessed to understand the difference between control group
and mindful intervention. Laboratory tests and neuroimaging studies also should be evaluated
in mindfulness intervention of musculoskeletal pain. Analogue scale (VAS) and numeric
rating scale (NRS) should be used for assessing pain in patients with musculoskeletal pain13.
Description of practice:
11 Vindholmen, S., Høigaard, R., Espnes, G. A., & Seiler, S. (2014). Return to work after vocational rehabilitation:
Does mindfulness matter? Psychology Research and Behavior Management, 7, 77–88.
12 Pike, A. J. (2008). Body–mindfulness in physiotherapy for the management of long-term chronic pain.
Physical Therapy Review, 13, 45–56.
13 Carlson, L. E. (2012). Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating
Levels of Evidence. International Scholarly Research Network ISRN Psychiatry. 2012.
doi:10.5402/2012/651583.
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Mindfulness programme like MSBR should be applied one session per for 8 weeks. In
addition to this, there should be daily 30 – 45-minute practice according to the instructions at
home. This programme incorporates, explanation of techniques, practicing of techniques and
session for feedback and experience sharing. There should not be any mindfulness
intervention in control group. However, control group should receive routine occupational
intervention for musculoskeletal pain. This 8 week programme should be scheduled in
systematic manner. In first week, there should be introductory session, conceptual
framework, rational behind intervention in pain management, fundamentals of mindfulness
intervention and explanation of schedule for forthcoming weeks. In second week, there
should be explanation of breathing in mindfulness in pain reduction. There should be
explanation of two breathing techniques. One should be breathing by formal sitting and
another should be anytime and anywhere. Provision also should be made in the form Mp3 cd
for performing breathing at home. At home, breathing should be performed for 10- 15
minutes daily. In third week, there should be explanation of effectiveness of sitting
meditation on pain management. Explanation of practice and procedure for sitting meditation.
There should be provision of Mp3 cd for practicing sitting meditation at home. Sitting
meditation should be performed at home for 15 – 20 minutes. In fourth week, there should be
explanation of the body scan technique, its usefulness and rational in pain management. Mp3
cd should be provided for body scan practice at home for 20 – 25 minutes daily. In week 5,
there should be advanced body scan technique. In week 6, there should be walking meditation
for management of pain. In week 7, there should be elucidation of mindfulness intervention
in reduction of pain. There should be instruction about mindful living and exercise. In week
8, there should be summary of all the sessions, feedback from the participants and
evaluation14,15.
Future questions:
More validation should be done for the application of mindfulness in the physical disorders
like pain management. More focus should be on the evidence based occupational therapies.
There is availability of established mindfulness protocols. These protocols should be
integrated with occupational rehabilitation for pain management. High quality research
14 Banth, S., and Ardebil, M. D. (2015). Effectiveness of mindfulness meditation on pain and quality of life of
patients with chronic low back pain International Journal of Yoga, 8(2), 128–133.
15 Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in
older adults: A randomized controlled pilot study. Pain. 2008; 134:310–9.
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should be carried out to address limitations of the current studies. Most of the studies of
mindfulness in physical rehabilitation like pain management should be carried out in large
number of participants. Most of the existing studies are carried out on the limited number of
patients. Hence, most of the results are positive for the mindfulness intervention in physical
rehabilitation. Randomised trials incorporating large number of population would be helpful
in identifying drawbacks of the mindfulness intervention. It would be helpful in the getting
substantial data out of the study. Same protocol for the mindfulness intervention should be
applied in different geographic regions, and in different socio-economic classes to get
validity of the protocol. Physical diagnosis should also be incorporated in the interventions
and it should be carried out in the randomized trials. Training should be provided to the
occupation therapist for the carrying out mindful interventions. Mindfulness interventions
should be incorporated in the professional curricula of occupational therapist. Continuing
education programme and other professional training should be provided to occupational
therapist. There should be more development and validation of the clinical practices for
integration of mindfulness intervention in occupational therapy. Cost effective methods
should be developed for the integration of mindfulness in occupational therapy16.
16 Chiesa, A, and Serretti, A. (2011). Mindfulness-based interventions for chronic pain: A systematic review of
the evidence. Journal of Alternative and Complementary Medicine. 17, 83–93.
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